12 May, 2020
Irrigation – The basics
Stoma Care Nurse Specialist
NUH NHS Trust Nottingham
Since becoming a stoma care nurse, I have developed an interest in using irrigation as an alternative way of managing a colostomy. As the benefits of colostomy irrigation are not widely acknowledged in the ostomate community, I have put together some useful answers to common questions on this topic.
What is colostomy irrigation?
One of the first mentions of irrigation is in 1793, when an ‘artificial anus’ was formed in an infant with a bowel obstruction and water mixed with drops of rhubarb syrup was introduced to cleanse the bowel1. Yet, despite this seemingly long history, colostomy irrigation is still not widely used. Rather than using a pouch to collect the contents of the bowel, irrigation gives the ability to take control. The aim of this procedure is for the bowel to be stimulated to contract (peristaltic action) and then to expel the contents of the last part of the colon. It involves the instillation of 500ml up to 1,500ml of warm tap water into the colon via the stoma to wash out faecal matter. Irrigation is generally carried out daily or every two to three days and results in little or no stool evacuation from the stoma until the next irrigation.
When colostomy irrigation can be taught?
Colostomy irrigation can be taught as little as three months after surgery or years after surgery, however individual circumstances will always be assessed, such as healing of the surgical wound or general postoperative recovery. The colorectal consultant’s approval must be obtained before any teaching is started and the general practitioner (GP) will be notified.
Can anybody irrigate?
An assessment is carried out by the stoma care nurse, who will gather important medical data and underlying conditions to check suitability for irrigation.
Colostomy irrigation is NOT appropriate if you:
- Have a colostomy on the right hand side or a transverse colostomy as the motion is likely to be too fluid.
- Have any active inflammatory bowel disease (ulcerative colitis or Crohn’s disease) as regular stimulation and contraction of the bowel may cause a flare up of the disease or fistulae formation.
- Suffer from irritable bowel syndrome as the procedure may cause abdominal pain and spasms.
- Suffer from diverticular disease or if you are prone to diarrhoea, as the procedure may not be successful.
- Have heart or kidney disease as there as there is a potential for complications caused by fluid absorption and “overload”.
- Have stoma complications such as a symptomatic parastomal hernia, colostomy prolapse or colostomy tightness (called stenosis); these may make irrigation too difficult.
- Have a fistula, radiation damage, existing colorectal cancer or metastatic disease
- Are having chemotherapy or radiotherapy treatment.
- Have poor eyesight or manual dexterity as it can be difficult to manage the equipment.
What are the advantages of colostomy irrigation?
With successful irrigation, it may be possible to gain continence and control over the stoma which can minimize or completely prevent odour and wind production. In addition, it may reduce or prevent problems related to your pouch, such as leaks or allergic reaction. As the output after irrigation is low, a cap or mini–pouch can be used to protect the stoma, making the colostomy less visible through clothing. Also, the equipment will last a considerable time and is more compact than the bulky supplies of appliances. Many ostomates report a better quality of life, with improvements in their working lives and social activities2.
What are the disadvantages of colostomy irrigation
The most commonly reported disadvantage of irrigation is related to the time involved in completing the procedure; generally it takes around 45 minutes to one hour. Some people may find it difficult to free up this amount of uninterrupted time, making it challenging to form a regular routine. Sometimes, irrigation can make you feel sick or faint, but this usually settles quickly and is less likely to happen as your body becomes used to you irrigating. There is also a very slight risk is of perforating the colon if an inappropriate technique is used.
What to expect from the teaching sessions?
Prior to attending the colostomy irrigation clinic your stoma care nurse may offer you various information sources such as booklets, videos, or photographs and can show you the equipment that is used. Sometimes, speaking to someone who already irrigates can be helpful and, where possible, an opportunity for you to do this will be provided.
The number of teaching sessions will be tailored to meet your needs and may vary from a minimum of one to a maximum of five sessions. On the first day, the stoma care nurse will demonstrate how to irrigate. It is often a stop and start process due to loaded bowel. You will be encouraged to have a go at holding the cone in place and regulating the water flow. Remember to drink plenty of fluids prior to coming to the teaching session to avoid a poor result as if you are dehydrated, the bowel will naturally absorb more of the water. On the second day, you may be encouraged to put the cone in place and do the procedure by yourself, with the stoma care nurse guiding and supporting you as necessary. Following the teaching sessions, once you and your stoma care nurse are happy that you can manage, it is advisable to irrigate every day at a similar time for approximately six weeks and to wear your usual pouch, until a routine has been established. After this time, it may be possible to irrigate less often, perhaps every 36–48 hours, but this varies from person–to–person. It is good to remember that initially some days may be better than others, but this should not be a cause for worry – don’t panic and try again the next day.
1O’Bichere A, Sibbons P, Doré C, Green C, Phillips R K, (2000) Experimental study of faecal continence and colostomy irrigation, British Journal of Surgery, 87, 902-908, p. 902.
2Grant M, McMullen C, Altschuler A, Hornbrook M, Herrinton L, Wendel C, Baldwin C, Krouse R (2012) Irrigation practices in long–term survivors of colorectal cancer with colostomies, Clinical Journal of Oncology Nursing 16, 514-519
Remember this is something you can arrange through Colostomy UK. Many of our volunteers are ‘irrigators’ and would be pleased to talk to you about their experiences of irrigating and impart some top tips. They will also tell you that in the early days perseverance is very important!