Patient Frequently Asked Questions (FAQs)
How often will I use the restroom?
Bowel frequency differs from patient to patient. Our goal is for patients to have to have three to nine stools per day. Stools can vary from pasty to watery to semi solid in consistency. As with any bowel operation, patients experience many changes both short and long term. Diet can significantly influence bowel frequency.
Why should I be concerned about dehydration?
One of the most important things to consider after pouch surgery is hydration. Increased bowel frequency or watery bowel movements can lead to dehydration. Dehydration occurs when your body loses more water than you intake from drinking and eating. You also lose electrolytes along with the water. Severe dehydration can be life threatening. Dehydration can be prevented by drinking of plenty of fluids.
Is traveling with a pouch safe?
After pouch surgery, it is safe to travel with some considerations.
If you are driving a long distance then it is advised to take breaks every two to three hours and walk around for five or 10 minutes to prevent possibility of deep vein thrombosis (DVTs) and or pulmonary embolism (PE). These recommendations also apply during long distance air-line travel. This is common information for the general population; however people with history of inflammatory bowel disease will be more encouraged to follow these recommendations.
During traveling it is very important to avoid consumption of contaminated water or food to prevent symptoms of pouchitis or pouch inflammation secondary to infection. It would be safe to consult with your GI physician and possibly carry antibiotics when you plan to travel internationally.
When traveling there can be issues of availability of restrooms or a time to get to one. It is safe to carry anti-diarrhea medications such as Loperamide or Lomotil with you. You can also keep pedialyte pouches with you that can be added to clean water in case you experience dehydration.
What if I have diarrhea with a pouch?
The function of the pelvic pouch will change over the first year and improve as it stretches and becomes larger after the ileostomy closure. Dietary changes may help to decrease the number of bowel movements. However, some patients may need dietary supplements or anti-diarrhea medications to thicken stool.
What is a pouchoscopy and why do I need one?
A pouchoscopy is an endoscopic exam that is performed by a slim, flexible tube. This tube has a camera at the tip to provide a close-up view of the lower small intestine and also to take colored images of the pouch. It allows specialists to assess the pouch.
What do I need to do to prepare for a pouchoscopy?
You may be asked to take a bowel cleaners or enema prior to the pouchoscopy. This is not always the case, so be sure to ask your specialist what he/she recommends.Please download the following information about preparation for a pouchoscopy procedure.
Is there a higher risk of pouch cancer?
Lifelong follow-up with your gastroenterologist in order to inspect your pouch on an annual basis is recommended. Gastroenterologists will take extensive biopsies during a pouchoscopy to rule out dysplasia or any abnormal precancerous cellular growth in the pouch. The risk of developing dysplasia is very low. However, it is very important to have regular exams and pelvic pouch biopsies to discover problems early on so that the remedy is easy and not severe.
When connecting to the pouch to the anal areas, there are two methods. The first method involves stapling the pouch to the anal area. If the stapling method is used, there is a small rim of "transitional" tissue, which may contain colon cells that are left behind. These colon cells are prone to get precancerous changes. Biopsies of this area are essential during pouchoscopy that can be done every one to two years.
Another way of connecting the pouch to the anal area involves stripping the anal lining away including the transition zone (termed mucosectomy) and sewing the pouch to the anal muscles. This procedure has the risk of not removing every cell of transition zone tissue, which may predispose it to some concerns in the future. Again annual biopsies of the area is very important to your health.
Should I be concerned about incomplete evacuation of my pouch?
Good bowel habits include spending less time to defecate and less straining. Since the pouch is also made up of muscles, some patients with straining symptoms should be screened for pelvic floor dysfunction. If there are outlet stricture narrowing or pouch prolapse at the outlet then it needs to be addressed by an expert gastroenterologist.
Should I be concerned about gaining weight?
Yes. Logically if one gets more belly fat than blood flow to the pouch, it can get compromised thus making you more prone to get ischemic pouchitis. Therefore, we recommend keeping weight stable after full recovery from a pouch surgery.
When can I begin to exercise again?
Extreme physical exercise and sport activities should be avoided for three months after the surgery. Most patients feel well enough to begin physical exercise well before three months, but it takes a minimum of three months for the incision to become strong enough to withstand strenuous exercise. Heavy physical exercise prior to three months may increase the chance of developing an incisional hernia. Light walking, biking or swimming are encouraged. Patients should also avoid strenuous abdominal exercises.
Male should lift no more than 25 pounds.
Females should lift no more than 20 pounds.
How do I protect my skin?
Bowel frequency and loose consistency of stools can cause perianal excoriation. Therefore, it is essential to take good care of perianal skin. Perianal or anal irritation can cause itching, seepage, bleeding. The vigorous wiping of perianal area should be avoided. One should avoid using dry toilet paper and instead use wet toilet paper or sensitive wipes. Using excessive wipes can also cause irritation to the skin. Zinc oxide based protective creams will protect the skin from small bits of stool or mucous, which may leak out of the anus. There are several products that protect the skin around the anus, such as Desitin®, Calmoseptine and Cleveland Clinic protective paste (a special ointment made at Cleveland Clinic).
Avoid using commercial wet toilet wipes or baby wipes, as these commonly cause worsened irritation.
Keeping a dry cotton ball or using panty liners by the anus might help to wick away moisture and keep the perianal area dry. One should change cotton ball and or panty liners more frequently if there are issues with bowel leakage. Other medicated treatment may be needed if there are signs of a fungal or bacterial irritation, similar to diaper rash. Aquaphore is an ointment that is available over the counter and can be used to coat the perianal area after a bowel movement. Aquaphore is more gentle than Vaseline and acts as a skin barrier.
We would recommend using one remedy at a time and monitor any improvement in your perianal irritation.
Stoma Skin Care
You may have a stoma when preparing for a pouch surgery or after you receive a K-Pouch. Emptying and keeping your stoma or bag clean is an important part of your care. Proper catheter as well as appropriate size of catheter for intubating K pouch is highly recommended to avoid any trauma during intubation. Skin around the stoma can get irritated and uncomfortable if there is too much rubbing or pressing against it.
A Wound, Ostomy and Continence (WOC) nurse will show and help you learn to take care of your stoma.
Could my pouch dysfunction be surgically fixed?
It is possible to repair some pouch problems after a full evaluation by our team of specialists. Outcomes may be dependent on the diagnosis of the dysfunction as it is the cause for pouch revision surgery.
Should I be concerned about bowel obstruction?
To construct the pelvic pouch, the small bowel can occasionally be stretched on the blood vessel, which provides blood to the pouch in order to reach the anus. This stretching may predispose you to bowel obstructions from scar tissue, adhesions, twisting or kinking. This may occur throughout your entire life. Maintaining a healthy weight throughout your life may help avoid this issue. It may require an operation to unkink the bowel or divide the scar tissue. Another reason, which may lead to problems with pouch emptying, is narrowing or stricture at the pouch anal junction (anastomosis). This is diagnosed by an exam of the anal area and may cause symptoms of a progressive need to strain more and more to move your bowels. Usually, dilation solves the problem and rarely an operation is needed to correct the problem. The dilations can also be done during a pouchoscopy by a specialist.
What will my diet be like after surgery?
Diet can significantly influence your bowel frequency. The altered anatomy of bowels after a J-Pouch procedure may require modification of diet in some patients.
In most cases, there are not strict dietary guidelines after recovery from pouch surgery. It is advisable to keep a food diary that will document consumed food items and related bowel frequency. This activity will help to assess essential inclusion or elimination of dietary items in your meals or snacks. Small, but more frequent amounts of food intake can also influence to control bowel frequency within normal baseline range.
In general, high protein and low sugar diets are helpful in the majority of patients who experience increased bowel frequency. Foods that have been found to help decrease the water content of the stool may help slow the number of stools down. These foods include applesauce, bananas, rice, creamy peanut butter, potatoes cheese, marshmallows, pretzels, toast, yogurt and tapioca pudding.
Bulking agents such as Metamucil®, Citracel®, Fibercon®, Benefiber ®, or Konsyl® also help thicken the stool. These products are ingested with minimal fluid to allow the extra fluid in the gastrointestinal tract to be absorbed. Every patient has different threshold to tolerate certain amounts of fiber. Modify one thing at a time in your diet from carbohydrate, protein to fiber intake and keep a food journal to monitor bowel frequency, abdominal cramping or pain accordingly.
A consultation with a nutritional therapist is the way to go if you need specific help with your diet recommendations. Cleveland Clinic's Center for Human Nutrition has specialists to help with your nutrition during your recovery and beyond..
Medications such as Lomotil® or Imodium® are sometimes prescribed to slow down the frequency bowel movements. They should not be used without your doctor's approval. Limiting the intake of fried and fatty foods and milk/milk products may decrease diarrhea. Reaction to foods varies with each individual and other foods may be found to increase the amount of stool produced or change the consistency.