Elderly mother - can you reverse J pouch to deal with incontinence?

My mother had her colon removed and has lived with a jpouch since 1984 -- YES, 1984. It has worked very well for her. She is now 88, however, and she is becoming more and more incontinent. She fell and broke her pelvis so she's in a skilled nursing facility rehabbing now. She is non-weight bearing. This creates lots of problems. Not sure this would be an answer, and not sure she's even a candidate for surgery, she's so frail, but it occurred to me that we could maybe fix her incontinence with a jpouch reversal. Is there such a thing? Could it be done arthroscopically? I'm afraid she will not be able to go to assisted living with this problem, as they will refuse her, or being non-weight bearing, she will recieve less than adequate care. Thoughts?

Doing any surgery at 88 is very risky. I am not sure what would be recommended, but I would consult with a colorectal surgeon and see what they say. Perhaps there's something they can give her to help with the incontinence, or a simple procedure if there's something wrong... I agree though sadly, yes, I would imagine the care she would receive would be reduced if she's suffering with these problems. Is she functional and happy otherwise? What does she think? Gosh, getting older is scary.

Thanks, nososicklygirl. I've spoken to you in the past on either the UC or the Depression forum about myself. Love, love, love your tag line at the end of your post. I've spoken to you about that, too!

Anyway, this is just an idea that occurred to me. She is functioning well otherwise, albeit having a touch of dementia, but I am concerned that this issue might cause an earlier-than-necessary move to a nursing home. I guess we will have to see if she can recover from this pelvis fracture and go back to taking adequate care of her bowel issues. She had been living with my brother and sis-in-law for the past eight months, and this is her third major fall since December of 2015 or '16, her first fall there.

Thanks again for your reply.

NO, I would NOT recommend surgery to reverse a J-pouch that works for decades, nor ANY major surgery on a frail 88 yr-old. The object of her treatment should be to keep her as comfortable as possible-- using the most minimally-invasive procedures. Has she been referred to a uro-gynecologist? According to the gynecologic-oncologist I see regularly since pelvic surgery a few yrs back, the uro-gyns have the most up-to-date knowledge RE treating female UT incontinence via minimally-invasive procedures and/or avoiding Rx meds as much as possible. Alas, your mom may need longterm care if the pelvic fracture permanently immobilizes her. A cousin of mine now has to go that route with his 85 yr-old spouse afflicted with Alzheimers, due to a pelvic fracture she suffered last Sept. (This is a woman who was previously very active & a retired speech therapist, very intelligent & involved with family/community.) Dealing with elderly health problems after age 80 definitely is complicated so it's good that you have sibs to share in decision-making on your mom's behalf. Wishing you the best available + kindest medical support in this matter! / Old Hat (38 yrs with left-sided UC; presently in remission taking brandname Colazal)

Incontinence is a common problem at 88. Ask any nursing home employee. Not worth surgery risks. Don't be afraid to get the help you need. Caring for an aging parent is incredibly difficult to do on your own.

I'd agree with those who commented above.

At 88 incontinence is a common thing, and those at a nursing-home care facility wouldn't be shocked at her having that issue. I'd agree that a surgery at 88 would be reserved for only immediately-life-threatening illnesses situations, where the benefit outweighed the risk. Otherwise, the risk of anesthesia, and slow recovery would be too much for her to handle.

Old Hat said...
Mitz, it could be that your mom's pelvic fracture affected levator ani, a pelvic floor muscle group that impacts on female continence. Some PT exercises to strengthen it can be done in prone position, in case your mom could get help with that. She probably cannot do the Kegel, but strengthening the transverse abdominal muscles via finger pressure & breath control while lying on one's back can ultimately enable one to Kegel, which definitely improves incontinence. You might be able to check on levator ani through a gyn or rehab physician who subspecializes in female pelvic functioning. / Old Hat (38 yrs with left-sided UC; presently in remission taking brandname Colazal)

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Thanks so much, Old Hat!. I'll print this out and give it to her PT or OT.

I would definitely not go back to a loop.

I don't have much experience with it yet but so far what I can tell is I'm pooping out of my j-pouch already. I'm waiting to be reconnected soon. If I had incontinence or a weak sphincter I would still have this issue PLUS a bag to take care of.

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Thanks, Andrina. The difference is the bag contents are not smeared all over her sore bottom, and at this point, she cannot get up and clean herself up -- and she may never be able to once again get up and clean herself up. It was a harebrained idea. I was trying to make her a little more independent of care many, many times a day and night. She has little or no warning this is going to happen and she is at the mercy of the speediness of the nurse or assistant. She also is mortified when at lunch or dinner and she soils herself and believes others at the table can smell her so she has to leave without finishing her conversation or her meal.