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Irrigation: A Colostomy Management Option

Anita Prinz, RN, MSN, CWOCN, WCC | Wound, Ostomy and Continence Nurse
11/12/19  9:38 AM PST
colostomy irrigation

Imagine if you didn’t have to wear an ostomy pouch anymore. If you have a sigmoid or end colostomy, you can be free from the ostomy pouch — if you are willing and able to learn the process of colostomy irrigation.

Irrigation is a method of instilling a large amount of water into your stoma to stimulate the evacuation of your colon, similar to an enema.  After irrigation, you should be stool-free for 24-48 hours, plus the added bonus of having less flatus. Colostomates around the world irrigate as a safe and effective method of managing their colostomy.

The irrigation process takes up to an hour to complete and should be done on a consistent basis: the same time every day.  Irrigation kits available from ostomy manufacturers include a bag for holding water with attached tubing and flow regulator, a malleable stoma cone, an irrigation sleeve and a belt. The procedure is quite simple but not always easy at first and can get quite messy until you figure out what you are doing. Basically, you will instill 500 – 1,000 ml of warm water into the stoma, and then wait approximately 30 minutes for peristalsis to be activated and purge the contents of your colon.

The step by step procedure can be found on The United Ostomy Association of America’s web page and/or your manufacturer’s website.

While there are benefits to ostomy irrigation, the procedure isn’t for everyone. Contraindications include: those with ileostomies, loose stools, active Crohn’s or Ulcerative Colitis, severe parastomal hernia, prolapsed stoma and strictured stomas. In addition, you must be able to dedicate about an hour a day at the same time every day for irrigation to be successful. People who are undergoing chemotherapy or have had pelvic radiation should check with their physicians before initiating irrigation.

The best tip for irrigators is to stay well hydrated and drink plenty of water before you start the irrigation procedure. Some people find that eating before irrigation also makes for a good output.  Know that your output will vary from day to day depending on your diet and hydration status. If cramping occurs, stop the flow of water and wait a minute or so until relieved then resume. Cramping occurs sometimes from too fast of a water instillation, or too cold of a water temperature.  The irrigation sleeve can be cut to whatever size you like, or it can be cuffed to keep the bottom clean. Breakthrough stools are very common in the beginning as you are getting regulated, so be sure to wear a small pouch until you feel confident that you won’t have any stool during the day. Once you are confident that you will be stool-free for at least 24 hours, you can switch to wearing a small stoma cap to protect your stoma and clothing.

Overall research demonstrates that irrigators have a higher self-esteem and better quality of life than non-irrigating patients. Several studies revealed that individuals who irrigated had fewer peristomal skin problems, better sleep, and improved sexual relations compared to those who evacuated naturally with an ostomy. Many people express a sense of freedom from not having to wear and empty a large ostomy pouch. Other positive benefits include decreased financial expenses and decreased plastic waste in the world.

Check out these links for more information about living with an ostomy:

Coloplast Care: Using Ostomy Irrigation Video

Everyday Ostomy Tips

Ostomy FAQs

Ostomy Lifestyle Videos Community

Serving Medicare Ostomates Nationwide
I had emergency ostomy surgery last march. I have a peristomal hernia the size of a breast. Is that normal?
Unfortunately, hernias can often occur following ostomy surgery.
We definitely recommend speaking to your surgeon about the issue, but additionally ...

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