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Colostomy Irrigation

Colostomy Irrigation – Yes or No

Colostomy irrigation is a procedure that allows colostomy patients to evacuate stool using a water enema through the stoma. Colostomy patients that irrigate may encounter compelling benefits:

  • No more emptying large ostomy bags during the day.
  • Gaining control over bowel movements.
  • No more odor problems.
  • Replacing regular size ostomy bags for stoma caps or mini-pouches.

Irrigations are an alternative for certain patients who refuse to wear a bag, as a result of a colostomy or ileostomy procedure. “Digestive stomas (ileostomy and colostomy) are installed for therapeutic purposes in different illnesses, such as Colorectal Cancer, Intestinal Inflammatory Diseases, including Crohn’s Disease and Ulcerous Colitis, hereditary diseases like Family Polyposis, abdominal traumas and congenital diseases, with Colorectal Cancer as the main motive to install a stoma. People who turn into ostomists after a surgery have to cope with a series of difficulties, related to the loss of anal sphincter control and the presence of an intestinal part in the abdomen through which feces and gases are eliminated. After the surgery, the patients are expected to effectively assume physiological functions their body used to perform autonomously until then.”1

How Does Colostomy Irrigation Work?

Patients should irrigate preferably at the same time every day or on alternate days, and at least sixty minutes after meals. The process still works if they cannot keep a schedule, but it is advisable to follow a routine. 

The process requires injecting water through the stoma and into the large intestine. Once in the colon, water induces evacuation. However, results are not necessarily immediate, so wait until the waste erupts. Adopting this routine will bring regularity and prevent constipation. 

In all, it takes 40 to 60 days to adjust to this process and l evacuate regularly. The colostomy patient may use a stoma cap instead of an ostomy bag, but do not discard the old bags until the patient ensures that bowels are in full control.

Some colostomy patients strive to insert water into the stoma, while others might already feel comfortable using their ostomy supplies. However, the option exists for certain people. Colostomy irrigation only requires around one hour on alternate days and your bowels start working again. If it is inconvenient, you can return to a regular ostomy bag.

The Impact of Colostomy Irrigation in the Quality of Life

“As an important component of stomatherapy in selected patients with permanent colostomies, colostomy irrigation (CI) may further help prevention or rehabilitation of many stoma problems CI is a mechanical method employed to empty the bowels by instilling liquid into the large intestine through the stoma. Recent popularity has been supported by the design of safe, cone-shaped delivery devices that are easy to handle. The method is also useful for achieving fecal continence in selected conditions, and may improve QOL. CI regulates bowel movements, hence preventing the flatus and feces in between irrigations and enabling controlled fecal excretion, instead of natural evacuation into a stoma bag. Therefore, CI can be used as an alternative to the colostomy bag by patients with permanent colostomies, especially if they are determined to continue with their sporting and other social activities, and religious worship. CI may also prevent the development of many skin problems and it is cheaper than using bags continuously. In Turkey, for example, colostomy bags and associated instruments cost 1000–1500 USD per patient, yearly. This cost is more than halved (300–500 USD) with CI, because when successful, CI offers a regular, predictable elimination pattern and only a stoma covering is needed for security between irrigations. In addition, it has been our observation, as well as others, that CI is a simple procedure that patients can easily learn.”2

Advantages of irrigation

  • “You are in full control of your bowel function.
  • Confidence in personal appearance increases.
  • No need to wear an appliance (bag).
  • Freedom to relax more in social activities.
  • Wind, irregular bowel motion and odor will be reduced.
  • Increased confidence regarding less/no appliance leakage.
  • Do not need to dispose of used appliances – but still need a cap.
  • Less equipment to carry around.
  • An irrigation kit comes in a small bag and is available on prescription

Disadvantages of irrigation

  • Colostomy irrigation is time-consuming and can take up to one hour each day or

on alternate days.

  • It is important to irrigate at about the same time each day (can be morning or

evening).

  • Inadequate toilet facilities (only one bathroom) may make this procedure difficult

for the colostomate and family members.

  • You may find irrigating difficult away from home.
  • You cannot start/stop the procedure. Irrigation must be continuous.”3

Who May Perform Colostomy Irrigation?

Colostomy patients with a dry colostomy, or Sigmoid Colostomy, are apt for irrigation. Since the stoma is in the downward part of the colon, the stool solidifies and enables irrigation. Chances improve if the patient had regular bathroom habits before the colostomy.

“CI (colostomy irrigation) is indicated in patients who have a left-sided end colostomy in the descending or sigmoid colon, are mentally alert, have adequate vision, and have adequate manual dexterity needed to perform the procedure. Contraindications include irritable bowel syndrome, peristomal hernia, post-radiation damage to the bowel, diverticulitis, and Crohn disease. Leong and Yunos found that early introduction of CI after surgery promoted long-term adherence to the technique when compared to patients who were taught to irrigate later in their postoperative course. They also reported that patient satisfaction is higher when CI is introduced during the early postoperative course. Despite these positive outcomes, few studies have examined whether CI is taught by the WOC (Wound, Ostomy and Continence) nurse, the proportion of patients who employ CI after creation of a colostomy, and patient perceptions of its positive and negative aspects.”4

Suitable patients would be those

  • “With a left-sided end colostomy in the descending or sigmoid colon.
  • Who are well motivated and mentally alert.
  • Who have no residual disease or any of the following conditions: irritable colon, diverticulitis (due to risk of perforation), or Crohn’s disease.
  • Who have good dexterity
  • With adequate eyesight.”5

Patients with ostomy on the ascending wall of the colon (transverse colostomy), those who suffer from intestinal irritation, or those with an ileostomy or urostomy are not candidates. Their stool is too liquid and the intestine is continually discharging, so irrigation is not possible. 

Irrigation equipment

“Suitable patients should be given the option and information to irrigate. When teaching new patients to irrigate, reservoir bags and available tubing sets are used. Using a pump certainly seems to be a very effective method of administering the water, but some may find it costly […].The pump must be sterilized. Care must be taken with the pump and the reservoir bag so as not to administer the water too quickly otherwise the patient can experience abdominal cramping. There are various leaflets available through the manufacturers on irrigation, which give a step-by-step guide for nurses and patients.”6

Some examples of irrigation equipment
Some examples of irrigation equipment [7]

 

Precautions

  • “You must check with your physician and receive his/her approval before attempting colostomy irrigation, to determine if you are an appropriate candidate for the procedure.
  • Once you have your physician’s approval, you must receive instruction from a qualified nurse, preferably an ET or ostomy nurse, who will be able to provide you with the best instruction.
  • Never consider irrigations for bowel control if your colostomy is located in a segment of the colon other than the sigmoid or descending colon.
  • Some people who irrigate may find that certain foods can interfere with the best irrigation outcome.
  • Realize that it may take 6-8 weeks for you to achieve a predictable bowel pattern with routine irrigation.
  • And, despite your best efforts and technique, you may still (rarely) find yourself the victim of an intestinal virus, complete with diarrhea. For this reason, you must always “be prepared” to resort to wearing a regular colostomy appliance for a limited time until you’re feeling better.”8

“Psychological, physical and social needs are also taken into account. It is important for you to be willing to learn and master the procedure and technique involved. An appropriate level of manual ability and eyesight is also required. Irrigation is time-consuming and can take up to an hour to complete, thus adequate bathroom facilities are essential.”9 

In case you are still unsure, talk to your ostomy professional or get some guidance from an ostomy nurse to select the most convenient alternative for your needs. 

 

References:

(1) Living with digestive stomas: strategies to cope with the new bodily reality. Nieves, C.B., Celdrán-Mañas, M., Hueso-Montoro, C., Morales-Asencio, J.M.,  Rivas-Marín, C. & Fernández-Gallego, M.C. Revista Latino Americana de Enfermagem. 2014. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692014000300394&lng=en&tlng=en

(2) Colostomy irrigation: results of 25 cases with particular reference to quality of life. Karadag, A., Mentes, B.B & Ayaz, S. Journal of Clinical Nursing. 2005.  https://www.researchgate.net/publication/228339074_Colostomy_irrigation_review_of_a_number_of_technical_aspects

(3, 9) Colostomy Irrigation. St Mark’s Hospital nursing team. St Mark’s Hospital & Burdett Institute. 2011.http://www.wakeman.co.nz/site/chriswakeman/files/Patient%20Information%20Leaflets/Colostomy%20irrigation.pdf

(4) Positive and Negative Aspects of Colostomy Irrigation. Carlsson, E., Gylin, M., Nilsson, L., Svensson, K.,  Alverslid, I. & Persson. E. Journal of Wound, Ostomy and Continence Nursing. 2010. https://nursing.ceconnection.com/ovidfiles/00152192-201009000-00011.pdf 

(5, 6, 7) Colostomy irrigation: are we offering it enough?. Woodhouse, F. British Journal of Nursing. 2005. https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2005.14.Sup4.19737 

(8) Colostomy Irrigation: A personal account of managing a colostomy. Rooney, D. The Phoenix. 2007. https://www.uoaa.org/forum/uoaaxt/files/Phoenix_Irrigation.pdf

 

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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