This topic is about a 72-year-old individual with a colostomy who is considering whether to start colostomy irrigation. They currently manage their situation by staying home after 7 p.m., emptying their pouch in the morning, and delaying food intake until about 3 p.m. They are unsure if adopting irrigation would be beneficial.

Here are some insights and advice on colostomy irrigation:

- Irrigation is not mandatory and is suitable only for colostomies located in the descending or sigmoid colon. Many people do not irrigate because disposable pouches have made it less necessary.

- A common routine shared by users involves irrigating once daily, often around 7 a.m., using 500–1,500 cc of warm tap water. This can result in minimal or no output for 24 hours, or even 2–3 days for some, allowing for normal activities without frequent pouch changes.

- Medicare may cover a standard irrigation set, which is similar to an enema bag. This set includes a water container, tubing with a flow-control valve, a stoma cone, and a long sleeve or bag that attaches to the flange for water and stool return.

- Some technique tips include starting with 500 cc of water and gradually increasing to a maximum of 1,500 cc. Sitting comfortably, drinking a hot beverage, and gently massaging around the stoma can help speed up evacuation. Eating a banana or other fiber each morning can also aid in regulation.

- For those who prefer not to irrigate, one person found that taking daily loperamide (Imodium) and reducing fiber helped them achieve predictable output times when their stoma was in the transverse colon.

- If constipation is an issue when irrigating, chronic constipation or colonic inertia can make water return difficult. Stimulant laxatives like senna may be needed but can worsen inertia. MiraLAX (polyethylene glycol 3350) is recommended as a safer long-term osmotic laxative, as it pulls water into the colon, softens stool, and makes irrigation easier without causing dependence.

- There is an expected learning curve, and it may take several months to achieve reliable "no-output" periods. Occasional small output between irrigations is common, so many people wear a mini-pouch or stoma cap.

- A new product option is the ConvaTec Vitala continence control plug, which can be used with or without irrigation to allow for pouch-free periods.

- Irrigation can be particularly useful for planning ahead for activities like swimming, weddings, travel, and other events where a flat stoma cap is preferred over a pouch.