Caring for your health is more than performing surgery, reading test results or writing a prescription. It's about taking the time to listen and to explain. The information below represents some general tips. It does not, however, take the place of consulting with your medical team.
We do hope you will check back often as we will update this section regularly.
Early Recuperation Period
- For the first several weeks after surgery, you will be asked to call and provide weekly progress reports. Once you have fully recovered and feel comfortable with your BCIR, after-care will vary by patient.
- The Barnett Continent Intestinal Reservoir (BCIR) is a self-sealing pouch that stores the liquid waste for several hours. The stool and gas is drained through a catheter approximately 2 to 5 times a day. It will take you several weeks or months to get to this point. Before you are discharged from the hospital, you will begin to intubate (process of draining) your reservoir every two hours during the waking hours and once in the middle of the night. Each subsequent week, you will add an additional hour between each daytime intubation interval until you get to the intubation cycle that is good for your lifestyle. Good news: the first week home will be the only week you will have to set an alarm clock and get up in the middle of the night. Manifestation for the need to intubate may be a feeling of tightness, distention or cramps.
- Total body relaxation improves the ease with which intubation can be carried out. Abdominal wall tension narrows the opening of the access segment and decreases the facility with which angles and curves can be negotiated by the catheter.
- If your stoma gets tender from the frequent intubation, contact the office as Viscous Lidocaine (numbing medication) may provide you with some relief.
- We recommend irrigation once a day. This is a simple process which involves a 60-70 cc syringe filled with tap water.
- The capacity of the internal pouch will increase from approximately 50 cc when first constructed to 600 - 1000 cc over a period of months. Once the pouch is of ample size, gas should not be a problem, but in the early stage anti-gas medication may be of help.
- When you are discharged, your activity level is restricted to a certain point: No heavy lifting or activity that involves the use of abdominal muscles for 3 months post-op. Return to work varies from patient to patient.
- Your mid-line incision should be kept dry. If it gets wet, pat it dry.
- During recuperation from major bowel surgery, the intestinal tract is edematous (swollen with fluid) and very sensitive to food. As your health returns, usually around the 3 month mark, you can usually resume eating a variety of foods from all the food groups, with emphasis on individual food tolerance. Each person should experiment with food choices, gradually adding new foods one at a time to determine the effect on BCIR management. Our program motto is "drink, drink, drink and chew, chew, chew!"
- The BCIR is a very vascular organ and a small amount of blood is not unusual. If you see more blood than usual, irrigate with ice-cold water. Don't hesitate to contact your health care provider if it continues or you have any concerns.
Ongoing Maintenance (late after recovery)
- Recommended catheter is a 30 French. It is recommended that you throw out the catheter after six months of use. If you tend to keep a catheter longer, please check the integrity of the tip.
- If you have an abdominal X-ray, alert the radiologist to the fact that you have a continent pouch/reservoir and that it will resemble a bowel obstruction.
- You may safely undergo a MRI. You have staples in your BCIR pouch but they are made out of titanium and you should suffer no adverse reaction.
- If you undergo a major operation and you are concerned about intubation, we suggest that you place a soft Foley catheter in your BCIR with the balloon deflated and secured with tape. Tell your local health care provider not to blow up the balloon while this catheter is in your BCIR. This catheter can be emptied when you feel the need or it can be placed to suction or bedside gravity.
- If you are undergoing abdominal surgery of any type, it is suggested that your local health care team contact your BCIR surgeon to discuss your general anatomy.
- It is highly recommended that you wear a medic alert bracelet or necklace. Your surgeon's phone number and name should be placed on this alert bracelet as well as the fact that a soft 30 French catheter should be used to drain your pouch.
- Each time you intubate, you potentially could lose some microscopic blood. As a result, it is recommended that you get your blood levels monitored on a routine basis. Suggested labs include: CBC, Ferritin Level and B12
- BCIR patients do not have a large bowel so you do not need much fiber in your diet. Fiber adds bulk to the stool, but few calories or nutritional value.
- People without a large colon tend to dehydrate more easily than someone with a normal digestive system. Maintaining adequate oral intake is necessary.
- For males only: when you have undergone a total proctocolectomy, your prostate can no longer be checked manually. You will need to have your PSA levels monitored instead.
- Pouchitis is the most common complication. It is an inflammatory condition involving the tissue lining of the pouch. It is characterized by swelling, redness, and irritation; in more sever cases, small ulcers may occur. Symptoms consist of cramping, abdominal discomfort in the region of the pouch and diarrhea with the need to empty more frequently. Early intervention is very important.
- It has been shown that probiotics and yogurt with live cultures as a daily dietary supplement can decrease the incidence of pouchitis. Despite this, some individuals will still require antibiotic therapy as part of their treatment protocol.
- Scoping of the pouch is not routinely required. It will be recommended based upon clinical symptoms.
- If you are traveling and are concerned about the local water, please play it safe and drink bottled water.
- If you are traveling abroad and are concerned about pouchitis, please take an antibiotic with you just in case.
- We do hope to maintain a relationship with you over the long term by your participation on our chat room, Facebook, Twitter and annual follow-up questionnaires. We also do hope that you participate in our annual educational symposiums that are sponsored by the Quality Life Association (QLA).