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Irrigation with a stoma



Flushing using the Malone technique/cecostomy
Flushing the colon with a colostomy
The rinsing of the rectal stump with a terminal stoma  
Flushing the colon with a double stoma
Flushing with an obstruction of the stoma (ileus)


Flushing using the Malone technique/cecostomy

With the Malone technique / cecostomy you have access to the beginning of the large intestine using a plastic hatch (button).You click a catheter securely into the hatch and then you can begin flushing. The advantage of flushing with a cecostomy instead of going through the anus is that you are flushing with the flow (the faeces come out of the anus as usual) and that you can sit on the toilet to flush.


Picture source: Cecostomy.com


There are various ways of flushing using the Malone technique. You can do this with a rinsing bag which has a tube attached. The bag is filled with water. You can also flush with the help of an irrigation pump. Another way to rinse is to use a syringe to squirt water into the stoma several times. You can also use a laxative as an aid during flushing. You need about a half hour / 1 hour a day to complete the flushing. Due to the flushing the large intestine is empty for 12 to 24 hours, which not only helps people with constipation, but also helps to prevent accidents by incontinence. Consult with your stoma nurse which method of flushing suits you the best.


In order to irrigate your intestine you can use an irrigation pump instead of an irrigation bag. The advantage of a pump like this over an irrigation bag is that you can change the water pressure with the pump yourself. You do not need to hang it up but can simply leave it lying on the ground. Also you do not need to lie down while using the irrigation pump, you can irrigate in a sitting position. Coloured lights on the pump indicate water temperature i.e. whether it is too hot or too cold.

Picture source: BBraun

You can read more about the Malone technique/cecostomy here

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Flushing the colon with a colostomy

There is a method for controlling the outflow of faeces in a colostomy. It can be done with the flushing of the large intestine, also known as colonic irrigation. You insert water into your large intestine using either a rinsing bag with a tube attached or with an irrigation pump. Note: this is only possible with a colostomy and not with an ileostomy. The purpose of irrigation is to have a period free of output, with an ileostomy the output runs continuously, making irrigation pointless. It can also damage the small intestine.


It is wise to flush at the same time of day. It is often easiest to empty the bowel in the morning. The height difference between your stoma and the rinsing bag is vital: if the rinsing bag is too high then the water will rush in too quickly. In place of a stoma bag you have a sleeve on your belly during the flushing. A sleeve is a long bag that is open at the top and bottom. There is a base plate or you can attach it to a belt. The bottom of the bag hangs into the toilet, so that the water and stools can flow out. The top opening allows you to connect the tube with a cone into your stoma. Tip: you can also cut a hole in your stoma bag through which you can stick the tubing into your stoma, then the stool will fall into your stoma bag. Make sure the water is not too hot or cold! It should be at approximately body temperature. If the water is too cold it can cause stomach cramps. If it is too hot it can damage the mucus.


If you notice that the water is not flowing fast into your stoma, it is possible that the intestine has a kink near the stoma. A useful tool if the Blue Line cone: a cone which has a catheter in it. You first insert the catheter into the stoma, and then close the cone over the stoma. The catheter ensures that the water can be inserted easier. Do not be afraid that water remains in your bowel; this will be absorbed by the body.


Information source and picture: Combicare


The intestine is clean and the stools remain away for 1 or sometimes 2 days. There is also less odour development and a reduced gas production. The stoma bag can be replaced with a mini bag or a stoma cap. This is a very small round stoma bag which you can have in a one or two piece system. There is often a gauze patch to absorb the intestinal mucus.


Note from left to right: Dansac and the other two are from Coloplast


There is also a stoma plug, a sort of “bung for the stoma”. A stoma plug temporarily closes off the stoma. It is a flexible skin coloured plaster with a kind of tampon and internal filter.


Picture source: UZ Leuven


The tampon goes in your stoma (similar to a suppository) and the patch goes over your stoma so that it is totally flat. The insertion does not hurt, since the intestinal mucosa is numb. Even if you do not flush the stoma, you can use the plug. It can be nice not to use a bag during swimming, sport or sex. It can happen that the intestinal working is so strong that it can push out the plug. Give your body a chance to get used to the situation and do not give up straight away! The intestine can often take up to 3 months to get used to this procedure.


Picture source: Baas op eigen buik


The cleaning of the large intestine sounds promising but there are also drawbacks. The irrigation, for example, is very time consuming, you are certainly busy for an hour a day. Also, you can irrigate if you have just eaten, as you can then have trouble with cramps and nausea. It is also important to do it regularly to have an optimal result. Therefore it is recommended to irrigate every day (or every other day) at about the same time. This can be experienced as a disadvantage. The intestine is most prepared to empty in the mornings. Irrigation is only possible is you have the last part of the large intestine (i.e. the largest part of the large intestine is still intact). With a stoma that is higher up made in the intestines it is pointless to irrigate, and in fact it can cause damage by, for example, the loss of important salts and minerals. There are also other criteria through which it is not possible to irrigate, thinking of a stricture, prolapse, certain intestinal illnesses and a weak heart or low blood pressure. You have to find out for yourself if you like to irrigate and use a plug.

You may only begin irrigation with the permission of your physician and/or stoma nurse.

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Rinsing the rectum with a terminal stoma

In people who have a stoma whereby the rectum is intact (e.g. in the Hartmann procedure) it is necessary that you should regularly rinse out that piece of intestine.


That piece of intestine continues to produce intestinal mucus (=lubricant for the faeces). Because there are no faeces it happens that more mucus is produced than previously. Because the large intestine has the task of thickening the faeces, the mucus also becomes thicker. It becomes a brown/gray mucus plug, which can lead to the sense of needing to go. Some people can push it out themselves with a little bearing down. Regular rinsing of the rectal stump prevents this sense of urgency. You also avoid any possible inflammation. You do not have to use much water with a rectal stump, often just one injection of 140ml lukewarm water is sufficient. A cone is attached to the syringe (see picture beneath). Sitting on the toilet, you can now carefully insert the water into your anus until you feel an urge. You have to decide for yourself how often to rinse it out. Sometimes once a week is sufficient, but it can be more or less often.


You can also rinse your rectum with a balloon syringe. Officially they were designed to rinse out ears, but meanwhile it has been discovered that the balloon syringe also works well with the rinsing of the intestines. You fill the balloon with water, and then you insert your syringe with a bit of lubricant on the canula, into the anus. Then you spray the contents of the balloon and then remove it from the pinched anus. This is very important because otherwise all the water seeps out. Beneath you see an example of such a balloon syringe. You can also get one with a hard (loose) canula.


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Flushing the large intestine with a double ended stoma.

Just as in people with a rectal stump, it is wise for people with a double ended stoma whereby (part of) the colon is still present to rinse out the large intestine. As described above the large intestine continues to produce intestinal mucus, which thickens and becomes brown/gray mucus plugs. This can give a sense of urgency. Some people can push out the plugs themselves, but it is wise to rinse out to prevent inflammation. The second reason why it is good to rinse regularly is that faeces can still be in the large intestine. Through the movements of the intestines, the stoma hole of the large intestine can draw in faeces. For some people this comes out the normal way, but there are also people whereby the faeces cakes up and tries to find another way out, for example by means of a fistula.

The rinsing can be done in various ways: you can use an irrigation pump or a rinsing bag.


Brand: Coloplast


You can also choose if you rinse through your stoma, such as rinsing the large intestine with a colostomy, or through the anus. You must choose what for yourself what you prefer. An advantage of rinsing through the stoma is that you can do it sitting and flush with the stream. But some people find it an unpleasant idea to stick something in the stoma, and then rinsing via the anus can be a better idea.


Picture source: the original is van BBraun

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Obstruction (Ileus)

An obstruction, also known as ileus, can have different causes. With an obstruction, which happens mainly with an ileostomy, it happens for some reason or other that no faeces comes out of the stoma any more. This can happen for example as a result of narrowing, inflammation, or an immovable lump which gets stuck in the opening of your stoma. The first symptoms are a raised stoma, abdominal cramps, nausea and later, if the obstruction is not removed in time, also vomiting. What should you do? Drink a lot and massaging the stomach around the stoma can help with a food lump near the opening. You can also rinse your stoma with water. You can do this with a female catheter with a syringe. Use a sleeve which you can attach to the bottom. Syringe some water into your stoma, in the hope of loosening the lump. If the water does not work, you can also insert a laxative. If you cannot solve it quickly by yourself, call your stoma nurse immediately or go to casualty! Because if you vomit you can quickly become dehydrated. With other causes of an obstruction the doctor will decide how to proceed further.





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