Colostomy irrigation

Overview

A colostomy is a surgical intervention that involves linking a portion of the large intestine (colon) to a surgically created opening in the abdominal wall called a stoma. The large intestine plays a crucial role in the digestive system by facilitating the elimination of waste (feces) from the body.

During a colostomy, feces exit the body through the stoma rather than through the rectum. A bag, attached to the skin surrounding the stoma, collects the feces. This bag requires regular emptying throughout the day.

While some individuals undergo colostomies temporarily to allow for healing of the colon or rectum, others may require them permanently. In the former case, once healing is complete, a surgeon reconnects the ends of the intestine and closes the stoma. However, in permanent colostomies, the stoma remains in place indefinitely.

It’s important to distinguish a colostomy from an ileostomy, which serves a similar purpose but involves connecting the small intestine (ileum) to a surgical opening in the abdominal wall.

Reasons for undergoing the procedure

A colostomy may be necessary for those with specific digestive tract conditions that impact the colon and rectum, the large intestine. Although there are many conditions that require this, the following are the more prevalent ones:

• Anal cancer or colorectal cancer
• Cervical cancer or vaginal cancer
• Large bowel (intestinal) obstruction
• Inflammatory Bowel Disease (IBD), including Crohn’s disease.
• Diverticulitis
• Intestinal injury or trauma
• Bowel incontinence
• Hirschsprung disease

Irrigation is most effective when stool consistency is firmer. Therefore, it’s typically recommended for individuals with specific types of colostomies.

• Descending: The stoma is connected to the descending colon, which descends the left side of the abdomen. In this section of the colon, solid stool begins to develop.
• Sigmoid: The sigmoid colon, the final segment of the gut, is connected to the stoma via a sigmoid colostomy. Solid waste moves from the sigmoid colon to the rectum.

Risks

Skin irritation around the stoma site may develop, prompting the need to contact your doctor if signs of infection, such as burning, itching, or watery discharge, arise. Occasional traces of blood at the stoma are typically normal.

Those with a colostomy may encounter challenges such as heightened susceptibility to constipation or diarrhea. Maintaining adequate fiber intake and hydration can help mitigate these issues. Some individuals may also experience minor stool leakage between irrigations.

Adjusting to life with a colostomy can impact self-perception and body image, particularly concerning issues like managing gas and odors. If feelings of anxiety or depression arise, it’s advisable to discuss them with your doctor.

Before the procedure

Before receiving the colostomy, you might want to consider irrigating around the time of day you usually had a bowel movement. You will learn how to administer colostomy irrigation from your doctor. 

During the procedure

During irrigation, nausea or abdominal pain may arise. This could indicate that the water is too cold or that the water flow is too quickly. In between irrigations, the stoma is covered by a cap. 

Arranging all of your supplies and gathering them together is the initial step in irrigating a colostomy. These could consist of:

• warm tap water 
• a new pouching system 
• water-soluble lubricant 
• cone irrigator 
• irrigation bag 
• irrigation sleeve 

As soon as your materials are prepared, you can start process. Here is a method that ostomy nurses employ:

• Join the irrigation bag and irrigation cone.
• Pour 500–750 milliliters of warm (not hot) tap water into the irrigation bag. It’s not required to use sterile water or certain cleaning solutions.
• Use the solution to prime the irrigation tubing so that liquid, not air, fills it.
• Put on the sleeve for irrigation.
• To assist the fluid’s passage into the colon, raise the irrigation bag to a height of approximately shoulder level.
• Apply the water-based lubricant to the cone irrigator.
• Slide the cone irrigator gently into your stoma.
• To start the irrigation fluid flowing with gravity, open the clamp on the irrigation tube. Steer clear of putting fluid into your stoma and don’t force it in. In the event that you encounter issues with flow, consider moving the irrigation cone. 
• Permit the entire fluid of the bag to pass through the stoma. If you feel a cramp coming on, you can stop the irrigation fluid flow and start it again after the cramping stops. 
• Keep the irrigation cone in position and wait an extra five minutes after injecting all the fluid. As your colon or intestines get stretched and enlarged, you could experience cramping. What will cause intestinal motility, or “peristalsis,” to be stimulated is this stretching.
• Take off the irrigation cone and watch for the movement of feces and liquid. This could take thirty to ninety minutes.
• Replace the pouching system or cover your stoma once stooling is finished.

After the procedure

• It may take an hour to complete the process. With time and experience, it becomes easier. 
• Irrigation could be simpler following a meal or hot beverage. 
• Irrigation should ideally be done at the same time every day. 
• Your bowels will usually adjust and your bowel motions will become regular after six to eight weeks. 

Outcome

If you value not using a bag, colostomy irrigation is a useful method for removing waste from the body.