I have thrown around a lot of terms that probably aren’t too familiar to you unless you or a loved one has ulcerative colitis or crohns disease. I thought I would spend a little time briefly explaining the difference between the main types of surgeries that are most prevalent in the life of an IBD patient. The five I want to go over are Jpouches, bowel resections, ileostomies, colostomies and kock pouches/BCIR.
Let’s start with the Jpouch. This surgery is usually done in 3 steps, the first being the removal of the colon where the patient is given a temporary ileostomy. A few months later the surgeon makes a pouch out of your small intestine in the shape of a “J” for the purpose of holding stool/taking the place of your large intestine. The third and final surgery is connecting the intestine to the Jpouch. When the Jpouch is working well, it is meant to act like a colon. It holds stool in an internal pouch where the individual goes to the bathroom just like a person would with a large intestine. This is the most popular surgery for someone with ulcerative colitis and for many with crohns disease.
A bowel resection is usually done for patients who suffer from crohns disease. As I understand it, it is cutting out the part of the intestine (small or large) that is diseased and causing the patient the most issues. It is the hope that with eliminating the diseased portion of the intestines, that medicines will allow the other parts of the intestinal track to take over and “behave” properly.
An ileostomy is when a small portion of your small intestine is brought up through the skin in your stomach. This portion of your small intestine kind of looks like a rose bud and is commonly referred to as a stoma. An appliance covers the stoma so waste goes right into the bag that is attached to the patient’s skin. The output is usually more liquid since the large intestine is what absorbs most of the water in your body. When the bag is about 1/3- ½ full, a person can empty the contents of the bag into the toilet and go about their business.
A colostomy is when a portion of your large intestine is brought up through your skin in your stomach. For some people, a portion of their large intestines have been removed but for many colostomy patients, their colons are still intact. I have never had this and the literature I read is different depending on my source and who I am speaking with but I am under the impression that the output isn’t liquidy since the large intestine is still present to absorb water. There are some people who don’t need the appliance on all of the time. That part really depends on the individual and what issues they are going through.
A kock pouch and BCIR are also called continent ileostomies. I had the kock pouch in an effort to rid myself of having an ileostomy. With this surgery, there is a stoma like the ileostomy only instead of it protruding out it goes inside. A pouch is created in your stomach which holds stool and a valve is made out of your small intestine to keep the waste inside of the pouch until it is time to empty it. When that time comes, you simply stick a catheter inside the inverted stoma and the waste should come out that way. This process doesn’t cause any pain as there are no nerves. There is usually no need to wear anything over it. I always wore a bandage or a small towel since there can be mucus that comes out at times. The BCIR has a different type of valve but other than that, it is pretty much the same surgery.
That is a pretty simple overview of the different types of surgeries that IBD patients whose symptoms cannot be managed with medication will most likely need to go through. As always, everything depends on the individual and circumstances of the disease.