Medical Oncologist
CION Cancer Clinics
Continent cutaneous diversion: the Indiana pouch and how you live with it | CION Cancer Clinics
A continent cutaneous diversion is a pouch made from your own bowel that stores urine inside the belly, with a small flat opening on the skin that does not leak. There is no bag. You pass a thin tube through the opening every few hours to drain it. The Indiana pouch is the usual version. This page explains how it is built, what the routine involves, and who it does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
17+specialists on panel
15,000+patients treated
35+centres across Telangana & AP
4.8★ / 800+Google rating
On this page
- What is a continent cutaneous diversion?
- How the pouch is made during the operation
- What living with a continent pouch actually involves
- Continent pouch and ileal conduit, compared at home
- Four things families tell us, and what is actually true
- Words you will see, in plain language
- Who a continent pouch does not suit, and what this page cannot tell you
- Common questions about a continent pouch
The short answer
What is a continent cutaneous diversion?
It is a pouch made from your own bowel that sits inside the belly and stores urine, with a small opening on the skin that does not leak. There is no bag. Instead, you pass a thin tube through the opening every few hours to drain the pouch. The Indiana pouch is the most common version.
How it holds urine without leaking
The pouch is built from the first part of the large bowel, and the short tail of small bowel that joins it is narrowed to form the channel to the skin. The natural valve between small and large bowel sits in that channel and acts as a one-way door. Urine stays in until a catheter opens the door.
Why it exists alongside the other two options
It is the middle path. A conduit needs a bag. A neobladder needs the urethra, with the cancer well away from it. When the urethra has to be removed, or a neobladder is ruled out for another reason, a continent pouch is the option left for avoiding a bag.
Who it is usually offered to
Someone who is motivated to avoid a bag, has good kidney function, steady hands and reasonable eyesight, and can commit to passing a catheter several times a day for life. It is done less often than the other two, so ask any centre how many they have made.
In the operating theatre
How the pouch is made during the operation
A length of bowel is set aside
The surgeon separates the first part of the large bowel together with the last stretch of small bowel, keeping their blood supply. The remaining bowel is joined back together.
The large bowel becomes the reservoir
It is opened along its length and folded into a rounded pouch, so it holds urine at low pressure rather than squeezing it out on its own.
The small bowel becomes the channel
The tail of small bowel is narrowed over a catheter and tightened at the valve, so it becomes a snug one-way passage that a tube can pass through but urine cannot leak out of.
The channel is brought to the skin
The end is brought out as a small, flat opening, often placed low on the belly or in the navel where it is nearly invisible. The ureters from the kidneys are joined into the back of the pouch, and a catheter is left in place while everything heals.
Not sure whether this applies to you?
Ask an oncologistDay to day
What living with a continent pouch actually involves
The routine is simple once learned, but it is for life and it does not take days off.
Emptying by catheter
You pass a thin, single-use tube through the opening, let the pouch drain into the toilet, then remove it. It takes a few minutes. Clean hands and a fresh catheter are enough; it does not need to be sterile.
How often
- Every couple of hours at first
- Every few hours once the pouch has stretched
- Once or twice at night, with an alarm
Flushing out mucus
Bowel lining makes mucus, and a stored pool of urine lets it thicken. You flush the pouch with water through the catheter every day or so, more often early on, to stop it blocking the channel.
Covering the opening
A small plaster or gauze covers the opening between emptyings. It stays dry. Nothing shows under a saree, a shirt or a dhoti, and there is nothing to change or stick down.
Carrying supplies
Catheters, a small bottle of water and a plaster go in a pocket or a handbag. You can empty in any toilet, including on a train. Keep a month of catheters in hand.
Side by side
Continent pouch and ileal conduit, compared at home
Continent pouch
Ileal conduit
No bag; a small flat opening under a plaster
A bag worn over the stoma at all times
You empty it with a catheter several times a day
Urine drains on its own; you empty the bag
Longer operation with more bowel joins
Shorter operation and simpler recovery
Needs steady hands, eyesight and a routine for life
Needs the bag changed every few days
Pouch stones and a tight channel can need small procedures later
Skin irritation and hernia around the stoma are the common later issues
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
Four things families tell us, and what is actually true
"Passing a tube every day will be painful and
dangerous."
The channel is built for it. Once healed, passing the catheter is a quick, dull sensation rather than pain. Infection risk is low with clean hands and a fresh catheter each time.
"It is the same as a neobladder."
Both are pouches inside the body, but a neobladder joins to the urethra and is emptied by pressing, while a continent pouch opens on the skin and is emptied only by catheter. The pouch is the option when the urethra is removed or a neobladder is ruled out.
"An old person cannot manage this."
Age itself is not the bar. What matters is eyesight, hand steadiness, memory for a timetable, and whether someone at home can help if needed. Some people in their seventies manage a pouch well; some in their forties are better served by a conduit.
"Once it is made, nothing else will ever be
needed."
Pouches need looking after. Stones can form in stored urine, the channel can tighten, and blood salts and vitamin B12 need checking for life. Follow-up is not optional with this diversion.
On your report
Words you will see, in plain language
- Continent
- Able to hold urine in. A continent diversion does not leak between emptyings; a conduit is called incontinent because it drains continuously.
- Cutaneous
- To the skin. The pouch opens on the belly rather than joining the urethra.
- Ileocaecal valve
- The natural one-way valve between small and large bowel. In an Indiana pouch it is the door that keeps urine in.
- Efferent limb
- The narrowed channel from the pouch to the skin. This is what the catheter passes along.
- Stoma stenosis
- Narrowing of the skin opening, which makes the catheter harder to pass. It is usually fixed with a small procedure.
Being straight with you
Who a continent pouch does not suit, and what this page cannot tell you
It does not suit someone with weak kidneys, because stored urine in bowel tissue puts more strain on them. It does not suit someone with bowel disease, previous bowel radiation or a large bowel that has been operated on. And it does not suit anyone who cannot, or does not want to, pass a catheter several times a day for the rest of their life.
It cannot tell you whether you should have one
That depends on your scans, your kidney results, your bowel history and what you can manage at home. It also depends on your centre's experience, because this is the least common of the three diversions.
It cannot tell you it will never need attention
Pouch stones, a tightening channel and salt imbalance are known problems with this diversion. They are usually manageable, but they mean lifelong follow-up with blood tests and the occasional small procedure.
What to do next
Ask whether a neobladder was considered and why it was set aside. Ask to be shown a catheter. Bring the family member who will be at home with you.
Not sure what your letter is saying? Call the helpline and someone will go through it with you.Questions we are asked
Common questions about a continent pouch
Does passing the catheter hurt?
Once the channel has healed, no. There is a brief sensation as the tube passes the valve, and then the pouch drains. The opening has few nerve endings. Pain, bleeding or a tube that will not pass are not normal and need a call to the team the same day.
What if I cannot get the catheter in?
Do not force it. Relax, change position, try a smaller size if you have one, and try again. If it still will not pass, go to an emergency department, because the pouch keeps filling and cannot be left. This is the one situation with a pouch that cannot wait until morning.
Can I sleep through the night?
Not at first. The pouch is small and needs emptying with an alarm once or twice a night. As it stretches over months the gap grows. Some people manage a full night, others always set one alarm. Overfilling the pouch is worse than losing sleep.
Is the opening visible?
Barely. It is a small, flat opening the size of a fingertip, often placed in the navel, covered by a plaster. Nothing shows under clothes and there is no bag or bulge. This is the reason many people choose it over a conduit.
Can I bathe, swim and fast?
Yes to all three. Water does not enter the pouch. During a fast, the pouch still needs emptying on time, and drinking well when you break the fast matters for thinning mucus. Talk to your team before a long fast so the routine is planned.
How many catheters will I use, and where do I buy them?
Several a day, every day, for life. Stoma clinics keep a list of suppliers and courier services that deliver to any district. Whether Aarogyasri, CGHS, ECHS, EHS or your insurer pays for them after discharge varies, so ask the billing team before the operation.
Why does the pouch need flushing?
Because it is made of bowel, and bowel makes mucus. In a pouch that stores urine, mucus can thicken, block the channel and give stones something to form around. A daily flush with water through the catheter keeps it clear.
Who will teach me to do all this?
A stoma or continence nurse, before the catheter comes out, with several supervised practice runs. One family member should learn alongside you. If your centre does not have a nurse who teaches this, ask who will, because the routine is the whole point of this diversion.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Sources
- American Cancer Society — Bladder cancer surgery
- National Cancer Institute — Bladder cancer treatment (PDQ), patient version
- Cancer Research UK — Bladder cancer: treatment
- Macmillan Cancer Support — Bladder cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Urinary Diversion: The Three OptionsThe pouch alongside the conduit and the neobladderWho Is Not Suitable for a Neobladder?The findings that lead to a pouch insteadIleal Conduit ExplainedThe bag option, for comparisonMetabolic Problems After Bowel-Based DiversionWhy blood tests continue for lifeStoma Nurses and Support in HyderabadWho teaches the catheter routine
Talk to us
Been told a neobladder is not possible and want to avoid a bag?
Call the helpline or send us your reports. A surgical oncologist will tell you whether a continent pouch is open in your case, and a nurse can show you what the catheter routine involves. One helpline serves every CION centre.