This topic is about a method some people with a colostomy use to extend the time between irrigations by performing the process twice in one session. The idea is to instill water into the colostomy, wait for it to return, and then repeat the process. This can help skip a day between irrigations and reduce the chance of residual stool. Here are some insights and advice on this practice:

1. Safety of Double Irrigation
- Many people report no known dangers with double irrigation. Some stoma nurses even recommend an initial flush to clear hard stool before the main irrigation.
- The main concern is mild electrolyte loss, which can be managed by staying hydrated and replacing electrolytes.
- If you feel bloated or uncomfortable, it's best to stop and let the water return before continuing.

2. When and Why to Use Two Irrigations
- This method is sometimes used when the first irrigation produces little return or when hard stool near the stoma blocks flow.
- Some find it helps them skip a day, but many still experience output within 12-36 hours despite the second irrigation.
- Some users have tried this method and decided that once-daily irrigation is simpler and just as effective for them.

3. Water Volume, Temperature, and Delivery
- Water volumes range from 1 liter (gravity feed) to 1.5 – 2 liters; more is not necessarily better.
- Warm water around 75 °F (24 °C) stimulates peristalsis; water that is too hot relaxes the bowel, while too cold slows return.
- Various delivery methods are used, including pressurized containers, standard gravity bags, or hand pumps.

4. Timing and Routine Tips
- Consistency, such as irrigating at the same time each day, improves predictability.
- Morning irrigation allows most users to stay output-free through the workday; some delay if going out in the evening.
- Drinking a glass of water or coffee just before or during irrigation can speed up the return; drinking cold water after warm irrigation can trigger faster emptying.
- Eating close to bedtime or consuming high-fat meals can cause late returns or watery output.

5. Managing Between Irrigations
- Users who still have intermittent output often wear an open-ended pouch instead of a small stoma cap.
- Those with very predictable results might use a stoma cap but usually carry an emergency kit.
- Using cotton gauze with Tegaderm film is possible but requires confidence in having zero output.

6. Equipment and Helpful Add-ons
- A stoma sleeve with sealing pegs can help contain late returns.
- A bidet or "bum gun" installed beside the toilet makes cleaning sleeves easier.

7. Individual Variability
- Factors like the length of the colon removed, diet, hydration, body size, and overall bowel motility affect success; experimentation is essential.
- Not everyone can achieve a 24- to 48-hour window even with double irrigation, and that is perfectly normal.