The Ostomy Files: A Look at the Purpose and Outcomes of Colostomy Irrigation

  For nearly 75 years, colostomy irrigation has been an accepted management option that allows a colostomy patient to control bowel evacuation. Colostomy irrigation evolved as an answer to the nearly universally chronic peristomal skin problems caused by a lack of commercially available pouching systems, protective skin barriers, and skin care products.¹

It was theorized that if the bowel could be evacuated once a day, no stool would seep onto the skin and, therefore, peristomal skin irritation would be minimized. Since that time, however, the procedure has gone in and out of acceptance by both patients and professionals - mostly due to fear of bowel perforation from irrigation catheters. This fear has been reversed by the introduction of soft catheter irrigation cones now available on most colostomy irrigation sets. For many years, nearly all colostomy patients were instructed on colostomy irrigation, but the outcomes were often less than satisfactory for the patient. Today, more realistic criteria have been developed to screen for those patients who have a better chance of success with it.

  Even though colostomy irrigation is not required to maintain bowel function, the procedure is a management option that may allow a patient to be free from fecal discharge for approximately 24 hours. The most important factors to evaluate in determining who is a candidate for colostomy irrigation are the patient's clinical situation and lifestyle. For example, a patient with a sigmoid colostomy who has good manual dexterity and visual acuity, had regular bowel habits prior to surgery, is not undergoing chemotherapy, and is not taking medications that cause diarrhea may appear to be a perfect candidate. However, an assessment of the patient's lifestyle reveals that he works "swing-shift" hours and has an irregular work schedule. It would be nearly impossible for this patient to attempt colostomy irrigation at a regular time each day. Similarly, a physician writes orders for the home care nurse to teach a new patient how to irrigate. The initial home visit reveals that the patient lives in a setting without adequate bathroom facilities and running water. A patient's inability to obtain control over bowel function in the manner prescribed by healthcare professionals can lead to feelings of frustration and failure, which decreases the overall quality of the patient's life.

  A small prospective, crossover study in Singapore² compared natural evacuation (ie, allowing the bowel to function on its own) to colostomy irrigation and found that colostomy irrigation after abdominoperineal resection was superior to natural evacuation in terms of cost and patient satisfaction. When patients irrigated, fewer peristomal skin problems, sleep disturbances, and sexual problems occurred. An overall decrease in management costs also was demonstrated due to a decrease in pouch usage. The study's researchers recommended that colostomy irrigation be introduced to qualified patients soon after surgery.

  In an outcomes-oriented environment, clinicians should evaluate each patient on a case-by-case basis to determine if the patient can benefit from colostomy irrigation. Below are some criteria to consider during this assessment.³ Candidates should have:
    •a descending or sigmoid colostomy
    •a history of regular bowel habits prior to surgery
    •the desire to learn and perform the procedure
    •the ability (manual dexterity and visual acuity) to perform the procedure
    •a lifestyle that is compatible to irrigation (work schedule, bathroom facilities, adequate time, other family or personal issues).

  Patients with stomal prolapse or peristomal hernia should not be taught colostomy irrigation because performing the procedure could potentially exacerbate the prolapse or cause bowel perforation, leakage between irrigations, or poor control over elimination. Chemotherapy, pelvic or abdominal radiation treatments, a poor prognosis, and diarrhea-producing medication are also contraindications to colostomy irrigation. Age, on the other hand, should not be considered a contraindication, as colostomy irrigation has been shown to be effective regardless of the person's age.^2,4 Therefore, each individual should be carefully evaluated as a candidate.

  Once taught, the patient always has the choice to discontinue the procedure should it become incompatible with his or her lifestyle. However, the opportunity to learn the procedure exists for candidate patients throughout the duration of their treatment within the healthcare system (ie, home health care, outpatient clinic, doctor's office, WOC nurse clinic).

  Colostomy irrigation is not the solution for all colostomy patients, but the decision to irrigate or not irrigate is ultimately the patient's - not the healthcare professional's.

  The Ostomy Files is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ.

1. Turnbull RW, Turnbull GB. The history and current status of paramedical support for the ostomy patient. Seminars in Colon and Rectal Surgery. 1991;2(2):131-140.

2. Peng Kheong Leong AF, Yunos ABM. Stoma management in a tropical country: colostomy irrigation versus natural evacuation. Ostomy/Wound Management. 1999;45(11):52-56. 

3. Erwin-Toth P, Doughty DB. Principles and procedures of stomal management. In: Hampton BG, Bryant RA, eds. Ostomies and Continent Diversions: Nursing Management. St. Louis, Mo.: Mosby Year Book, 1992:29-103. 

4. Venturini M, Bertelli G, Forno G, et al. Colostomy irrigation in the elderly. Effective recovery regardless of age. Dis Colon Rectum. 1990;33:1031-1033.