Colostomy irrigation is a controlled method of bowel management that involves introducing water into the colon through the stoma. This process stimulates a predictable movement of stool, similar to an enema but performed via the abdominal opening. Regularly flushing the lower large intestine helps evacuate contents at a scheduled time, providing control over bowel function and reducing unpredictable output.
Understanding the Purpose of Irrigation
The primary goal of colostomy irrigation is to establish a predictable schedule for bowel evacuation. Consistent performance trains the colon to empty its contents at a specific, convenient time. This regularity allows for long periods, typically 24 to 48 hours, without output from the stoma between sessions.
This predictable pattern offers significant benefits, including the ability to wear a smaller stoma cap or mini-pouch instead of a full collection bag. A reduced appliance size provides greater freedom in clothing choices and increased confidence. Irrigation is only suitable for individuals with a descending or sigmoid colostomy, as these lower sections of the large intestine produce naturally more formed stool. Individuals with other types of ostomies, such as ileostomies, where output is consistently liquid, are generally not candidates for this method.
Necessary Equipment and Preparation
The process requires a specialized irrigation kit, along with water-soluble lubricant and warm tap water. Preparation involves setting up the equipment in a comfortable, private location, usually a bathroom near a toilet. The kit typically includes:
- An irrigation sleeve
- A water reservoir (often marked for volume measurement)
- Tubing with a regulator clamp
- A stoma cone tip
The water must be comfortably warm to avoid causing discomfort or cramping. The reservoir is filled with the prescribed volume, typically 500 to 1,000 milliliters (mL). To ensure correct flow pressure via gravity, the water bag must be hung so the bottom is positioned approximately 18 inches above the stoma. Irrigation is often most effective when performed about one hour after a meal or hot drink, as this naturally stimulates colon activity.
Step-by-Step Guide to the Procedure
The first step is removing air from the tubing by briefly opening the flow regulator and allowing water to run through the cone tip. Next, remove the standard pouch and attach the irrigation sleeve over the stoma, directing the open end into the toilet. The cone tip is then gently lubricated and slowly inserted just inside the stoma opening.
With the cone in place, gradually open the flow regulator to allow the water to instill slowly into the colon. The instilled volume typically ranges from 500 mL to 1,000 mL, depending on individual needs. Beginners are often advised to start with a smaller volume, such as 250 mL, and increase it incrementally to allow the bowel to adjust. Instillation should take approximately five to ten minutes; maintain a relaxed posture and breathe normally during this phase.
If the water flow stops or leaks around the cone, gently adjust the cone’s angle to find the correct path within the stoma. Once the full volume is instilled, close the regulator and carefully remove the cone. The next phase is the evacuation, or return, which involves waiting for the water and stool to drain into the sleeve and then into the toilet. This process typically takes 30 to 45 minutes, and it is important to remain patient. After the return has slowed considerably, remove the irrigation sleeve, clean the stoma area, and apply a fresh stoma cap or mini-pouch.
Addressing Common Irrigation Challenges
Abdominal cramping is a frequent issue, often signaling that the water is flowing too quickly or is too cool. If cramping occurs, immediately stop the water flow by closing the regulator clamp. Take slow, deep breaths and gently massage the abdomen to help the colon muscles relax. Resume the water flow at a slower rate once the discomfort subsides.
An incomplete return occurs when the colon has not fully emptied after the allotted time. If this happens, do not attempt to instill more water immediately; wait and try again at the next scheduled irrigation time. If water does not flow easily into the stoma, first check the reservoir height to ensure gravity is working, then gently change the position of the cone tip within the stoma.
If the water flow is blocked by stool ready to evacuate, remove the cone to allow the stool to pass through the sleeve, then re-attempt irrigation. Minor bleeding from the stoma is not uncommon, especially if the cone is inserted roughly, but persistent bleeding or significant irritation around the stoma should be addressed by a healthcare professional. The entire process may take up to an hour, and managing these challenges with patience and correct technique is necessary for a successful routine.