Learning about irrigation played a big part in my decision to opt for a permanent ostomy instead of an attempt at reversal. I knew that irrigation would offer me the ability to have control over when I had output. So what is colostomy irrigation? Colostomy irrigation is a way to remove stool. For some people, this can allow them to not need to wear a bag at all times.
The procedure is performed every 24-28 hours and uses warm water to cleanse the bowel by infusing it through the stoma. This is similar to the use of an enema to cleanse the bowel in preparation for a procedure, only with different equipment. The warm water entering the bowel stimulates output, which drains into a sleeve that is either clipped or drains into the toilet during the irrigation process.
Colostomy irrigation can only be performed if you have a descending or sigmoid colostomy because the stool is firmer. People with ileostomies and urostomies are not able to irrigate. There are contraindications to colostomy irrigation including being on chemotherapy, undergoing radiation treatment, and the use of some medications. Your ability to irrigate may be affected by the presence of a hernia, strictures, or adhesions in the bowel. Before you try irrigating your colostomy it is important to get the approval of your surgeon. I taught myself to irrigate, but ideally, you would learn the procedure from a certified Wound, Ostomy, and Continence Nurse (WOCN). A step-by-step guide to irrigation can be found here.
What will I need to irrigate?
Irrigation kits are sold by all of the major ostomy supply brands and a few lesser-known companies. These kits are not necessarily compatible with every ostomy appliance offered by your manufacturer so it is important to speak with your ostomy nurse or a company representative in order to ensure you are able to irrigate with the kit they provide. For example, I wear the Coloplast Sensura Mio appliance on my ostomy and, unfortunately, the sleeve in the irrigation kit offered by Coloplast is not compatible with my wafer. However, I am able to use adhesive sleeves and simply stick them to my wafer. It is likely that you will have to do some research and problem-solving before you can find your ideal irrigation routine.
Let’s dive into the supplies; what exactly do you need to perform colostomy irrigation? The basic supplies you’ll need are:
- A water bag that holds at least 1 liter (but preferably 2L)
- Stoma cone
- Irrigation sleeve
Once you have gathered all the supplies, you will first fill the water bag with warm water and connect the stoma cone to the attached tubing of the water bag. Second, allow the warm water to flow through the tubing. This is called priming the line. Priming the line removes air from the tubing and prevents air from being pushed into the bowel. Third, remove your ostomy appliance and put on an irrigation sleeve. The irrigation sleeves have a number of ways of being worn. While these are the most basic items needed to irrigate, there are a few features that make certain kits more desirable than others.
How do I choose the right irrigation system for me?
I have had the opportunity to try the irrigation systems offered by Coloplast and Hollister. There are a few features of the Coloplast kit that make me prefer it over others. The Coloplast water bag has a temperature gauge at the bottom which is not a feature on the Hollister or Convatec bags. I do not use this temperature gauge to determine the temperature of the water I put in, but it helps me be aware of the temperature of the water as I’m irrigating. This is beneficial because water that is too cold can cause uncomfortable bowel cramping. If irrigation is taking longer than expected (the irrigation process can be lengthy, especially in the beginning) and the temperature of my water has dropped, I can simply add a little more warm water to the bag to ensure that I do not get cramping.
One other unique feature of the Coloplast bag is the presence of the paddlewheel. The wheel allows you to see the speed at which you’re infusing the water. If the paddle wheel is no longer spinning, this might indicate that water is no longer entering the stoma. I found this feature to be extremely helpful, especially in the early days of irrigating and helped me avoid the discomfort and cramping you may experience when water is instilled into the bowel too quickly. Other water bags have only a clamp to regulate the flow of water which does not allow for the same amount of control over the installation process.
I also found that the Coloplast stoma cone was softer and the shape was more natural to insert into the stoma. I would encourage you to try different irrigation systems if you have the opportunity but in my opinion, the Coloplast kit has the most desirable features. However, one downside is that Coloplast does not make an irrigation sleeve that is compatible with the Sensura Mio line.
So what about the irrigation sleeve? There are a number of different options as I described above. I use an adhesive, disposable sleeve that I stick directly on my wafer. Many of the ostomy appliances available have an irrigation sleeve that is compatible with your wafer. In this case, you can simply click the sleeve to the barrier and perform irrigation that way. The third option is to use a sleeve that clips onto a baseplate. In this scenario, you have removed your ostomy appliance and the baseplate is cinched tight against the skin to prevent leakage of output during irrigation. I have attempted this method a few times and was never able to get the belt quite tight enough so that there wouldn’t be some leakage of output at the bottom of the baseplate. This option also would not allow you to move around while you wait for the irrigation process to complete.
Whether you choose a disposable or reusable sleeve is a personal choice. I was unable to find a reusable sleeve that was compatible with my wafer so I use the disposable, adhesive sleeves offered by Coloplast. Many ostomates choose a reusable sleeve and cleanse it between uses. This is a more economical and environmentally friendly option but ultimately it comes down to what sleeves are compatible with your device and your personal comfort level with cleansing the sleeve and reusing it.
Tips and tools to improve your irrigation experience
There are a number of non-ostomy-related products that I rely on to make my irrigation experience as easy as possible. Although the instructions for irrigation are standardized, you will find that you develop your own tips and tricks to make the process work for you.
Do I still have to wear a bag if I irrigate?
You may be also wondering about what kinds of appliances are available for colostomates who irrigate. Since irrigation reduces or eliminates output, you could consider switching from a wafer and bag to a stoma cap or plug once you have an established routine and your output is more predictable. This progression should also be discussed with your healthcare provider. Even with consistent irrigation that produces predictable bowel movements, accidents and illness can happen so it is important to have supplies available both at home and out in public.
Hopefully, this article has given you an idea of the irrigation products available and some important features to look for when choosing an irrigation system. As always, I encourage you to try different systems to figure out what is right for you. Irrigation is a simple process at first glance, but you will discover that there are aspects of the procedure that will be unique to you. Once you are familiar with the process, irrigation can offer a way to feel in control of your body and allow for less worry about leaks or accidents. I encourage any colostomate with a descending or sigmoid colostomy to look into irrigation to decide whether it is right for them.