From the Guidelines
Irrigation colostomies are still performed today, though they are less common than in the past, and their use is generally considered in specific cases where fecal diversion is necessary, such as in the management of Fournier’s gangrene or other conditions requiring fecal diversion 1.
Key Points to Consider
- Irrigation colostomies are used to regulate bowel movements by instilling water into the colon through the stoma to flush out stool at regular intervals.
- The procedure is typically done every 24-48 hours using specialized equipment, including an irrigation sleeve, cone, water container, and tubing.
- Irrigation works best for people with descending or sigmoid colostomies where stool is more formed.
- Many patients who successfully establish an irrigation routine can achieve predictable bowel function and may only need to wear a small stoma cap or patch instead of a regular ostomy pouch.
- However, irrigation requires time (30-45 minutes), manual dexterity, and consistent scheduling, making it unsuitable for everyone.
Recent Guidelines and Recommendations
- The 2018 WSES/SIS-E consensus conference recommends consideration for fecal diversion, either by colostomy or fecal tube system with or without negative pressure therapy, in cases of Fournier’s gangrene with fecal contamination 1.
- The 2017 WSES guidelines on colon and rectal cancer emergencies suggest that Hartmann’s procedure should be considered the procedure of choice for left-sided perforation, and loop colostomy should be reserved for unresectable disease or if neoadjuvant therapy is planned 1.
- A recent clinical practice update on the management of ostomies suggests that colostomy appliances are usually changed once every 6 to 7 days, and the output from a colostomy is typically formed with bowel movements commonly occurring once daily 1.
Patient Selection and Training
- Patients interested in colostomy irrigation should consult with their healthcare provider or ostomy nurse for proper training and to determine if they are appropriate candidates.
- The decision to perform an irrigation colostomy should be made on a case-by-case basis, taking into account the individual patient’s needs and medical condition.
From the Research
Current Practice of Irrigation Colostomies
- Irrigation colostomies are still performed, as evidenced by recent studies 2, 3, which discuss the benefits and techniques of colostomy irrigation.
- The procedure is not offered to patients as standard, but rather as an option for those with permanent descending and sigmoid colostomies 3.
Benefits of Colostomy Irrigation
- Colostomy irrigation can reduce the frequency of bowel elimination episodes and allow some patients to reduce or eliminate ongoing use of a pouching system 2, 4.
- It can also improve quality of life, body image, and confidence, and reduce patient anxiety 3, 5.
- Additionally, colostomy irrigation may help reduce odor and flatus, prevent or address peristomal skin irritation, and alleviate constipation 3, 6.
Implementation and Support
- A structured protocol-led follow-up can be implemented to ensure that patients are well-supported throughout the first year of carrying out the procedure 3.
- Quality of life and the efficacy of colostomy irrigation can be monitored using questionnaires 3.
- Instruction on principles and techniques of colostomy irrigation should be considered when managing patients with a permanent, left-sided colostomy 4.