Question:
I had an APR surgery on March 24 with a permanent colostomy. My stoma pancakes excessively, there is always an odor, and I experience uncontrollable output at inconvenient times. I am a candidate for irrigation but have been unsuccessful in getting water in for the past five months—the water just spurts into the sleeve.
My ostomy nurse lacks training in irrigation, and the hospital ostomy nurses no longer run clinics. My home care providers haven’t been able to find anyone knowledgeable in irrigation and don’t seem concerned. This has left me feeling depressed, frustrated, and isolated. I find my ostomy highly unpredictable and difficult to manage.
I would like to try using a catheter but don’t know how to do so and need guidance. Can someone provide advice on what I should do next?
My surgeon confirmed on Monday that I don’t have a hernia, but he only examined my stomach. I have had about five successful irrigations, but the rest have been unsuccessful.
Any advice would be greatly appreciated.
Response:
I’m so sorry to hear that you are facing these challenges. Before addressing irrigation, I’d like to offer some insights that may help.
Managing Pancaking
Pancaking is often caused by a lack of fiber in the diet, leading to stool that is too thick. Many people struggle to consume enough soluble fiber to naturally thicken their stool. You might consider adding a fiber supplement such as Metamucil, increasing the amount gradually to find the right balance. Be sure to drink plenty of water while taking fiber supplements to avoid further complications.
Irrigation Challenges & Solutions
It sounds like you understand the irrigation process, but you’re struggling with water flow and achieving a proper seal with the cone. Here are some possible reasons and solutions:
Potential Issues:
- The irrigation cone may be blocked by stool or pressing against the bowel wall, preventing water from flowing in.
- The cone may not be inserted with enough firm pressure, failing to create a proper seal.
Suggestions to Improve Irrigation:
- Ensure Proper Water Height
- Hang the water container high enough for gravity to aid water flow—door height is often recommended. A wire hanger or hook on the back of a door may help.
- Eliminate Air from the Tubing
- Before inserting the cone, remove any air in the tubing to ensure smooth water flow.
- Check the Direction of Your Bowel
- Gently insert a clean, lubricated finger into your stoma to determine which direction your bowel curves.
- When inserting the cone, angle it in that direction for a better fit.
- Create a Proper Seal
- Firmly press the cone against the stoma to create a tight seal.
- Maintain steady pressure to prevent leaks.
- Relax Your Muscles
- Take deep breaths and try to relax your abdominal muscles, as tension can prevent water from flowing in.
- If you experience leakage, gently adjust the angle of the cone while maintaining pressure until the water begins to flow.
- Change Positions
- If you usually sit while irrigating, try standing, placing one leg on the toilet, or experimenting with different angles.
- Gentle abdominal massage may also help, though it can be challenging while holding the cone in place.
- Use Warm Drinks to Relax Muscles
- Some people find that drinking a warm beverage before irrigation helps relax their muscles, making the process easier.
Next Steps
- If you’re considering using a catheter for irrigation, I recommend seeking guidance from a qualified ostomy nurse or reaching out to ostomy support groups for additional advice.
- If you would like, I can send you an irrigation guide once it is finalized, though it may not offer more insights than those provided here.
I understand how difficult this has been for you, and I hope these suggestions help make your irrigation routine more successful. You are not alone—many people face similar challenges, and support is available.
Lauren Wolfe, RN, BSN, MCISc (WH), NSWOC, CWOCN
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