I will share my favorite tricks right after reminding us all that if intubation is often very difficult, it might be time to see your surgeon because you might be having a valve problem that needs to be fixed before it progresses any further. I've had my pouch for 16 years; I started having intermittent leaking problems a year ago which got worse and worse -- misdiagnosed by NYC Famous Pouch Surgeon as pouchitis, which does NOT cause leaks. In fact my valve was developing a kink, is now not functional at all (chronic leaking) and the valve will have to be rebuilt (yup, full open-belly surgery). I don't mean to scare anyone but if your intubation problems are frequent and/or you're also experiencing any leaking of gas or liquid or solid waste, see your doctor. My upcoming surgery would have been necessary anyway but probably much easier if I had been correctly diagnosed from the start. I did not have intubation problems at first -- only leakage -- but as the situation progressed, intubation got mighty tricky.
What I do when intubation gets tricky: first, I get generous with the lube. Then I sit up very, very straight, pull in my abdominal muscles (hardening the gut a bit)... and then I press the whole pouch area toward the middle of my belly by pressing into my belly from the right (on a right-side stoma) with the pinky-side of my flattened hand. Sometimes you can feel the catheter heading one way or another if its not going straight in -- in that case, put the catheter in just a little bit, then feel for the valve and push the valve gently toward the middle of your belly before inserting the catheter further. If the catheter is heading left or right, the valve is not straight so you want to press the whole pouch and valve over and that usually straightens it enough to let the catheter enter. And always remember: lube, lube, lube!