Irrigations - To Do or Not To Do
Issue Eight

 

"The thing you need to know is that you don't have to irrigate your colostomy in order for it to work."

The following contribution is from guest author Susan Wolf, R.N., E.T., graduate of USC Cosler E.T. Educational Program, Los Angeles, California. Presently practicing at a leading healthcare center in Berkeley, California, Susan Wolf has been a registered nurse since 1977 working primarily on surgical assignment.

I'd like to discuss with you the number of people I have talked to lately who have been having a problem with irrigating. Their problem is that they just don't like to irrigate. They find the whole procedure disagreeable, time consuming and often unsuccessful. Despite irrigation they experience passage of stools one or more times a day.

Irrigating does not work for everyone. For one thing, your colostomy has to be in the descending or sigmoid colon. If your colostomy is in the ascending or transverse colon, the stool will be watery and you won't be able to regulate it.

People who had a very unpredictable bowel schedule before surgery may continue to do so after surgery despite efforts to achieve regulation with irrigations.

Some people have work schedules or lifestyles that do not permit them to irrigate at a consistent time each day. This too can cause irrigations to be unsuccessful.

The thing you need to know is that you don't have to irrigate your colostomy in order for it to work. Your bowel will work anyway, irrigation or not. The purpose of irrigating is to achieve regulation of the bowel so that no stool is passed between irrigations. The reason for regulating the bowel is for the ostomate's comfort and convenience. If irrigating is not accomplishing regulation (and if it is making you more uncomfortable) you should not be doing it.

Why were you told and taught to irrigate in the hospital? Some doctors use irrigations to stimulate the bowel after surgery. Some simply assume it is preferable for the ostomate. If your doctor told you to irrigate but you no longer want to, check to see if there is a medical reason for doing so. If there is not, the choice to irrigate or not to irrigate is up to you.

If you prefer to irrigate and are not having success, before you give up, seek professional advice from an E.T. You may have to modify your technique and here's where experienced E.T. knowledge can help you.

For your own knowledge, here are some general pointers to keep in mind for successful irrigation. It may help to review them right now.

  • Have the irrigating container about 18 inches above shoulder height.
  • Use no more than 1000 cc of tepid water.
  • Insert the lubricated cone into the stoma gently. You don't have to push all of the cone in - just enough to create a snug fit so that no water leaks out around the cone.
  • If you use a catheter tip to irrigate, never insert more than 3 or 4 inches as there is danger of perforating the bowel. Press the plastic disc that comes with the catheter tubing against the stoma to prevent leakage. In fact, unless your stoma is so tight or so small that only a catheter will fit, you might consider switching to a cone since cones pose less risk to the bowel.
  • Instill the water slowly over a period of 5 to 10 minutes. Choose a rate that is comfortable to you and causes no cramping. If cramping does occur, stop the flow, take a few deep breaths, wait for the cramping to stop, and resume the flow at a slower rate.
  • When you have instilled all the water, remove the cone from the stoma, close the top of the sleeve and wait for the returns. After about 20 minutes you can wipe off the end of the sleeve, fold it up or clamp it, and do whatever else you want to do for the next 40 minutes or so until the returns are complete.
  • Remove the sleeve, cleanse the skin and apply a pouch, cap or gauze pad (whichever you use as a stoma cover).

But let me repeat again. If you are not having success with your irrigations seek professional help from an E.T.