For some people, colostomy irrigation is a liberating alternative to the traditionally worn colostomy bags and pouches needed to collect fecal matter. The desire to recapture an aspect of control over bowel movements that patients used to have before their operation makes irrigation so alluring and rewarding for those that are able to go this route. This method of is not for everyone who has had colostomy surgery and it takes a little work and adjustment to get it down to a reliable routine, but it may be a solution worth looking into.
What Is Colostomy Irrigation?
Basically, CI is a technique that introduces water into the colon through the stoma which activates the colon to empty itself, much like a water enema. By using this process patients have the ability to develop a routine and a schedule to empty their colon and feel confident enough to not have to wear any of the usual collection pouches or appliances needed by colostomy patients. They may just wear small pouch for rare accidents or apply a cap or patch on their stoma for protection.
It works on the theory that by emptying the entire length of the colon of fecal matter at one time that it usually takes 1 to 2 days for new waste material to make its way to the stoma preventing the patient from having to worry about fecal discharge during that time. Everybody’s digestive system is different so for some they are able to irrigate every couple of days while others have to do it every day.
It is usually a several week process of trial and error before someone is totally confident enough to not wear any type of appliance in between irrigations. And for some patients, even though they may meet all the requirements of a CI candidate, it may just not work at all for them.
Colostomy irrigation has been around since the 1920’s. Back then it used to recommended more often because the alternative colostomy appliances were not well made. As time has progressed and the quality of colostomy devices has drastically improved, the popularity of CI has gone down. Some ostomy nurses may not even offer up any information on irrigation so if this is something that you are interested in pursuing you might have to bring it up with your doctor or nurse.
Is Colostomy Irrigation For Me?
First, the patient must have enough healthy colon to produce firm, less watery stools so colostomy irrigation is usually only recommended for those who have had an end descending or sigmoid colostomy. It is not recommended for anyone that has chronic colon conditions such as irritable bowel syndrome or someone with heart or kidney problems, a hernia or anyone who has had a transverse or ascending colostomy.
Anyone interested in colostomy irrigation must discuss it with their doctor and see if they are a suitable candidate. They should not start colostomy irrigation on their own without their doctor’s approval. Once approval is given by the physician a consultation with their ostomy nurse should take place. The nurse should go over and explain everything that is involved with the process as well as show you how to use all the equipment needed for colostomy irrigation. They may give you the supplies needed for the process and tell you what tends to work best given the experience of their past patients. Each ostomy nurse’s instructions may be slightly different from other nurses due to varying training methods and feedback with patients they have worked with over their career. It is important to try and follow their instructions closely and should you run into any problems make sure and contact your ostomy nurse or your doctor.
The Colostomy Irrigation Process
First you will need the right supplies in order to proceed with colostomy irrigation. They make specific kits for CI that will probably include some of the following:
- An irrigation sleeve
- An irrigation bag, similar to an IV bag, this will be used for the water that will be introduced into the stoma. It has a small tube with a stoma cone attached to the end with a flow control apparatus.
- A stoma cone. This is what is inserted into the stoma so that water can move through it into the colon.
- A clip for the sleeve.
- A hook of some sort in order to hang the irrigation bag and give it some elevation so that the water can readily flow down through the tube attached to the cone and eventually into the stoma.
Additional tools that may be helpful but are optional:
- A thermometer, although some irrigation bags come with a temperature gauge ensuring the water is not too hot or too cold.
- Cup of water to pour down the sleeve when cleaning it out at the end.
- Hand sanitizer
- Something to lubricate the stoma.
- Empty waste basket to dispose of used sleeves and pouches.
- Flow indicator.
- Extra towels or wipes
After you have everything you need it might be a good idea to lay everything out and become familiar with all the supplies and how they work. If it is your first time doing colostomy irrigation you might want to practice a couple of times and run through all the steps without actually inserting water into the stoma.
Below is a simple guideline of the steps involved in CI. The instructions that you receive from your doctor or ostomy nurse may be different and those are the instructions that you should always follow.
- Make sure you have all the supplies out and handy that you will be using.
- Fill the irrigation bag with water. Only use water you would feel safe drinking. If it is not safe enough to drink it is not safe enough to use for CI.
- The water should be the around the same temperature as the human body, somewhere between 98 and 100 degrees F should be fine.
- Once the bag is full, hang it somewhere around the same height as your head or neck level.
- Sit or stand somewhere near the toilet, sitting on the toilet is fine.
- If you are wearing a pouch on your stoma, remove it and attach the irrigation sleeve. The sleeve may hang down in the toilet or you may let it hang outside of the toilet but make sure the clip is attached to the end.
- Grab the tube with the cone attached and open the flow valve a bit until water starts to drip, this ensures that any air that may be trapped in the bag is released. Then shut off the valve.
- Reach into the opening in the sleeve with the cone and insert it into the stoma with a gentle press.
- Now open the valve and let the water start to drain through the cone into the stoma. If you feel some cramping just use the valve to slow the flow of water.
- Once all or most of the water is gone from the irrigation bag hold the cone in place against the stoma for a few seconds longer.
- After a few seconds, remove the cone from the stoma, pull it out of the sleeve and then make sure you close up the opening in the sleeve.
- Then you just relax and wait. The colon should start to empty with stool ejections at different intervals. When you think the colon might be done emptying itself out, wait an extra 15 to 20 minutes just to make sure.
- Once the colon is done, it is time to clean up.
Beginners should keep wearing their regular bags or pouches when first starting colostomy irrigation in order to avoid any accidents. It may take several weeks before the colon is “trained” to respond to this process in a reliable enough way that you would feel confident going without wearing a bag or pouch full time. It is advisable to do your CI routine at the same time of day to develop a reliable schedule for your colon.
Advantages of CI
For those that are ideal CI candidates, colostomy irrigation can offer many benefits which may include:
- Probably the biggest plus to successful irrigation is freedom from having to constantly wear the large colostomy bags or pouches or for those that choose to continue to wear them, the bag will for most part remain empty. The need to change or empty bags throughout the day is eliminated or substantially reduced. A certain sense of “freedom” is gained.
- Reduction in constant odor. Successful irrigation means not having a pouch that is constantly getting filled up producing long periods of not having to deal with foul odors.
- Regaining some control over bowel movements. While it won’t be the same as prior to having a colostomy, CI can help someone recapture some feeling of control they may have lost.
- Reduction in skin irritation.
- Reduction in gas. Once a routine and a diet is situated, colostomy irrigation can have a positive impact on the amount of gas that is produced.
- Fewer or smaller pouches will usually lead to lower ostomy supply costs for the patient.
Disadvantages of CI
Like everything in life, with the positive there is bound to be some negative. Some disadvantages of colostomy irrigation may include:
- CI takes time. For some it may seem like an event, but usually it takes somewhere around 1 hour to irrigate. You will need access to a bathroom during this time so it may be a slight inconvenience if the amount of bathrooms is limited.
- Colostomy irrigation also requires some trial and error. It takes a few weeks to feel confident in the process and develop a routine and learn what will work and what won’t work for you.
- Even once a routine is developed an occasional accident may happen. Digestive illnesses that may produce diarrhea or irregular bowel movements are always a possibility. Some folks choose to wear a small pouch for rare instances when this might take place.
- Some patients are not comfortable with inserting things into their stoma or having so much contact with it.
As always, if you feel you would like to give this method a try or this is the route that you would like to move towards after surgery, it is important to discuss it with your doctor and make sure that it is a viable option in your particular case.
Note: If you are uncomfortable watching someone else deal with their waste disposal process then this video might not be something you would like to watch. It does however provide great insight on what you might expect from colostomy irrigation.