Colostomy irrigation (for descending and sigmoid colostomies only)

Irrigation puts water into the colon through the stoma to help regulate bowel movements. Whether to irrigate is up to each person, but you should fully discuss it with your doctor or ostomy nurse before a decision is made. Your doctor or ostomy nurse will teach you how to irrigate your colostomy. The procedure may be a little different than what we describe here, depending on the experience of the person teaching you.

Whether you will irrigate your colostomy and how you do it depends on many factors, such as:

  • The amount of active bowel you have left.
  • Your lifelong bowel habits.
  • Your skill and comfort level with irrigation.
  • Your personal feelings about the colostomy.
  • Your talks with your doctor or your ostomy nurse.

If you decide to irrigate, try to find a method, or combination of methods, that most closely matches your body’s normal bowel habit or pattern. At first, you may need to try different things under a doctor or nurse’s guidance. Just remember, it will take time to set up a routine. Having regular daily habits will help. If you find certain foods or irrigation procedures help regulate your bowel movements, keep doing those things at the same time every day. Regular habits will promote regular bowel functions, but occasional changes in routine won’t harm you.

The equipment (Figures 17 to 20) you’ll use includes:

  • A plastic irrigating container with a long tube and a cone or tip. The plastic cone-shaped piece at end of the tubing fits snugly against the stoma to run water into the colostomy.
  • An irrigation sleeve to carry the irrigation output into the toilet.
  • A tail closure clip and a belt for extra irrigation sleeve support. (This is optional.)
illustration showing an irrigation system and sleeve
illustration showing a tail closure and adjustable belt

When to irrigate

  • Choose a time in the day when you know you’ll have the bathroom to yourself.
  • Irrigation may work better if it’s done after a meal or a hot or warm drink. Also, consider irrigating at about the same time of day you usually moved your bowels before you had the colostomy.

How to irrigate

  • Get your irrigation supplies together
  • Clamp the tubing and put 1000 cc (about 1 quart) of lukewarm (not hot) water in the irrigating container. You may need a little less. NEVER connect the tube directly to the faucet.
  • Hang the container at a height that makes the bottom of it level with your shoulder when you are seated.
  • Sit on the toilet or on a chair next to it. Sit up straight.
  • Seal the plastic irrigation sleeve onto your skin barrier and put the bottom end of the sleeve in the toilet bowl.
  • Wet the end of the cone or lubricate it with water-soluble lubricant.
  • Remove air bubbles from the tubing by opening the clamp on the tubing and letting a small amount of water run into the sleeve.
  • Re-clamp the tubing and put the cone into your stoma as far as it will go, but not beyond its widest point.
  • Slowly open the clamp on the tubing and allow the water to gently flow into your bowel. The water must go in slowly. You may shut the clamp or squeeze the tube to slow or stop the water flow. It takes about 5 minutes to drip in 1000 cc (about 1 quart) of water.
  • Hold the cone in place for about 10 seconds after all the water has gone in.
  • The amount of water you need depends on your own body. You may need less, but do not use more than 1000 cc (1 quart). The purpose of irrigating is to remove stool, not to be strict about the amount of water used.
  • You should not have cramps or nausea while the water flows in. These are signs that either the water is running in too fast, you’re using too much water, or the water is too cold. After the water has been put in, a bowel movement-type cramp may happen as the stool comes out.
  • After the water has run in, remove the cone. Output or “returns” will come in spurts over the next 45 minutes or so.
  • As soon as most of the stool has come out, you may clip the bottom of the irrigating sleeve to the top with a tail closure clip. This allows you to move around, bathe, or do anything you wish to pass the time.
  • When done, recheck the wafer seal and put your usual pouch back on. Rinse the bag, cone, and sleeve and hang to dry.

With time and experience, you’ll know when all the water and stool have come out. A squirt of gas may be a sign that the process is done, or the stoma may look quiet or inactive. If the complete irrigation process always takes much more than an hour, talk to your doctor or ostomy nurse.

In its original form this document was written by the United Ostomy Association, Inc. (1962-2005) and reviewed by Jan Clark, RNET, CWOCN and Peg Grover, RNET. It has since been modified and updated by:

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: December 2, 2014 Last Revised: December 2, 2014

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