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Irrigating Your Sigmoid or Descending Colostomy

This information explains how to irrigate your sigmoid or descending colostomy.

Colostomy irrigation puts water into your large bowel (colon). The purpose is to empty your bowel at the same time each day. This will help train your bowel to function on a regular schedule. This may allow you to stay free of drainage for 24 to 48 hours.

Supplies

  • Irrigation bag, tubing, and cone tip
  • Irrigation sleeve
  • Water-based lubricant
  • Colostomy pouch or stoma covering
  • Paper towel or washcloth
  • Water

Instructions

The irrigation will take up to 1 hour. To train your bowel, do it at the same time each day.

  1. Fill the irrigation bag with warm water (never hot or cold). On the first day, use 250 mL (cc) of water. On the second day, use 500 mL (cc). The third day, use 750 mL (cc) and then increase to 1000 mL (cc). Later, you can use the smallest amount to make you regular.
  2. Let the water run through the tubing of the irrigation bag. This will push out any air. Once the air is pushed out, clamp the tubing.
  3. The irrigation bag should be about 18 inches above your stoma. Place the bottom of the bag at shoulder level while sitting. The best position for irrigation is sitting on the toilet. A hanging device can be put in the bathroom to hold the irrigation bag.
  4. Unsnap and remove the colostomy bag. Snap on the irrigation sleeve.
  5. Place the end of the irrigation sleeve in the toilet.
  6. Cover the cone tip with the water-based lubricant.
  7. Insert the cone through the top open end of the irrigation sleeve.
  8. Gently put the lubricated cone into your stoma. Angle the cone so that it follows the natural direction of your colon. Never force it.
  9. Hold the cone in place for 1 to 2 minutes before starting the irrigation. Take a slow, deep breath. This will relax your abdominal muscles.
  10. Release the clamp little by little. This will allow the water to flow slowly into your colostomy.
  11. Once the water flows into you colostomy, you may feel bloated.
  12. When the irrigation bag is empty, close the clamp, remove the cone, and close the top of the irrigation sleeve.
  13. Returns (water and stool) from the irrigation will start within 5 to 10 minutes. After 15 minutes, you may close the bottom of the irrigation sleeve. Use the clamp provided. You may wish to use the next 30 to 45 minutes to shave or wash. At this point, it is safe to leave the bathroom. However, you should stay close by in case you have more returns from the irrigation.
  14. After the second return, empty the contents into the toilet. Remove the irrigation sleeve. Then, snap on your colostomy pouch.
  15. To clean your equipment, use mild soap and lukewarm water. Hot water will damage the plastic.

Important Points

  • Try to irrigate at the same time each day.
  • Never rush the procedure.
  • Irrigation may be more helpful if it follows a meal or hot drink.
  • If water back flows around the cone or does not flow into your stoma, gently change the angle or position of the cone. Keep adjusting until water flows and there is no backflow of water. If this doesn't help, remove the cone from the stoma to allow stool to flow from your colostomy.
  • If you have cramping:
    • Stop the flow of the water, take some slow deep breaths and gently rub your abdomen. This will help relax the muscles.
    • Check the height of the irrigation bag. If the bag is too high, the increased pressure can cause cramping.
    • Check and reset the clamp. If water flows too rapidly, it can cause cramping.
  • Do not irrigate if you have diarrhea.
  • Do not irrigate if you notice a bulge (hernia) around your stoma.
  • Check with your doctor or nurse about irrigating during chemotherapy or radiation therapy. It is not recommended during these treatments.
  • The amount of returns will vary from irrigation to irrigation.