This topic is about exploring the possibility of transitioning from a stoma to an internal pouch for individuals with Crohn’s disease. An internal pouch, also known as a continent ileostomy or Kock pouch, is a surgical option that some people consider. Here’s a simple breakdown of what it involves and some important considerations:

1. **Understanding the Internal Pouch**
- An internal continent pouch is created using a section of the small intestine. This section is cut open, folded, and sewn to form a reservoir.
- A stoma with an internal valve is made, allowing stool to be stored in the pouch. The person empties the pouch several times a day using a catheter through the stoma.

2. **Suitability for Crohn’s Disease**
- Generally, having Crohn’s disease makes one unsuitable for a continent or ileo-anal pouch. This is because Crohn’s can attack the pouch, leading to failure and the need for more surgery.
- Some people have shared their experiences: one person had a pouch created in the 1970s, but it failed within a couple of years. Others have had similar experiences, needing further surgery after a Crohn’s diagnosis.

3. **Pre-operative Testing and Second Opinions**
- Before considering a pouch, it’s crucial to have thorough testing, including biopsies of the small intestine, to rule out Crohn’s. Even then, results can be unclear, so getting a second opinion from both a surgeon and a gastroenterologist is advised.

4. **Common Complications**
- Even without Crohn’s, complications like pouchitis (inflammation), valve stenosis, low-capacity reservoirs, and the need for revisions or removal can occur.

5. **Considerations for Rectal Cancer and Sphincter Removal**
- If the anal sphincter or rectum has been removed, a continent or ileo-anal pouch isn’t possible because there’s nothing to connect to for continence.
- If the sphincter is intact, surgeons often prefer a direct connection (anastomosis) without a pouch. Otherwise, a permanent colostomy or ileostomy might be necessary.
- For those with a sigmoid or descending colostomy, irrigation might be an option for bowel regulation if a pouch isn’t feasible.

6. **Finding the Right Surgeons and Centers**
- Not all surgeons perform continent pouch procedures. It may be necessary to seek out specialized colorectal centers that handle pouch surgeries for conditions other than Crohn’s, such as ulcerative colitis or familial adenomatous polyposis.