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is it possible to have surgery and not have a bag or pouch?

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Ulcerative Colitis
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Posted 3/2/2013 5:26 AM (GMT 0)
I was just wondering, is there anyway to have surgery for this and not have a bag or pouch?
Posted 3/2/2013 5:59 AM (GMT 0)
Well, what would one have? A rectum, or a colon? All three surgeries for UC involve a pouch or a bag.

Sue
Posted 3/2/2013 6:07 AM (GMT 0)
You can avoid having an external appliance, a bag connected to a stoma, that has to be emptied. That surgery is j-pouch (or less often k-pouch/bcir) and it requires that you have an internal "pouch" created from the small intestine. You will go to the bathroom more than most healthy non-UC people but WAY less than a person in a flare up. It's also non-urgent. You can't know whether you would be a good candidate for the internal "pouch" without consulting a surgeon.
Posted 3/2/2013 6:55 AM (GMT 0)
Just wondering if they could connect intestine to the rectum... I'm not interested in any of those other options
Posted 3/2/2013 7:04 AM (GMT 0)
if you have ulcerative colitis the most diseased part of your colon will be your rectum, so thats going to be removed with any surgery
Posted 3/2/2013 7:05 AM (GMT 0)
oh, you mean like a drip system for your yard, only in your tighty-whities ......... hmmmm!
Posted 3/2/2013 7:29 AM (GMT 0)
With the Jpouch you go to the bathroom normally basically just more times than a normal person. The pouch is internal.
Posted 3/2/2013 12:15 PM (GMT 0)

freddyj said...
Just wondering if they could connect intestine to the rectum... I'm not interested in any of those other options

No, not if you have UC. The rectum has to go other wise the UC will just manifest itself there. Everything has to go. I have read about a colectomy with a connect to the rectum but in cancer patients that had to have their colon removed from cancer.
Posted 3/2/2013 2:43 PM (GMT 0)
Add to that the fact that the stool is completely liquid when it enters the colon, and you would have constant liquid stool seeping out. You'd be far worse off than you are now.
Posted 3/2/2013 3:00 PM (GMT 0)
We had a surgical consult in Italy and the surgeon wanted to wait a year and treat the rectum post colectomy topically. If it healed he wanted to connect the ileum to the rectum, which would be a straight pull through. Some MDs will do it and there have been a couple of cases on this board of people who've had it done. Of course, problem is diseased rectum but benefits (according to this surgeon) are better control and fewer BM (he was an adult CR surgeon and had a number of patients who had this type of set up and were doing better than the jpouchers from what i understood though my Italian is not the best). Now, we asked our current/would be surgeon and he said no way. I know a few kids who've had this done - one whose mom posts here (name chris's colon I think) and they're doing well. Depends - why do you now want a pouch post surgery?
Posted 3/2/2013 4:16 PM (GMT 0)

killcolitis said...
We had a surgical consult in Italy and the surgeon wanted to wait a year and treat the rectum post colectomy topically. If it healed he wanted to connect the ileum to the rectum, which would be a straight pull through.

Wow, that just sounds totally crazy to me for a UC patient. Why on earth would they put someone thru a surgery only to keep having to treat the rest of the disease in the rectum when a j pouch would do away with the need for that? I don't get it. Most of my trouble was in my rectum, I would be a train wreck if I still had my rectum. But like you said, some cases are just different.
Posted 3/2/2013 6:25 PM (GMT 0)
I don't know why. Just that he has done it with some patients and they have better control and fewer bms but he did say that we would have to watch her rectum was after a year or so and treat it topically in the mean time. I do know it's more common in children to do this as their bodies adapt better somehow but this surgeon was talking about his adult patients. ?
Posted 3/2/2013 6:59 PM (GMT 0)
So interesting. I would still think with a straight pull through the patient would still have an average of 4 to 6 bms a day which is what a typical j poucher has anyway. After all, the colon is still gone, speeding up transit time. Essentially, all the j pouch is is your new rectum.
Posted 3/3/2013 2:53 AM (GMT 0)
Hey byebye- I know that the official literature often talks about 4-6 BMs/day being the ideal goal... But isnt the true number more like 6-10 or more? I know this number varies wildly and some of you pouchers do get 4-6 but I think even a poll on jpouch.org had a higher average with a goodly chunk above 10. My surgical consultant gave a higher figure. Not to split hairs- i e if one poops when one pees the whole number thing may be academic (not quite as academic to guys, since stalls are few and far between in mens bathrooms- many have just one and it is often occupied), but I just think the 4-6 thing is rare, isnt it?
Posted 3/3/2013 11:34 AM (GMT 0)
No, I don't think 4-6 is rare at all. You have to remember you are reading polls on a support site. Think about all the thousands of people who have had this procedure who you don't hear about. Believe me, I do have days that I go more. And it's usually because I ate too many sweets (I have a horrible sweet tooth!) or I ate a lot of fruit....diet related. My sister has a long time j pouch and she goes 2x a day. Now that's rare!!
Posted 3/3/2013 4:48 PM (GMT 0)
I think an IRA (hooking up the small bowel directly to the rectum) might have fewer BMs on average than a j-pouch, just because the rectum is "better" at holding fecal matter than a j-pouch. That said, the rectum will always start to flare again in UC so IRA isn't commonly done anymore. If you have really strong feelings against a j-pouch or permanent ileostomy you might be able to find a surgeon who is willing to do it (like killcolitis found in Italy) but it's definitely not the preferred surgical treatment for UC.

Judy2 isn't quite right about output being "pure liquid" when it enters the colon... The small intestine absorbs water too, and anyone with an ileostomy can tell you that output from the small intestine isn't always liquid. Mine is usually quite formed, like the consistency of thick polenta -- I joked to my surgeon that my ileo output is way more formed than my BMs ever were when I had my diseased colon, and he said that isn't at all uncommon. Without a colon you're never going to get really *solid* output, but pure liquid isn't right either.
Posted 3/3/2013 4:57 PM (GMT 0)
There are many days that I have formed stool with my j pouch. Not like a colon formed stool, but formed none the less. I actually don't like it when it's formed because its harder to empty. The small bowel really does adjust over time and absorb more liquid in the absence of the colon. I know not too many people believe that but its true.
Posted 3/3/2013 9:07 PM (GMT 0)

ByeByeUC said...
There are many days that I formed stool with my j pouch. Not like a colon formed stool, but formed none the less. I actually don't like it when it's formed because its harder to empty. The small bowel really does adjust over time and absorb more liquid in the absence of the colon. I know not too many people believe that but its true.

Quoted for truth! I learned something interesting recently... "Each day approximately 9L of water arrive in the small intestine - about 1.5L of this is drunk and the remainder is secreted into the intestine (McGeown, 2002). Only about half a litre of this water reaches the large intestine - the rest is absorbed throughout the small intestine and this is closely linked to the absorption of sodium chloride."

In other words, even if you have a perfectly functioning small and large intestine, the vast majority of water absorption happens in the small intestine. The colon's main job is absorbing water, but absorbing water doesn't mainly happen in the colon.
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