Caring for an Ileostomy or K-Pouch

The continent ileostomy, also known as a K-pouch, is a connection between the end of the small intestine (ileum) and the skin on your abdomen. It allows waste to be drained. Unlike other ileostomies, the K-pouch has a valve that prevents waste from leaking out. Instead, a catheter is used to empty the pouch.

When the pouch fills with intestinal contents, pressure builds up on the stitches and stretching occurs. This can lead to perforation, tearing, or leakage if not relieved.

How Often Do I Drain the K-Pouch?

To prevent problems, follow your doctor’s instructions on draining your K-pouch. The frequency varies, but initially, you will have an indwelling catheter that continuously drains the pouch for about three to four weeks. After the catheter is removed, you will drain the pouch several times a day, gradually reducing the frequency over time.

Discuss your specific needs with your doctor, surgeon, or enterostomal therapist (ET), a nurse specializing in stoma care. They will provide instructions and support.

General Guidelines for Draining the K-Pouch

Follow these general guidelines but consult with your healthcare providers for your individual case.

• Relax your abdominal muscles, consider bending your knee to aid relaxation.
• Use water-soluble lubricant to relubricate the catheter (do not use Vaseline or products with petroleum jelly).
• Insert the catheter up to the preset mark, if you encounter difficulty, change positions and try again.
• During the initial period, irrigate the catheter several times a day with 1 ounce of tap water and allow it to drain off.

If you suspect pouch drainage has stopped:

• Irrigate the catheter
• Pinch the catheter to check for fluid or air movement
• Check for fluid return
• "Wiggle" the catheter about an inch

If you still believe drainage has stopped, remove the catheter, flush it with cool tap water, and reinsert it.

• Drain the pouch every two hours while awake.
• Drain at bedtime and upon waking.
• Avoid drinking or eating within two hours of bedtime.
• At night, consider setting the catheter to constant drainage or set an alarm to wake and empty the pouch.

Over time, you will be able to go longer between drainages. Empty the pouch four to six times per day and use irrigation during two of those times. Empty the pouch whenever you feel full or uncomfortable.

How Do I Care for the Catheter and My Skin?

Take care of your catheter and skin after leaving the hospital by following these guidelines:

1. Collect the necessary supplies:

• Washcloths or paper towels
• Non-oily soap (Ivory and Dial recommended)
• Plastic bag or newspaper
• Dressing
• Irrigation supplies: tap water, bulb syringe, and basin

2. Wash your hands thoroughly with soap and warm water.

3. Irrigate the catheter:

• Remove the dressing
• Separate the catheter from the drainage bag
• Drain the contents into the basin
• Collect 30 cc (1 ounce) of tap water in the bulb syringe
• Slowly insert the tap water into the catheter
• Release the catheter from the bulb syringe
• Drain the contents into the basin
• If necessary, repeat the irrigation process

4. Reconnect the catheter.

5. Cleanse the skin:

• Wash the skin around the stoma and catheter with non-oily soap and warm water.
• Rinse the skin thoroughly.
• Dry the skin with a soft towel or paper towel.
• Apply two layers of dry gauze dressing around the catheter and over the stoma. Secure with tape.
• Dispose of waste, wash the basin and bulb syringe with soap and warm water, and dry the supplies.
• Wash your hands again.

Other Tips for K-Pouch Care

Follow these additional tips for the best care:

• Regularly check the catheter for proper drainage.
• Irrigate the catheter twice a day as instructed by your nurse or doctor.
• If you experience pressure beneath the pouch, absence of stool drainage, or stool leakage, check for kinks, irrigate the catheter, and seek medical advice if symptoms persist.
• Inspect the stoma daily and report any changes to your doctor.
• If stool becomes thick or difficult to pass, increase your fluid intake.
• Avoid laxative preparations as they can cause diarrhea and dehydration.

WebMD Medical Reference

Reviewed by Arnold Wax, MD on September 19, 2009