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Irrigation - A Possibility? A Viable alternative and a personal story.
Written by Robert Picken.

For all colostomists of whatever age the shock of the two worlds before and after your operation can be very daunting. The days before, when the natural muscle control that had been learnt as a child, meant you hardly had to think about the process of evacuating waste products from your body, you dealt with it automatically, it just happened! This contrasts vividly with the complete lack of control following the operation. Suddenly the bag that has been attached over your newly acquired stoma fills with excreta and you are aware of that aroma (despite the filter in the bag) which you just hope and pray others will not be aware of. For whom is it most unpleasant? Those of your nearest and dearest who know and care for you or those who don’t know and wonder why you are embarrassed and edging away from them.

This what partly prompted me to investigate how I could once more gain some sort of bowel control. My surgeon and stoma nurse both challenged me to tackle the problem and see if I could get to grips with it. Like so much in life you must want to achieve it very much and that is what spurs you on. Irrigation is an alternative way of dealing with the problem a distinct possibility.

I can assure you I am delighted to have achieved my goal It educated my bowel to a possibility! Through irrigation I have gradually given me the daily freedom of just wearing a small cap or plug. I have the most unique sense of triumph imaginable. It is a revitalising and invigorating experience. Over the years I have been privileged to know young colostomists as well as older people who have achieved this freedom.

Let me explain what is involved. Irrigation consists of giving your bowel a washout or enema through your stoma. For some it may be required daily1 for others, alternate days. For most the whole procedure takes about three quarters of an hour. For others it may take a little more than an hour, but it is still worthwhile if you have the time and patience. However it is not for all colostomists. Firstly, you must have permission from both your surgeon and stoma nurse before attempting it. (What will prevent you trying is if you have a hernia on your stoma).

If you are determined to have a ‘go’, your stoma nurse will supply you with the equipment required :- 1 A water bag, complete with hose and cone. 2. Plastic sleeves. 3.Sheets of ‘wipes’. 4.Disposable bags, caps and plugs.

Additional extras from around the house 1 A means of hanging up the water bag - a fixed hook, metal meat hook, string, firm shower rail window catch etc. approx. just above head height and within easy reach. 2 A plastic indoor child’s watering can. 3.A wooden ‘spring’ clothes peg. 4.Absorbant toilet paper. 5.Matches/air freshener The plastic see-through water bag is rather like a hot water bottle in shape without the stopper and a handle to hang it up by it will hold the four pints of water at blood heat. Some suppliers make these water bags with a built in thermometer which helps to get the water temperature just right at 37 C (98.F.). Attached to the base of the bag is a hose approx.120 cms. Long. with a plastic cone at the end and a control switch. The open ended plastic sleeve ( 1 metre in length} has an adhesive ring near the top which sticks over the stoma.

Ready - steady - go.... Preparation 1. Ensure the bathroom temperature is comfortable and that you have all the equipment you need to hand.

2. Most people irrigate sitting on the loo, but I find it easiest to lie on a towel in the (empty) bath with a cushion at my head!

3. Having chosen your position, fix the empty water bag securely above head height using a strong hook/rail/window catch etc. A length of string can be useful for fine adjustments. (The ‘head’ of water is necessary to penetrate your inner reaches). Hang the bag on the hook.

4. Using the water can, fill the suspended bag ¾ full with water from the hot tap, then add enough water from the cold tap until blood temperature is reached 37oC. (98.4oF). If using a bag with a built in thermometer, you can easily see the green indicator moving down the scale. Approx. 4 pints is needed. Action

5. Now for irrigating Strip off the old bag, cap or plug. Stick the sleeve over your stoma, settle into a comfortable position with the end of the sleeve hanging between your legs and down into the bo (or in the direction of the bath plug hole).

6. Place the cone into the stoma through the top of the sleeve and stop/start the control to allow water into the bowel, making sure the water goes into the bowel and not straight down the sleeve. It is in fact just like filling the petrol tank of your car make sure the displaced air can escape. This procedure takes some 5 to 6 minutes if there is no hold up. (Sometimes the perastalsis of the bowel or the involuntary muscular movement which pushes the waste material along the colon kicks into action so patience is required).

7. The flow-back starts almost immediately so be ready with a full watering can to pour water down the inside of the sleeve to reduce smell and direct the waste away rapidly. If you are in the bath, quickly told the bottom of the sleeve to the top, peg into place and move over to the bo for the rapid evacuation of the bowel. (standing or sitting) For your own comfort, keep the watering can at the ready to wash down each flood of faeces if this comes in bursts you can, if you are a fellow1 manage to shave during the quiet spells by hooking up the bottom of the sleeve with a peg?

Normally this phase is the busiest part of the procedure and certainly the most satisfying, seeing how much you are moving on. You will notice that at first there will be very small stool formation but very soon it is totally without form - very much wet mud apart from tiny bits of undigested food like sweet corn etc. It this stage of irrigation ends with a good gurgle and explosive spatter this is a useful indication that the bowel is pretty well empty and very soon you will be able to put on a small bag or even a smaller cap or plug. For the next 23 or 47 hours you will then be able to forget you even have a colostomy no more ballooning bags, and in my case eating anything I like....what a joy!! It’s GREAT.

8. Finally the clearing up process. The use of an air freshener, or opening a window or just striking a match (make sure you are not near a smoke detector!) wilt help towards clearing the air for the person following you in the bathroom. Put equipment away remembering to wash out your water bag and dispose of your used sleeve and bag etc.

N.B. Without doubt from my own experience it has been very helpful to have a couple of clementines or satsumas each day to keep the whole process flowing freely.

I trust that all this does not put you off irrigating . Once you have developed your own personal technique and routine you will feel so different, so ‘normal’. The transformation gives me a feeling that I am walking on air and am specially blessed. The new found freedom is certainly worth all the effort