Friday, April 6, 2007


Its called Kock pouch - And yes, it is pronounced exactly the way it looks!
It was invented by a Swedish doctor named Nils Kock so of course its named in his honor. It's weird to think that something that is created entirely from the small intestine could be "invented" but there you go....

The Kock pouch is an internal pouch constructed from the small intestine which stores the waste products until the person is ready to irrigate, ie a thin tube is inserted into the stoma to drain the contents a few times a day.
A one-way nipple valve sitting flush with the skin, stops the stool from coming out at all other times.
In this way a person avoids having to wear a bag and usually just has a just a piece of gauze or even a Band-Aid to protect the stoma during most of their daily activities.

People with a continent ileostomy usually only have to empty the pouch 4-5 times a day and not at all at night once the pouch is fully matured (grown to accommodate 500 - 1000 mL of fluid).

In the first 4 weeks following surgery I will have a constant drain left in the pouch. This will help me as I recover and allow the pouch time to heal. After the constant drain is taken out I will be on an intubating schedule where I will catheterize the pouch every 3 hours, then after a week or so every 4 hours, and so on and so forth until the pouch is mature.

Now for those of you who are not medical professionals - and in practical terms, what does all this mean?

#1 I'll never poop like a normal person again. I'm having all the sphincters and rectal cuff removed because of that nasty fistula that cannot be fixed and instead I'm being fitted with this internal pouch. As mentioned above, the way that waste exits the pouch is via a catheter. What is a catheter? Basically a long flexible tube that is inserted into the pouch and the waste is syphoned out. It does not hurt because the intestine does not have nerve endings. I've had a catheter shoved into my current stoma before and a scope and it did not hurt either time, just feels kinda funny.

#2 Everything that goes in my mouth must come out the tube which is not much bigger in diameter than a straw. I see the wheels turning. Here's where it may become a little "to much info" so feel free to skip ahead to the next paragraph! -- I don't have a colon so my waste is already pretty liquidy and there are MANY things I don't digest. If I don't chew it it doesn't change form and comes out just like it goes in: lettuce or other leafy greens, corn, nuts, seeds, fruit skins or membranes etc. so you can imagine that it could be problematic in getting it to come out through a long straw. Therefore, my diet will be very limited until I figure out how much trouble different foods cause me. I have to CHEW and CHEW and CHEW everything down to baby food consistency before swallowing or else I could have major difficulty in getting it to come back out. Dinnertime will become a marathon event.

So now maybe the question on your mind is "Doesn't it freak you out to think of sticking a catheter in your belly to 'go to the bathroom'?" Well, YES! Of course I'm a little freaked out about it. I'm human after all and this is a completely unnatural experience! But if there's one thing I've learned through all my medial problems is that things that are unnatural and bizarre can become commonplace when you do them often enough.

Maybe you're thinking "I could never do that!" But you're thinking about it like a person with a healthy colon. I haven't had a colon in 15 years - in fact, I cannot remember what it is like to go to the bathroom like a normal person. Also my options are extremely limited. It's not like I get to choose between being normal and having a k-pouch.

Am I intimidated? Yes. Am I going to let that stop me? NO. But if I obsess about it for a while and it takes me a half hour to eat a sandwich, I hope you will understand!