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What is BCIR?

BCIR is an appliance-free intestinal ostomy. The BCIR itself is a surgically created pouch located on the inside of the abdominal wall made from your small intestine. The pouch’s function is to store intestinal waste, which is drained several times a day by inserting a catheter into a small opening in

the abdomen called a stoma. The BCIR can be a life-changing option for patients who have had removal of their large intestine (colon and rectum)
in that it creates a new pathway for the evacuation of waste. The BCIR is 100% internal, or intra-abdominal. It’s also 100% appliance free.

 

B is for
Dr. Barnett, the
man who modified
the Koch pouch into
the BCIR procedure
performed
today.

C is for
Continent, which
means the patient
is in control of
his or her
own waste

I is for intestinal.
The BCIR is made
from the patient's
small intestine and is
located inside the
abdominal wall.

R is for reservoir,
another word for
the pouch that
holds the waste.

 
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Why have one?

“I can do
anything now that
I couldn’t do before
because I couldn’t
wander that far away
from the house.” -Joe

“I control my life now
whereas before an
illness controlled me.” -Joe

“Having the BCIR
surgery was the best
decision I ever made! I
feel awesome and it has
improved the quality of
my life ten-fold!” -Kim

“From a wife's
perspective, a BCIR is a
big improvement over the
ileostomy! We can once
again enjoy water sports
without the worry
of 'the bag.'” -Paulette

“I am wearing a bikini
again and I my life no
longer revolves
around finding the
next restroom.” -Michelle

“I have been skiing
in Vail, zip lined in the
rainforest of St. Lucia,
parasailing in Hawaii,
and work 50+
hours a week!” -Jim

“I'm an avid scuba diver
and have my advanced
certification. I swim
several nights a week
at the local YMCA.” -Leeane

“For the first time,
at the age of 50, I
became an active adult.
No longer am I a
cheerleader on
the sidelines.” -Eileen

“Our quality of life
couldn't be better. If
I had not had my BCIR
surgery there are many
things that my family
and I would not
have enjoyed.” -Robin

 
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Q & A

 

  • Q: I have a malfunctioning Koch pouch, am I a candidate?

    A:Yes. A malfunctioning Kock pouch can be revised, including transforming it into the BCIR design.

    Q: I have a j-pouch and suffer from frequent incontinence. Am I a candidate?

    A: Yes – it is important to understand that a patient with a failed J-pouch does not need to have a standard Brooke ileostomy with the external appliance!

     

  • Q: Am I a candidate for BCIR?

    A: Candidates include: People who are unhappy or dissatisfied with the results of their procedure – whether it be a conventional Brooke ileostomy, a malfunctioning Kock pouch or malfunctioning ileoanal J pouch – and people with poor anal sphincter control who either elect not to have the IPAA or are not a candidate for IPAA/J-Pouch.

    Q: I have a traditional Brooke ileostomy. Am I still a candidate?

    A:Yes. Many patients who have the BCIR are converted from an ileostomy, some after several decades.

     

  • Q:How old are BCIR patients?

    A: Patients who have the BCIR vary widely in age, however, it is advised that adolescent growth period be complete before having a continent ileostomy. Patient ages range from teens to 70s, roughly.

    Q: Who is not a candidate for BCIR?

    A: If you have active Crohn’s disease, an inadequate length of small intestine, or a permanent colostomy, you would not be a candidate for BCIR.

     

  • Q: What is the recovery time for the BCIR Procedure?

    A: 12 weeks are required to return to strenuous activity after a major abdominal surgery. Many patients recover sooner than 12 weeks and return to non-strenuous employment within 4-6 weeks of surgery.

    Q: How long will I be in the hospital for the BCIR procedure?

    A: Average stay varies depending on individual circumstances. Generally the stay is 18-21 days.

     

  • Q: What is the history of the BCIR?

    A: The BCIR was developed in 1979 when Dr. William Barnett began modifying the Kock pouch to correct its problem with frequent valve slippage. Dr. Barnett performed over 300 procedures perfecting the BCIR before joining Palms of Pasadena Hospital.

    Q: Will I lose a lot of blood during surgery?

    A: It is rare for a patient to require transfusions for a procedure converting a failed Brooke ileostomy to a continent ileostomy. However, if a patient desires, he or she can donate one or two units of blood in the 3-4 weeks prior to surgery.

     

  • Q: Where can I have the BCIR procedure performed?

    A: Palms of Pasadena hospital has been performing BCIR the longest. To get in touch with Palms of Pasadena, please fill out the contact form at the bottom of the page.

    Q: What is the mortality rate for the BCIR procedure?

    A: BCIR is a major surgery, hence the risk of death is no different than any other similar major surgery. Potential complications will vary with individual patient history. Discussing your full history with your surgeon will better inform you of risks involved.

     

  • Q: Can I revert back to another surgery if I am unhappy with the BCIR?

    A: Yes. If you are unhappy with your BCIR, it can be ultimately removed and you can revert back to a permanent, conventional ileostomy with an external appliance.

     

  • Q: How does going to the bathroom work with a BCIR?

    A: The BCIR is an internal reservoir for intestinal waste. So whenever a patient feels a sensation of fullness in the pouch, a small catheter is inserted throughout the stoma, a surgically-created opening flush with the abdomen, and waste is emptied from the pouch directly into any toilet.

    Q: What is a stoma?

    A: The stoma is a small, elliptical, surgically-created opening in the abdomen wall. Unlike traditional ileostomies, the stoma is flush with the abdomen and is not visible through tight fitting clothing. It is usually located low on the abdominal wall.

     

  • Q: Is intubation (draining the BCIR pouch) painful?

    A: There is very little to no pain involved with draining the pouch since the pouch does not contain any nerve endings. An increased production of mucus around the stoma helps with inserting the catheter. Some patients use lubricating jelly and water on the catheter to help.

    Q: How many times will I need to go to the bathroom each day?

    A: Most patients report draining the pouch 2-4 times daily, and most times they sleep through the night. This number can vary depending on the types and quantities of food you eat.

     

  • Q: How will I know when to go to the bathroom?

    A: When you first leave the hospital, you will intubate every few hours, gradually extending the time between intubations in order for your pouch to expand in size over time. When your pouch has matured, you may go to the bathroom when you feel the need. Most patients describe a “feeling of fullness” similar to when you need to urinate. You’ll know when to empty the pouch, but most times it is possible to wait until its convenient for you to intubate.

     

  • Q: What will my diet be like with a BCIR?

    A: When you first leave the hospital, you should avoid fruits, nuts, and vegetables that may clog the catheter. Further along in your recovery, and once your pouch has expanded in size, you will be able to eat almost any food. Many patients avoid the tough skins on apples, potatoes, and tomatoes, as well as foods which do not digest well, including corn, mushrooms, and peanuts simply because of the difficulty in passing them through the catheter.

    Q: Will I need to take any dietary supplements or routine medications with a BCIR?

    A: No, most patients do not require any supplements as long as you eat a well-balanced diet.

     

  • Q: Is there any sort of maintenance required for my BCIR or catheter?

    A: You will need to flush the catheter out with water after each use. Daily irrigation of your BCIR pouch is recommended.

    Q: Can you have children after having the BCIR procedure?

    A: Women with a BCIR may give birth through normal vaginal delivery or by Caesarian section.

     

  • Q: Will I have to get up in the middle of the night to drain the BCIR?

    A: When your pouch has matured, there should be no need to get up in the middle of the night. Exceptions would be if you have eaten late or eaten a large meal you are not accustomed to.

    Q: What is pouchitis?

    A: It is an inflammation of the tissue lining of the BCIR pouch. While most BCIR patients experience pouchitis to some degree, most report that they do not consider pouchitis to be a major problem. In most cases, symptoms can be managed at home with oral antibiotics.

     

  • Q: Where can I find out more information about BCIR?

    A: We have a resource list to get you started at the bottom of the page.

     

  • Q: What is the recovery time for the BCIR Procedure?

    A: 12 weeks are required to return to strenuous activity after a major abdominal surgery. Many patients recover sooner than 12 weeks and return to non-strenuous employment within 4-6 weeks of surgery.

    Q: How long will I be in the hospital for the BCIR procedure?

    A: Average stay varies depending on individual circumstances. Generally the stay is 18-21 days.

     

  • Q: Where can I find out more information about BCIR?

    A: We have a resource list to get you started at the bottom of the page.

    Q: I have a malfunctioning Koch pouch, am I a candidate?

    A:Yes. A malfunctioning Kock pouch can be revised, including transforming it into the BCIR design.

     

  • Q: I have a j-pouch and suffer from frequent incontinence. Am I a candidate?

    A: Yes – it is important to understand that a patient with a failed J-pouch does not need to have a standard Brooke ileostomy with the external appliance!

    Q: What is the history of the BCIR?

    A: The BCIR was developed in 1979 when Dr. William Barnett began modifying the Kock pouch to correct its problem with frequent valve slippage. Dr. Barnett performed over 300 procedures perfecting the BCIR before joining Palms of Pasadena Hospital.

     

  • Q: Will I lose a lot of blood during surgery?

    A: It is rare for a patient to require transfusions for a procedure converting a failed Brooke ileostomy to a continent ileostomy. However, if a patient desires, he or she can donate one or two units of blood in the 3-4 weeks prior to surgery.

    Q: Is there any sort of maintenance required for my BCIR or catheter?

    A: You will need to flush the catheter out with water after each use. Daily irrigation of your BCIR pouch is recommended.

     

  • Q: Can you have children after having the BCIR procedure?

    A: Women with a BCIR may give birth through normal vaginal delivery or by Caesarian section.

    Q: Am I a candidate for BCIR?

    A: Candidates include: People who are unhappy or dissatisfied with the results of their procedure – whether it be a conventional Brooke ileostomy, a malfunctioning Kock pouch or malfunctioning ileoanal J pouch – and people with poor anal sphincter control who either elect not to have the IPAA or are not a candidate for IPAA/J-Pouch.

     

  • Q: I have a traditional Brooke ileostomy. Am I still a candidate?

    A:Yes. Many patients who have the BCIR are converted from an ileostomy, some after several decades.

    Q: Where can I have the BCIR procedure performed?

    A: Palms of Pasadena hospital has been performing BCIR the longest. To get in touch with Palms of Pasadena, please fill out the contact form at the bottom of the page.

     

  • Q: What is the mortality rate for the BCIR procedure?

    A: BCIR is a major surgery, hence the risk of death is no different than any other similar major surgery. Potential complications will vary with individual patient history. Discussing your full history with your surgeon will better inform you of risks involved.

    Q: How does going to the bathroom work with a BCIR?

    A: The BCIR is an internal reservoir for intestinal waste. So whenever a patient feels a sensation of fullness in the pouch, a small catheter is inserted throughout the stoma, a surgically-created opening flush with the abdomen, and waste is emptied from the pouch directly into any toilet.

     

  • Q: What is a stoma?

    A: The stoma is a small, elliptical, surgically-created opening in the abdomen wall. Unlike traditional ileostomies, the stoma is flush with the abdomen and is not visible through tight fitting clothing. It is usually located low on the abdominal wall.

    Q: What will my diet be like with a BCIR?

    A: When you first leave the hospital, you should avoid fruits, nuts, and vegetables that may clog the catheter. Further along in your recovery, and once your pouch has expanded in size, you will be able to eat almost any food. Many patients avoid the tough skins on apples, potatoes, and tomatoes, as well as foods which do not digest well, including corn, mushrooms, and peanuts simply because of the difficulty in passing them through the catheter.

     

  • Q: Will I need to take any dietary supplements or routine medications with a BCIR?

    A: No, most patients do not require any supplements as long as you eat a well-balanced diet.

    Q: Will I have to get up in the middle of the night to drain the BCIR?

    A: When your pouch has matured, there should be no need to get up in the middle of the night. Exceptions would be if you have eaten late or eaten a large meal you are not accustomed to.

     

  • Q: What is pouchitis?

    A: It is an inflammation of the tissue lining of the BCIR pouch. While most BCIR patients experience pouchitis to some degree, most report that they do not consider pouchitis to be a major problem. In most cases, symptoms can be managed at home with oral antibiotics.

    Q:How old are BCIR patients?

    A: Patients who have the BCIR vary widely in age, however, it is advised that adolescent growth period be complete before having a continent ileostomy. Patient ages range from teens to 70s, roughly.

     

  • Q: Who is not a candidate for BCIR?

    A: If you have active Crohn’s disease, an inadequate length of small intestine, or a permanent colostomy, you would not be a candidate for BCIR.

    Q: Can I revert back to another surgery if I am unhappy with the BCIR?

    A: Yes. If you are unhappy with your BCIR, it can be ultimately removed and you can revert back to a permanent, conventional ileostomy with an external appliance.

     

  • Q: Is intubation (draining the BCIR pouch) painful?

    A: There is very little to no pain involved with draining the pouch since the pouch does not contain any nerve endings. An increased production of mucus around the stoma helps with inserting the catheter. Some patients use lubricating jelly and water on the catheter to help.

    Q: How many times will I need to go to the bathroom each day?

    A: Most patients report draining the pouch 2-4 times daily, and most times they sleep through the night. This number can vary depending on the types and quantities of food you eat.

     

  • Q: How will I know when to go to the bathroom?

    A: When you first leave the hospital, you will intubate every few hours, gradually extending the time between intubations in order for your pouch to expand in size over time. When your pouch has matured, you may go to the bathroom when you feel the need. Most patients describe a “feeling of fullness” similar to when you need to urinate. You’ll know when to empty the pouch, but most times it is possible to wait until its convenient for you to intubate.

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Patient Stories

 

"I was fortunate that on the eve of getting an ileostomy I heard an advertisement on the radio while at work. After research I contacted Palms of Pasadena and in 2005 had my Barnett Continent Intestinal Reservoir. It is the best thing I ever did."

Barbara

Age at surgery: 54

 

"It is much easier to change and shower at the gym!!!  I do yoga every day. Other days I mix up weight training, biking, swimming, walking, and golf.  And I like to shoot BB baskets.  I'm lucky to work at an awesome fitness center."

Rita

Age at surgery: 60

 

"I trusted Dr. Rehnke and the BCIR staff with my life and in turn they gave me my life back--better than it was before. A small hospital in St. Petersburg, Florida not only restored my health, but my faith in the medical profession in this country. So that's two miracles and still counting . . ."

Brian

Age at surgery: 48

 

"It has been 10 months since my surgery and life is wonderful! I can go to the beach and not worry where a restroom is. I can wear light colored clothes again and not be stopped by the TSA in the airport. I thank God every day for this wonderful gift."

Lisa

Age at surgery: 54

 

"I had a J-pouch and I was miserable. My mom, sister and I prayed for a miracle. We then saw an advertisement in the Phoenix Ostomy magazine. That was the day my life changed! I had my BCIR surgery and I have never felt better or have been happier. I owe my life to Dr. Rehnke. I am now 25 years old and have been reborn."

Jeananne

Age at surgery: 24

 

"I live with a Barnett Continent Intestinal Reservoir, or BCIR for short. I am also using my hobbies, which are bodybuilding, acting, and modeling to help motivate others who have digestive diseases and who are struggling to find a solution to their digestive issues. The BCIR, in my opinion, is by far the best procedure to have if you have no choice but to get your colon removed. I know this because I've lived with the ileostomy bag and the j-pouch, the two most commonly used procedures to have after your colon is removed. The BCIR is not as well known, but I'm educating people on how much more comfortable you'll be with the BCIR versus the j-pouch or the ileostomy bag."

Michael

Age at surgery: 29

 

"Dr. Rehnke performed my BCIR surgery in 2007 and he gave me a life back without wearing a bag on my side. I wore a bag for 35 years. Now I am bag free and LOVE it. Thank you Dr. Rehnke for all you did!"

Robin

Age at surgery: 47

 

"This is a picture of the bike and run portion of the Sprint Triathlon.  It was a 250 meter swim, 10 mile bike and 2.5 mile run.  I started training 8 weeks prior to the event with two goals in mind...to finish and not finish last!  I am proud to report that I met both goals!  At 63 years old, I was the third oldest participant (out of 170 women).  I would have NEVER attempted that kind of activity when I was wearing an external pouch...out of fear of it showing through my clothes and also fear of leakage or the worse yet, it coming dislodged!  I have been bitten by the exercise bug and will continue to train for future events. I have to add that I heard several girls express concern about having to go to the bathroom or having a 'diarrhea attack' when they got nervous before an event...I thought, 'If they only knew!'"

Pam

Age at surgery: 39

 
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Let’s Talk!

BCIR

If you would like to proceed to the next step of learning more about this life-changing procedure, please fill out the form below. Your information will only be sent to qualified, relevant healthcare professionals at Palms of Pasadena, a hospital renowned for their BCIR program. Your information is completely confidential. We're here to help you get connected with the right resources and people to make the right decision for you!We would love to hear from you! Please fill out this form and we will get in touch with you shortly.