Colostomy irrigation is a method of bowel management involving gently flushing the colon with water through the stoma. This technique stimulates the lower bowel to empty its contents at a scheduled time. The goal is to achieve predictable, regulated bowel movements, allowing the individual to remain free of output for 24 to 48 hours. This offers greater control and the potential to wear a smaller stoma cap instead of a traditional pouch.
Determining Suitability and Gathering Supplies
Colostomy irrigation is recommended for individuals with a descending or sigmoid colostomy, where the stool is more formed and solid. Patients with ileostomies or ascending/transverse colostomies are not candidates because their output is liquid and constant, making regulation impossible. Before attempting this procedure, you must receive medical clearance from a physician and hands-on training from a certified Wound, Ostomy, and Continence (WOC) nurse.
The process requires a specific set of equipment:
- A complete irrigation set (water bag, tubing with a flow-control clamp, and a stoma cone tip).
- A long irrigation sleeve or bag to direct the effluent into the toilet.
- Water-soluble lubricant for cone insertion.
- A small cap or closed pouch to wear afterward.
The water should be lukewarm tap water, ideally between 100°F and 105°F, to prevent discomfort or cramping. Fill the water bag with the volume recommended by your healthcare professional, typically between 500 and 1,000 milliliters.
Step-by-Step Irrigation Procedure
The irrigation process takes approximately 45 minutes to one hour. Position yourself comfortably, either sitting directly on the toilet or on a chair next to it, with the supplies nearby. Hang the water bag on a hook or stand so the bottom of the bag is at about shoulder height when you are seated.
Remove your existing pouch, clean the stoma and surrounding skin, and secure the irrigation sleeve over the stoma, directing the open end into the toilet bowl. Before inserting the cone, open the flow clamp briefly to run water through the tubing and cone tip. This removes trapped air that could cause cramping. Close the clamp once the air is cleared.
Apply water-soluble lubricant to the tip of the stoma cone. Gently insert the lubricated cone into the stoma, following the natural direction of the bowel, until it fits snugly enough to prevent water leakage. Never force the cone, as this can injure the stoma tissue.
Hold the cone firmly in place with one hand and slowly open the flow control clamp to begin the water infusion. The water should flow slowly and steadily into the colon over five to ten minutes. If you experience cramping or discomfort, immediately stop the flow by closing the clamp, wait for the feeling to pass, and then restart the flow at a slower rate.
Once the prescribed amount of water has been instilled, close the clamp and gently remove the cone. The initial return of water and stool, often called the “first return,” occurs almost immediately. Fold or clip the top of the irrigation sleeve closed and allow the main evacuation period to begin, which lasts 30 to 45 minutes as the colon empties. After the flow has completely stopped, remove the irrigation sleeve, clean the stoma and surrounding skin, and apply a stoma cap or mini-pouch.
Managing Common Issues During Irrigation
Experiencing minor issues during irrigation is common.
Cramping
Cramping typically occurs if the water is too cold or flows into the colon too quickly. To alleviate cramping, immediately close the flow clamp. Take slow, deep breaths to relax the abdominal muscles, or gently massage the abdomen before resuming the flow at a reduced rate.
Slow or Stopped Flow
If the water flow stops or is very slow, the cause is often a blockage or incorrect cone placement. Gently adjust the angle or depth of the cone, ensuring it is pressed against the stoma just enough to maintain a seal. If repositioning does not work, stool may be blocking the stoma. Remove the cone, allow the initial output, and then attempt to re-insert it.
Vagal Response
A vagal response, though rare, can be triggered by water that is too cold or by excessive pressure in the colon. Symptoms include sudden dizziness, clammy skin, or nausea, indicating the vagus nerve is overstimulated. If this occurs, immediately stop the procedure, remove the cone, and lie down to allow the symptoms to subside. Contact a healthcare provider if they persist.
Leakage
Leakage around the cone means the cone is not creating a sufficient seal against the stoma opening. Adjust the position of the cone or gently increase the pressure with which you hold it in place until the backflow stops. Persistent or severe problems, especially intense pain or bleeding, require immediate discontinuation of the irrigation and a call to your medical team.
Establishing a Consistent Routine and Equipment Care
Establishing Routine
Successful colostomy irrigation relies on establishing a consistent routine that trains the bowel over time. Choose a consistent time of day, often about an hour after a meal or a hot drink, as this encourages bowel activity. Sticking to this schedule daily, or every other day as advised by your nurse, is essential for achieving control and predictability.
The process of regulating the bowel takes time, and adaptation can last several weeks before the body fully adjusts. During this initial phase, continue wearing your standard pouching system until you are confidently free of output between irrigation sessions.
Equipment Care
Maintaining the cleanliness of your irrigation equipment is important for hygiene and preventing bacterial growth. After each use, thoroughly rinse the irrigation sleeve, cone, and tubing with lukewarm water to remove residual stool or mucus. Wash the equipment with mild soap, rinse to remove all soap residue, and hang it to air-dry completely before being stored.