Pouchy.orgContinent Ileostomy & Kock Pouch (Alternatives)
Internal-pouch alternatives to a J-pouch — less common, but important to know.
What Are These Alternatives?
A continent ileostomy is an internal pouch made from the small bowel that is connected to a small opening (stoma) in the abdomen — but, unlike a standard ileostomy, it doesn’t need an external bag. The patient empties the pouch by inserting a small tube through the stoma several times a day. The original version is called a ‘Kock pouch’; the BCIR (Barnett continent intestinal reservoir) is a modified version.
When Are They Considered?
- Patients who can’t have a J-pouch (for example, after pouch failure or because of damaged pelvic anatomy)
- Patients who have had their pouch removed but want an alternative to a standard ileostomy bag
- Patients with severe incontinence or pouch dysfunction who would otherwise need a permanent ileostomy
- Selected patients with FAP or other diagnoses where a J-pouch isn’t an option
Pros and Cons
The main advantage is no external bag. The main trade-offs are that these pouches require more maintenance (tube emptying multiple times per day), can develop their own complications (especially valve problems), and are technically demanding to create — they are usually offered at a small number of specialized centers. Most patients who do well with a continent ileostomy are very satisfied, but the option isn’t right for everyone.
Where to Learn More
Because these procedures are uncommon, most local surgeons do not perform them. If you are interested, ask your surgeon or gastroenterologist for a referral to a center that has experience with continent ileostomy. Travel for evaluation is often needed.
Last reviewed: June 27, 2026 · Pouchy.org patient education, medically reviewed by Stefan D. Holubar, MD, MS (Cleveland Clinic).