Management of Colostomies: No Routine Monthly Rectal Cleanouts Needed
Routine monthly rectal cleanouts are not recommended for patients with colostomies to prevent mucous buildup. 1, 2 There is no evidence in current clinical guidelines supporting the need for scheduled rectal cleanouts in patients with colostomies.
Understanding Colostomy Anatomy and Function
When a colostomy is created, the intestine is typically configured in one of two ways:
- End stoma: The intestine is divided with the proximal end brought out as a stoma, while the distal end remains in the abdomen 1
- Loop stoma: A continuous piece of intestine is brought through the abdominal wall with two openings side by side 1
In both configurations, the distal (downstream) segment of bowel that remains in place will continue to produce mucus, which is normal physiological function.
Management of Mucus in the Rectal Stump
The distal segment of bowel that remains after colostomy creation (often called the rectal stump) will continue to produce mucus. This is a normal physiological process and typically does not require routine intervention. Key points:
- Mucus production is a normal function of the remaining rectal mucosa
- Most patients will naturally pass small amounts of mucus through the rectum periodically
- The 2023 AGA Clinical Practice Update on Management of Ostomies does not recommend routine rectal cleanouts 1
- The Ostomy Care Guidelines similarly do not include rectal cleanouts as part of standard ostomy care 2
When Intervention May Be Needed
While routine monthly cleanouts are not recommended, there are specific situations where intervention might be warranted:
- Patient reports uncomfortable buildup of mucus
- Patient experiences discharge of large amounts of mucus
- Symptoms of pressure or discomfort in the rectal area
- Signs of inflammation or infection in the rectal stump
In these cases, intervention should be targeted to address the specific problem rather than performed on a routine schedule.
Evidence on Colostomy Management
Research has focused more on irrigation of the colostomy itself rather than rectal cleanouts:
- Studies show that colostomy irrigation (through the stoma) can help regulate bowel function and reduce the frequency of colostomy actions 3, 4
- Irrigation of the colostomy can improve quality of life by providing more predictable bowel function 5
- However, these studies address management of the functioning colostomy, not the defunctionalized rectal segment
Potential Risks of Unnecessary Rectal Cleanouts
Performing unnecessary rectal cleanouts carries potential risks:
- Mechanical trauma to rectal mucosa
- Disruption of normal mucus barrier function
- Potential for electrolyte imbalances with repeated enemas
- Psychological burden on patients
- Unnecessary healthcare costs
Best Practices for Colostomy Care
Current guidelines emphasize these aspects of colostomy care:
- Proper sizing and fitting of ostomy appliances
- Regular monitoring for skin complications
- Education on managing output
- Consideration of irrigation through the stoma if appropriate
- Access to wound/ostomy nurse consultation 2
Conclusion
Based on current clinical guidelines and available evidence, routine monthly rectal cleanouts are not recommended for patients with colostomies. 1, 2 Management should focus on proper ostomy care and addressing specific symptoms if they arise. Patients experiencing problematic mucus buildup should be evaluated individually, and interventions should be targeted to address specific issues rather than performed on a routine schedule.