ok, so the intestine is looped back on itself forming a J. The bottom of the curve is cut so it forms a new opening. My question is: is there still tissue in between the sides of the pouch? if I were to insert two fingers, would one finger be in one side of the pouch and the other in the other, or is the middle "cut out" so it's one big true pouch?
Not that I want any fingers in there. It's just the best way I could imagine posing the question to show what I was asking.
Hi cajundoc. According to Wikipedia, the inner walls are removed to form the pouch. Good question. I certainly didn't know.
Yes, the j pouch is a true pouch. It is hollow inside. When your small intestine was looped to form a "J" an instrument was inserted into the "cut end" (the bottom of the loop that is sewn to your anus). The instrument looks like a long staple gun and it staples your loop together permanently. While stapling, this same instrument also cuts the piece of middle tissue so that your loop is now a hollow pouch. I asked my surgeon, he said it is definitely hollow, and he drew a picture for me. There is also a YouTube video of an actual surgery removing the colon (for real) and constructing the j pouch, showing the staple gun making the cut. You need a strong stomach to watch.
Can you post the link? My entire surgery was videoed. Very strong stomach here.
Hi, Cajundoc. I searched for a post I made here in 2016 with the video attached but couldn't find it on this site. If you go on YouTube and search for "IMEDEX, Understanding the techniques of a colectomy with an ostomy and j pouch" you will find the video. There are several IMEDEX surgery videos so look for the one that is 22:19 minutes long. It shows a surgeon lecturing on a j pouch creation and stapling the pouch. Warning: it is graphic so if anyone is waiting for their surgery, please be aware.
Thank you for this topic, the video and explanations. I'm always interested in the physiology of the j-pouch and I wondered the same thing. This topic has helped.
The inside of the pouch is an open reservoir. Like a balloon. The seam, or stitching, seen in your posted diagram is only to show where the two limbs were stapled together. If the pouch was two separate limbs stapled together the stool would fill up only in one limb before you feel pressure to go to the toilet. What would be the use of the other limb? Ask your surgeon at your next appointment if the pouch is hollow, or stapled into two separate limbs. Or, Google for real images of the inside of a j pouch. You will see "owl's eyes" at the top (the view of the camera looking into the pouch via the anus) and an empty, hollow chamber that is the pouch. No stitching or stapled tissue. Not separate limbs. It took me a while to understand this concept, but it makes perfect sense, and my surgeon confirmed this. He has created hundreds of pouches in his long career.
I figured as much and googled dozens of time but the images always showed the exterior surface of the staples pouch. I’ll google the owls eye. I’m also a wildlife rehabber and have seen many owls eyes. I’ll look for a comparison!
I asked my surgeon. They said they staple the intestine for form a J and at first there is indeed a septum but as they staple it they cut the septum out and sew it to a true pouch so it holds more stool.
Good post and replies, everyone. THANKS!
My pouch just seems small. Thanks for the replies, people! I wish the biologics were around back in the days of my UC. Also, I have to use the toilet about 5 times a night. What about you?
I do not eat anything past 6 pm and am usually able to make it through the night without going.
WOW. I haven’t had a full night’s sleep in 21 years!
One week post take down I go 1-2 times per night
I’m kinda baffled. I would pay 1000 bucks to just go twice in a night. My sleep suffers terribly. I think my pouch is just smaller. Things may have progressed since mine 22 years ago.
Cajun, I had mine in 1986. At THAT time they didn't leave all the nerve endings inside the rectal cuff, and so I'm totally incontinent at night. I have always worn an Always pad with wings all night and all day too, but of leakage. I wake up about 3-4 times a night and have to go a little bit. But I just keep myself quiet, don't fret about it and fall right back to sleep. It is possible. That's always the way it is for me, so not a big deal. You COULD have a small pouch, OR it could be you haven't stretched it out. Try to hold it in just a little bit longer during the day (wear some protection just in case) and it will stretch. Also, don't eat 4 hrs. before you go to bed, don't eat processed and fried foods. Those go thru your system faster, and it's not good for us to eat that stuff. Hope that helps a bit.
Thank you!!! I do eat late at night. I’m just so hungry all the time. I’ll take your advice and try it though! Thanks!!
That's definitely the problem, and WHAT you eat. If you're eating processed junk food, that will definitely cause a problem. Probably not hungry, just habit. Drink water!