To inform clinicians of evidence based best clinical practice in colostomy irrigation.

• To stimulate peristalsis, which promotes the evacuation of faeces from the colon.

• To clean the proximal and distal loops of a temporary loop colostomy prior to surgical closure.

Colostomy Irrigation: A method of cleaning the distal colon and rectum of faeces and mucus, by instilling water into the colon via the stoma at regular intervals.

Bowel Regulation: A method of routinely performing colostomy irrigation to empty the colon at a scheduled time once every day or every second day, in order to establish a regular bowel pattern. In doing so the colon should not pass faecal matter between each irrigation. 

Reasons why regulating bowel movement through colostomy irrigation may be required:

• Bowel Regulation: This is usually a lifestyle option, as the stoma is predominantly inactive between each colostomy irrigation.

• Bowel Preparation: Clearing the colon of faecal matter prior to diagnostic studies or in preoperative preparation, such as closure of the stoma.

• Bowel Stimulation: To stimulate peristalsis, thus promoting the evacuation of faecal matter in order to establish regular bowel control.

Colostomy irrigation is suitable for sigmoid/descending colostomies only, irrigation is not suitable for a person with an ileostomy.

Colostomy irrigation is also contraindicated for people with a history of:

• Diverticular disease, irritable bowel disease, irradiated bowel.

• Crohn's disease, ulcerative colitis.

• Heart disease.

• Visual or cerebral impairment.

• Stoma complications including stomal prolapse, stenosis and parastomal herniation.

 A surgeon or doctors permission must be obtained prior to commencement of the procedure and a written authority to the patient's ostomy association, for colostomy irrigation equipment, must be obtained.

A stomal therapy nurse must provide education and procedural demonstration sessions, prior to the patient performing self care in colostomy irrigation.

In times of illness routine colostomy irrigation can be suspended, resulting in a return of natural colostomy function. Once well, colostomy irrigation can be reinstated.

NOTES / PRECAUTIONS:

• Use only the required amount of water tailored to the patients needs. Tap water is appropriate, so long as it is suitable for drinking (potable).

• Try for a consistent regimen and irrigate at scheduled times.

• Flow rate of water: allow approximately 10 minutes per litre irrigated.

  • Too slow = will be ineffective.

  • Too fast = may cause cramping/vasovagal syncope.

NOTE: Universal Precautions must be adhered to when attending to this procedure, including the use of personal protective equipment. Irrigation equipment is to be single patient use only.

• Irrigation bag, complete with tubing and regulator valve to control the flow.

• Stoma cone.

• Drainage sleeve, open top and bottom.

• Belt to hold the sleeve in position, if required.

• Clip to fasten bottom of sleeve allowing freedom of movement during procedure.

• Lubricant.

• Colostomy appliance or stoma cap.

• Lukewarm/tepid tap water.

1. Explain the procedure to the patient, ensuring privacy. This will help to gain the patients cooperation and allay anxiety.

2. Ensure hand hygiene is attended to, prior to commencing the procedure - refer to CPP0266 hand hygiene.

3. Don gown, gloves and protective eye wear - refer to CPP0394 transmission based precautions.

4. Assemble equipment and place within easy reach.

5. If using irrigation equipment, connect the water container to the tubing, flow control/regulation clamp and cone and fill the bag with lukewarm/tepid water. NEVER use hot or cold water.

6. Hang the bag on a hook at patient shoulder height.

7. Open the regulator to run the water through the tube to expel air.

8. Sit the patient on the toilet or on a comfortable chair facing the toilet or bucket and remove the patient's usual ostomy appliance.

9. Place the drainage sleeve over the stoma, holding it in place with a belt if required. The end of the sleeve is placed in the toilet or bucket.

10. Lubricate a gloved finger and insert into the stoma to determine the direction of the colon, this ensures that the cone is positioned within the stoma at the correct angle.

    • The stomal therapy nurse will do this the first time providing the patient with instructions.

    • This procedure does not need to be repeated each time if irrigation is to be a usual routine for the patient.

11. Through the top opening of the sleeve, the lubricated cone is gently inserted far enough into the stoma at the correct angle, to allow water to flow in and to prevent back flow.

    • Apply gentle pressure only, to hold the cone in position.

12. Open the regulator to allow the water to run SLOWLY into the colon. The stomal therapy nurse will be able to advise as to the volume required.

    • A guide to volume is 800-1200 ml, optimum volume is 700-1600 ml.

    • If cramping should occur, turn the regulator off and hold the cone in place and instruct the patient to take several deep breaths to relax.

    • Tension, posture and cold water may cause cramping.

13. After the required amount of water has entered the colon, turn off the regulator holding the cone in place for a few moments.

14. Remove the cone and close the top of the sleeve to prevent splashing. Be aware that some water and faecal matter may be released when the cone is removed.

15. The initial return takes 15-20 minutes in which time the sleeve should remain in the toilet/bucket. After this time, the bottom of the sleeve can be fastened with a clip, this allows the patient freedom to move around if desired.

16. Once all the water and faeces have been returned (usually 30-45 minutes), the sleeve can be removed.

17. Clean the stoma and apply a new ostomy appliance/cap.

18. Discard used equipment appropriately and attend to hand hygiene - refer to CPP0266 hand hygiene.

19. Document actions, total amount of water administered and the outcome in the patient notes. If appropriate, record input/output on the fluid balance chart.

20. The irrigation equipment is for single patient use only and is reusable. The equipment used for the irrigation must be cleaned after each use. Simply wash and dry it, soaking is not required.