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Made from the small intestine
In the summer on the beach with a stoma? I do not think so! You don’t want to be ashamed and you don’t want to bother with stoma bags. A pouch may be the solution.
If you have a bowel disease, or a greatly increased risk of colorectal cancer, this may mean that the colon needs to be surgically removed. The removal of the colon is also known as a colectomy.
Stoma or pouch
Until the late 1980s, an ileostomy always had to be made after a colectomy. An ileostomy is an exit from the small intestine on the abdomen, around which a pouch (stoma) can be stuck. The feces can be collected in the bag.
Nowadays a stoma is no longer always necessary, many patients are eligible for a pouch. This is a reservoir made from the end of the small intestine.
There are different types of pouches. In the Netherlands, the J-pouch is almost always used. There is also an S and a W pouch. The letters indicate the shape of the pouch. With the J-pouch, the end of the small intestine is folded once. Two times with the S-pouch and three times with the W-pouch.
A hole is made at the bottom of the reservoir that is connected to the anus. This allows the faeces to pass out in the normal way. If the J-pouch turns out to be too small over time, it can possibly be expanded to an S or a W.
People with the following conditions are eligible for a pouch:
- Patients with ulcerative colitis, a chronic inflammation of the colon. If the disease does not respond well to medication, in some cases the entire colon must be removed.
- Familial Adenomatous Polyposis (FAP), a hereditary condition that can cause thousands of polyps. These polyps mainly occur in the large intestine. The polyps can develop into colon cancer. To prevent this, the colon is removed as a precaution.
- HNPCC: a hereditary condition with a strongly increased risk of familial colorectal cancer (Lynch syndrome).
Circular muscles
There are a number of conditions for getting a pouch. The sphincter muscles of the anus must work properly, because of the risk of incontinence. That is why many elderly people opt for a stoma instead of a pouch.
Furthermore, it is important for ulcerative colitis patients that it is established with certainty that they do not have any Crohn’s disease to have. Crohn’s disease is very similar to colitis. An important difference is that colitis is only in the colon. Crohn’s can occur anywhere in the gastrointestinal tract, including the small intestine. In a Crohn’s patient it therefore makes no sense to apply a pouch, because it can also become inflamed.
stool
Pouch wearers have thinner stools than usual because the colon is gone. It is the function of the large intestine to extract moisture from the stool. Over time, the pouch will increasingly function as a rectum, which is the last part of the large intestine. The pouch then becomes a bit wider and the stool thickens a bit better. Shortly after the operation, a patient still has to go to the toilet very often, but ultimately only four to six times a day.
Sources):
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- Pouch.nl