Colostomy Irrigation Is it Right for You ?

Christine Kijek, RN, BSN, WON Article published Aug 09, 2021 Article updated Sep 05, 2023

Colostomy irrigation has been around for many years, although not used as much in recent times. Irrigation is not right for everyone, nor is it appropriate for all colostomies. The supplies needed for irrigation are minimal and can be reused for a period of time. Technique for irrigation can differ, depending on the nurse providing instruction. Should colostomy irrigation be something you choose, you will develop a technique that works best for you.

How do colostomy irrigation works?

Irrigation works very much like an enema. Water is instilled into the large intestine via the stoma. This flushes out waste (stool) from the colon. Typically, irrigation is done daily or every other day. It is based on how your body responds to it.

Why choose Colostomy Irrigation?

It allows you to control colostomy output and keep your bowel movements regular. Many will avoid wearing a pouching system and can use a small stoma cap or mini closed-end pouch without having the need to empty or drain it daily. It offers freedom to the ostomate.

Colostomy Irrigation Complications

Irrigation is not appropriate for all colostomies. You must have a sigmoid or descending colon colostomy. The functioning colon must be enough to produce a formed bowel movement. Irrigation is not an option for those with ileostomies, urostomies or colostomies created on the right side (ascending) or the transverse colon. Prior to ostomy surgery, if your bowel movements were formed and regular, chances are irrigation will work well.

Irrigation is not recommended if a parastomal hernia is present. It can cause pain and bowel obstruction. It may be difficult for the water to be infused.
For those with colostomies secondary to inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis (UC), irrigation is not recommended. Bowel habits in this population are often irregular and less formed. Irrigating would not be beneficial. If active inflammation is present, irrigation can be harmful. It is also contraindicated for those with irritable bowel syndrome (IBS). Again, bowel habits are too irregular for irrigation to be a benefit.
Colostomates with heart or kidney disease should not use irrigation as a means of management. Water instilled into the colon via the stoma can be absorbed into the system. Extra fluid can be detrimental, causing fluid overload in this group. This can add strain on the heart
If choosing irrigation, you should have good eye/hand coordination, have time to commit to frequent irrigation sessions and be able to learn and follow the steps of irrigation. Motivation to control this aspect of life is important.
It is not recommended to irrigate if you are undergoing treatment for cancer, either chemotherapy or radiation therapy. Always check with your doctor before starting irrigation.

What colostomy irrigation supplies do you need?

Supplies needed for irrigation include:

Irrigation kit (bag with attached tubing, cone tip)
Irrigation sleeve
Ostomy belt
Clip or clamp
Water-based lubricant
Wall hook or coat hanger

Hollister Adapt Stoma Lubricant

Marlen Colostomy Irrigating Bag Unit

How do you irrigate a colostomy?

Irrigation should be done at the same time each day. Assemble your supplies and connect the cone tip. Be sure the tubing is clamped prior to the start. Fill the irrigation bag with warm water and hang it higher than your shoulder level. Flush air out of the tubing by opening the clamp, allowing water to flow to the cone tip. Attach the irrigation sleeve to your body with the belt and clamp the end securely.

Beginners should sit on the toilet or on a chair close to the toilet and allow the clamped irrigation pouch to lie on the floor. Wear little clothing until you are comfortable with the equipment and procedure (In the beginning, you may have “slip-ups” and soil your clothing).

Marlen Colostomy Reusable Irrigation Bag Assembly

Hollister Adjustable Ostomy Belt

Using a water-soluble lubricant, lubricate the end of the cone tip and place it half way into the stoma. Be sure it is inserted firmly. The goal is to have the water flow into the stoma without leaking out. If leaking occurs, adjust the cone tip. Using the clamp on the tubing, allow water to flow through the stoma. Try to relax your abdominal muscles. If you develop cramping, stop the flow, take a few deep breaths and try to relax. Slow the flow of water in.It is normal to feel bloated as water enters the soma. If water is not flowing freely, adjust the angle of the cone tip until water flows. If this does not help, you may have stool trying to empty. Clamp the tubing, remove the cone and allow the stoma to drain. Once cleared, replace the cone tip and resume irrigation.

Beginners should use only 250 ml of water on the first day. Increase to 500 ml day 2 then 750 ml day 3. If you have a large bowel movement (BM) when irrigating with 750 ml and do not have a BM between irrigations, this is the amount you should use daily. If having a BM between irrigations, increase to 1000 ml each day.

Once completing fluid in, the stoma may immediately expel water and stool. Empty the sleeve and clamp it again. You may leave the bathroom to attend to other things. Expect additional output for the next 30-45 minutes. The amount expelled may be less than instilled. The colon may absorb some of this fluid. Never rush irrigation and return of waste. Once emptying is complete, place a new pouching system or stoma cap and go about your day.

Author Profile: Christine Kijek, Registered Colorectal Nurse

Christine Kijek

Christine Kijek is a colorectal nurse at Danbury Hospital in Danbury, CT. She has a wealth of knowledge in this field as well as personal experience. HPFY is thrilled that she has been an active participant in the Ostomy Support Group. She has experience working as a coordinator for cancer patients, post-operative care, and home health care for disabled children and adults. And guess what! Christine is also the recipient of the Nurse Exemplar Award. Christine lives in Bethel, CT with her husband Ed. Her children are married and live nearby. She has 4 grandchildren and is known as GiGi. Christine enjoys riding motorcycles and spends many hours gardening. She can often be found onboard a Carnival Cruise ship lounging by the pool.

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Christine Kijek, RN, BSN, WON

Christine Kijek is a registered nurse with a Bachelor of Science degree in Nursing. She has completed courses for wound and ostomy specialty and has 20 years of experience. She has ...