Irrigating Your Sigmoid or Descending Colostomy

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

When you irrigate your colostomy, you’re putting water through your stoma into your large bowel (colon). This allows you to empty your bowel. Irrigating your colostomy at the same time every day 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.

You may want to irrigate within an hour after having a meal or hot drink. The irrigation will take up to 1 hour. It’s important that you never rush the irrigation.

Before you begin irrigating on your own, make an appointment with a Wound, Ostomy, and Continence (WOC) nurse. Your WOC nurse will give you instructions and will show you how to irrigate during this appointment.

Instructions for Irrigating Your Colostomy

  1. Gather your supplies:
    • Irrigation bag, tubing, and cone tip
    • Irrigation sleeve
    • Water-based lubricant
    • Colostomy pouch or stoma covering
    • Paper towel or washcloth
    • Water
  2. Irrigate your colostomy in a bathroom. Set up your supplies on a countertop or small table near the toilet.
  3. Fill the irrigation bag with warm water (never hot or cold). On the first day, use 250 milliliters (mL) of water. On the second day, use 500 mL. The third day, use 750 mL. From the fourth day onward, use 1,000 mL.
    • Once you’re emptying your bowel on a regular schedule, you can use the smallest amount of water necessary to make you regular. This amount is different for every person, and finding it is a trial-and-error process. Your WOC nurse will help you.
  4. Let some of the water drain through the tubing of the irrigation bag. This will push out any air. Once the air is pushed out, clamp the tubing.
  5. Sit on the toilet or in a chair next to the toilet for the irrigation. Hold the irrigation bag so that the bottom of the bag is at your shoulder level. This means the bag should be about 18 inches above your stoma. A hanging device can be put in the bathroom to hold the irrigation bag.
  6. Unsnap and remove the colostomy bag from your stoma. Snap on the irrigation sleeve. Place the end of the irrigation sleeve in the toilet.
  7. Cover the cone tip with the water-based lubricant.
  8. Insert the lubricated cone tip through the top open end of the irrigation sleeve and gently put it into your stoma. Angle the cone tip so that it follows the natural direction of your colon. Never force it. Never insert it beyond its widest point.
  9. Hold the cone tip 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 on the irrigation bag tubing little by little. This will allow the water to flow slowly into your colostomy. Once the water flows into you colostomy, you may feel bloated.
    • If water back flows around the cone tip or doesn’t flow into your stoma, gently change the angle or position of the cone tip. Keep adjusting until water flows and there is no backflow of water. If this doesn’t help, remove the cone tip from the stoma to allow stool to flow from your colostomy.
    • If you have cramping:
      1. Stop the flow of the water, take some slow deep breaths, and gently rub your abdomen. This will help relax the muscles.
      2. Check the height of the irrigation bag. If the bag is too high, the increased pressure can cause cramping.
      3. Check and reset the clamp. If water flows too rapidly, it can cause cramping.
  11. When the irrigation bag is empty, close the clamp on the tubing, remove the cone tip from your stoma, and set the irrigation bag, tubing, and cone tip aside. Close the top of the irrigation sleeve.
  12. 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’s safe to leave the bathroom. However, you should stay close by in case you have more returns from the irrigation.
  13. After the second return, empty the contents into the toilet. Remove the irrigation sleeve. Then, snap on your colostomy pouch. Flush the toilet and clean your hands.
  14. To clean your equipment, use the paper towel or washcloth to wash it with mild soap and lukewarm water. Hot water will damage the plastic.
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Important Points

  • Try to irrigate at the same time each day.
  • Don’t irrigate if you have diarrhea.
  • Don’t irrigate if you notice a bulge (hernia) around your stoma. If you notice a bulge or hernia, call your doctor.
  • Check with your doctor before irrigating while you are getting chemotherapy or radiation therapy. Irrigation is not recommended during these treatments.
  • The amount of returns will vary from irrigation to irrigation.
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