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Colostomy irrigation: A method of bowel management

What is it exactly?

Colostomy irrigation (or washout) is a process done at home which allows you to empty your bowel regularly, and at a predictable time each day. The frequency of irrigation can vary from daily to every 2-3 days, as each person will develop a routine for complete success. The desired outcome is that after emptying the bowel of faeces, there may a period of time, 24-48 hours usually, where your stoma is inactive. It can help you regain control through bowel re training, and often reduces the effects of gas and odour. This process may mean that you do not need to wear a pouch, but can cover the stoma with a small cap or plug in between the washouts. It can help improve quality of life and provide a new sense of freedom. 

Am I suitable?

It is important to know that colostomy irrigation is not suitable for all people with a colostomy, it depends on many things. If you are suitable, it would not be considered safe until well after you recover from your surgery. Before you go any further, it is necessary for you to discuss with your surgeon and your Stomal Therapy Nurse (STN) if this option is suitable for you. There are some medical conditions and circumstances that could exclude you from the option of learning irrigation. The irrigating process is definitely NOT suitable for people with an ileostomy.

How do I do it?

The process for irrigating involves administering lukewarm tap water (tepid water) into the colon via the colostomy stoma, (bottled water is used in areas where tap water is not fit for human consumption). Special equipment is needed, which is available through the Stoma Appliance Scheme (SAS), after a mandatory certificate is completed. Your STN will help you complete the certificate after your surgeon has approved your suitability and the STN has given you the necessary information and education. Once the stoma association has received your certificate, the equipment can be ordered, just the same as you order your usual stoma supplies.  

What equipment do I need?

A basic irrigation kit consists of a irrigation reservoir with a two litre capacity, connecting tubing with a safe flow control valve, adhesive or coupling irrigation sleeves, pouch closures, belt and face plate for sleeves, cone tipped irrigator, lubricant and equipment for cleaning materials.

A: Irrigation Bag B: Belt C: Stoma Cap D: Irrigation Sleeve E: Pressure Plate F: Cone.

How does it work?

The purpose of the irrigation is to clear the colon of all faecal content as you sit on the toilet.  An irrigation sleeve is attached to a plate that surrounds your stoma, with a stoma belt attached to keep it in place. After the water is instilled through the stoma, using a soft cone, the colon will swell with the influx of water, stimulating waves of peristalsis that causes your colon to empty faeces out of your stoma through the irrigating sleeves and into the toilet. 

Evacuation occurs over the first 15 minutes during which time the plastic irrigation sleeve directs output into the toilet. Once the initial evacuation has stopped, the end of the sleeve is cleaned and clamped, allowing freedom of movement if desired. After another 30 minutes or so, the remaining evacuation of stool should be complete. Some people may choose to sit in the toilet for 45 minutes to one hour until the colon has emptied, others may choose to attend to other activities while they wait. Other diversions such as reading a book or listening to music may be used to pass the time while the irrigation is in progress. Some ostomates may find having a drink of water or a meal prior to the washout, assists with stimulating the colon to empty.

Full evacuation of the faeces may take up to 1 hour, so it is important you have uninterrupted access to a bathroom for the time needed. The process, while easy to learn, can take some time to feel fully comfortable with, and routines will become established over the first few weeks. The best results are often obtained if the irrigations are done around the same time of the day, so the colon is used to being emptied at that time. The best time of the day for you will depend on when you have the time and feel the most comfortable.

Some comments from some who have learned the colostomy irrigation process… 

I underwent this training with a stoma nurse over a couple of hours and have never looked back. I have only been irrigating for the past four months but am looking forward to irrigating for the remainder of my life. It is awesome, it’s better than being normal, I irrigate every three days at night time so I’m freer than ever. It’s now the opposite when I’m out, friends look for a toilet…… I don’t. I know you have heard the term, “better than sliced bread or a cold tinny, well irrigating is better”.

If you wish to learn more about colostomy irrigation check out the video below.