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Colostomy Irrigation: A Guide For Optimal Output Control

Colostomy Irrigation: A Guide For Optimal Output Control

Colostomy? Then you can be really lucky, because we have some “magic” for you. Did you know that there is an easy solution to manage and plan your stoma output? 

Colostomy irrigation – that’s the magic word. It is incredibly safe and superbly effective; it enables you to be in control of your stoma discharge, minimizing odor and other related problems. Allowing you to enjoy your long needed continence to delightfully relax and relish your personal and social relationship. 

This article will tell you who exactly and when you can irrigate and gives you an easy step-by-step guide for irrigating your colostomy, together with 10 useful tips to prevent any issues. But first – what is Colostomy irrigation? We will give you the answer right here.

Colostomy irrigation is the process of flushing the stoma with 500-1000ml water by using an irrigation bag, sleeve, a tubing with flow control, and a cone to insert the water. After flushing, all the stool gets removed within one hour. This is then followed by 24-48 hours of no stoma output.

What is the purpose of colostomy irrigation?

The colostomy irrigation purpose is to stimulate your bowel movement in order to manage stoma output. By self instilling water through the stoma opening, all colon content gets flushed. Therefore, a period of no stoma output of about one to two days follows. This allows for a more predictable bowel movement with the use of smaller pouches such as stoma caps.

Who can do stoma irrigation?

Suitable candidates for stoma irrigation are those ostomates with permanent colostomies made in the descending colon or the sigmoid part of the bowel and who had a regular bowel function before doing the colostomy. In other words, having enough large bowel to produce reasonably formed stool.

Ostomates who can not irrigate are those with:

    • Transverse colostomy: The stool is liquidy and the stoma is continually or frequently discharging. This is why irrigation doesn’t work and is generally regarded as a waste of time.
    • Ileostomy: Ileostomy irrigation is not recommended because the output is usually frequent and too liquidy and the irrigation may cause dehydration and electrolyte imbalance.
    • Urostomy: As the output is very frequent and liquid.

When can I start to irrigate?

Some colostomy patients can start to irrigate as early as 10 days after surgery, where others might need to wait 2-3 months following the surgery. It depends on many factors such as your surgery type, your medical condition, and your medications (chemotherapy).  Discuss with your physician about the appropriate time for you to start irrigation.

How often should I irrigate?

Usually, colostomy irrigation should be done regularly every 1-3 days to be effective. Nevertheless, the irrigation schedule depends on your body, bowel motion and diet. 

As an example, you can start daily and then make it every 2nd day, then every 3rd day. But if you notice a leakage is starting on the 3rd day, then you are likely better suited to stay on every 2nd day pattern.

When should I irrigate?

The irrigation should be done regularly at the same time of the day and preferably, one hour after having your meal or hot drink. This way your bowel will get used and trained to the irrigation process and learns its elimination timing better on a regular schedule. It usually takes about six to eight weeks for the bowel to get regulated with the irrigation routine.

How long should the irrigation take?

The colostomy irrigation procedure will take about 1 to 1.5 hour. The more frequently you will do the irrigation, the shorter time it will take as you gradually master the steps and the technique. However, every person is different and techniques might vary a little. So, some may spend as long as three hours while others can finish in as short as half an hour.

In which situations should I not irrigate?

In the following scenarios, you must not irrigate: 

  • If you are experiencing diarrhea, it might be best to stop irrigating for a few days until your bowel gets back to normal.
  • If you are having stoma prolapse (your stoma is protruding out) or hernia (you have a bulge around your stoma). You will find it difficult or even impossible to get the irrigating water through your stoma. In this case it is better to seek medical help.
  • If you get chemotherapy or radiation.
  • If you have a history of Irritable Bowel Syndrome, kidney and heart disease.
  • If you have physical limitations such as arthritis, paralysis, palsy, visual impairment, learning disabilities, and who are severely or terminally ill.
  • If you have a transverse colostomy, ileostomy, or urostomy.

 

Advantages (Pros)

  • Greater control of your bowel function (no stoma output except at the time of irrigation).
  • Eliminating the need to for emptying and/or changing of the bag several times a day.
  • Minimizing the costs of the pouching system.
  • Minimizing your colostomy appliance profile. No more bulges under clothing that attract attention. Instead, you can use smaller alternatives like a stoma cap, mini-pouch, or just a patch to protect your stoma in between irrigation. 
  • Wind and odour is greatly minimized because of the emptied colon and the minimal bowel movements.
  • Minimal peristomal skin irritation. No fecal output that could leak underneath the pouching seal and irritate your skin. 
  • Can help you avoid having thick and pasty stool (constipation) which might cause pancaking.
  • Better sleep, and improve sexual relations, and fewer peristomal skin problems
  • General positive impact on quality of life

 

Disadvantages (Cons / Drawbacks)

  • Commitment: Some may find it difficult to follow the regular routine, which is preferred to get the best results from irrigation.
  • Time-consuming: Others may find the time needed for the procedure is too long (about one hour each time).
  • Unpleasant: Some people may find it uncomfortable and difficult for them to handle their stool or touching their stoma. 
  • Late returns: Late stoma output that might fill up your sleeve or occur when you’re just about to take off your sleeve is possible, even after you have established a regular safe time routine.
  • Despite doing your best in the technique, you may still (rarely) get an intestinal virus causing diarrhea or your colon suddenly misbehaves with unexpected discharges from your stoma.

Colostomy irrigation procedure – What do I need?

The supply list should include:

  • Colostomy irrigation kit which includes: Ostomy irrigation bag, Irrigation sleeve, tubing with flow control or clamp, and a cone (a nozzle with a smooth rounded tip). (Colostomy irrigation set styles may vary from one manufacturer to another).
  • Thermometer to measure the water temperature. Sometimes built-in with some types of irrigation bags.
  • A wall hang, towel hanger, or any hook to hang the irrigation bag.
  • A colostomy pouch or stoma cap to be worn after the procedure.
  • Paper towels, toilet paper, or tissue.
  • A mild soap (with no perfumes or oil). We recommend using Farmoderm – bioderm stoma Plus – Dermo Detergent which is a unique formula that enables pH – autobalancing and provides optimal hygiene for your stoma and the skin around it. Other conventional products can cause peristomal skin irritation and can significantly harm your stoma. 
  • Lukewarm water that is safe to drink.
  • Ostomy or irrigation belt (optional).
  • Rubber or latex gloves (optional).

5 easy steps for the right Colostomy Irrigation Procedure

If you are planning to start irrigating your stoma, it’s best to get trained first by your doctor or stoma nurse to learn the proper technique. Once you start doing it all by yourself at home, you can use this guideline to remember the colostomy irrigation steps and all details.

 

Step 1: Prepare the equipment

  • Connect the irrigation bag, together with the tubing, and the cone.
  • Close the flow control or clamp the tubing connected to the irrigation bag then fill the bag with body-temperature water (37-38 C). If it’s too warm, damage to the stoma may occur. If it’s too cold, it may cause cramping.

We suggest starting with 500 millilitres for the first few irrigations. Then adjust it later on. If you are having bowel motion and fecal discharge between irrigations, then increase the amount to 750 mL.

  • Hang the bag on the wall hook so the bottom of the bag is at your shoulder level (whether you are sitting or standing).

Hanging the bag higher than that might increase the force of the water flow and cause abdominal cramping and lower than that will give you a more gentle flow.

  • Holding the tube over the toilet, open the flow control or remove the clamp to let the water run inside the tube, allowing air to be flushed out. Once water starts to come out, stop the flow.
  • Sit on the toilet seat or in a chair next to the toilet (some might also prefer standing).

 

Step 1: Prepare the equipment

Step 2: Prepare the stoma and insert the cone

  • Remove the current pouch system.
  • Apply the irrigation sleeve over your stoma (which comes with either self-adhesive or with a mounting ring). Then, place the end of this sleeve in the toilet, it should not touch the water in the toilet. If it is too long, cut it to the appropriate length.
  • Lubricate the tip of the cone with a water-soluble lubricant, if you want an easier and smooth entering of the cone inside the stoma.
  • Pass the lubricated cone through the top open end of the irrigation sleeve and gently press it into the stoma about halfway in without causing any discomfort. 

Never force the pointy tip of the cone into the stoma. And do not insert the whole cone inside.

  • Hold the cone in that position for about 1 to 2 minutes while taking slow and deep breaths, which helps to relax your abdominal muscles and makes the irrigation easier.

 

Prepare the stoma and insert the cone

Step 3: Allowing water flow

  • While keeping the cone in that position, open the flow control or remove the clamp on the tubing slowly. Allowing the water to flow gradually and gently into the stoma.
  • It should take about 5 to 10 minutes to finish installing 500-1000ml of water. Then close the clamp on the tubing.
  • Hold the cone in place for about 10 seconds.
  • Commonly encountered problems – how to deal with them:
    • If you feel abdominal cramps, slow down or stop the irrigation and try to relax and take deep breaths. Then try again.
    • If water back flows from around the cone, then gently  try to adjust the angle or position of the cone tip. And try again.
    • If adjusting didn’t help, there might be stool blocking the way. Clamp the tubing and remove the cone out of your stoma. And let the stool pass through your colostomy. Then insert the cone tip again and start irrigating.

 

Allowing water flow

Step 4: Remove the cone and allow evacuation

  • Remove the cone and close the top part of the irrigation sleeve.
  • Returns may start immediately or might take 5 to 10 minutes to start coming out of your stoma.
  • Allow the stool and water to flush out through the sleeve and into the toilet for about 15 minutes. 
  • Then you can clamp the bottom end of the sleeve, clean and dry it with a paper towel or tissue.
  • You can leave the bathroom now and continue with your usual daily life routine for about 45 minutes. In the meantime, there will be periodic discharge of watery stool which will come out in waves until the colon is completely empty. The entire process should take about one hour.

 

Remove the cone and allow evacuation

Step 5: Remove the sleeve (and cleaning up)

  • Empty the sleeve into the toilet. 
  • Remove the sleeve from your stoma.
  • Clean and dry skin around your stoma. We highly recommend Farmoderm – bioderm stoma Plus – Dermo Detergent for a mild and healthy cleaning. Bioderm Cellusoft is a very absorbent cloth with a highly absorbent power for easy and delicate cleaning and ideal drying.
  • Put on your chosen stoma cap or colostomy pouch back on.
  • Wash the sleeve and the cone with water and soap to remove any stool particles. Then dry it together with the irrigation bag with a paper towel or tissue. 
  • Flush the toilet and clean your hands with soap and water.

 

Step 5: Remove the sleeve (and cleaning up)

 

If you like to watch the irrigation procedure, check out those Colostomy Irrigation demonstration videos :

Video 1: Colostomy Irrigation Procedure Care 

Video 2: Adventures in Irrigating

10 Tips to prevent colostomy irrigation problems

Whether you just started irrigation or you are an experienced person, difficulties and problems are common to encounter during this procedure. But with practice and repetition, the process will get a lot easier and faster. 

The following 10 tips will help you learn ahead and plan your strategy to have a successful colostomy irrigation:

  1. Get trained by a nurse: If you are planning to start irrigation, we recommend getting trained by a nurse to learn the technique until you are confident enough to do it alone. If you are experiencing any problems or difficulties during the irrigation procedure, look again athe the explanation of each step or ask for help from your ostomy nurse to show you the proper technique.
  2. Inform the family about your routine: Choose a time in the day when you know you will have the bathroom to yourself, avoiding any disturbances while doing the irrigation.
  3. Develop a regular routine for the procedure to train your bowel and have successful irrigation results.
  4. Wear minimal clothing in your first few tries of irrigation. You might soil your clothes. When you feel confident and comfortable with the procedure, then do it fully clothed.
  5. Consider drinking fluids and eating one hour before the irrigation. It’s really useful for an easy irrigation procedure because of the active bowel motion which will help to ease the washout procedure.
  6. If you are dehydrated, drink a glass of water then start irrigating again. When your body is dehydrated, your colon may absorb some of the irrigation water and your stoma output will be less than the amount you start irrigation with. 
  7. Don’t rush the irrigation session to avoid late stoma output (late returns).
  8. If you started to feel abdominal pain, cramps, and nausea during the procedure, pause your procedure for 1 to 2 minutes. It’s a sign that either the water flow is too fast, you’re using too much water, or the water is too cold. Therefore, it is better to stop and take deep breaths for a couple of minutes until you feel better and check what’s causing the problem, then resume your procedure.
  9. Always carry spare supplies (colostomy pouch) with you. Because despite doing your best in the technique, your colon can suddenly misbehave with unexpected discharges from your stoma or you may still (rarely) get an intestinal virus causing diarrhea.  Being always ready and prepared for such emergencies can make your life a lot easier. This is why we have created an ostomy travel bag that helps you exactly with that – having all your supplies ready. Check out the article to see which bags fit well and what exactly should go in it.
  10. Use body-temperature water (37-38C). Use a thermometer or test it by hand. If it’s too cold, you might feel cramps. And if it’s too warm, you might damage your stoma.

For many, colostomy irrigation means a return to “normal” life by giving them a greater control over their stoma output while having less bulges under their clothing by using smaller appliances (like a stoma cap). In result, regaining their social confidence and maximizing their self liberty and merit for a happy life and relationships. So, we hope this guide helped you learn about this technique and its benefits with useful steps and tips to assist you on how to master this procedure.

FAQ

Could you still not find the answer to your question? We have collected the most frequently asked questions related to colostomy irrigation:

Which solution is used for colostomy irrigation?

It is a body-temperature water that is usually used in colostomy irrigation, and it should be drinkable water. If you can not drink the water from the bathroom tap, it means you can not irrigate with it. So use bottled water instead.


Do you irrigate ileostomy?

Ostomates with ileostomy should not irrigate their stoma as they usually have more frequent and liquidy type output. Additionally, it might lead to dehydration and electrolyte imbalance, which are absorbed normally from the content of the bowel that you flushed out.

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