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Aug 15, 2018

Need advice on irrigation for better quality of life

The topic is about finding reliable tips for ostomy irrigation to help someone live an active, leak-free life. The person is dealing with liquid output that affects the wear-time of their pouch, keeping them mostly at home. After trying different brands without success, their surgeon suggested colostomy irrigation, which might allow them to use a small stoma cover instead of a bulky pouch. They are seeking practical advice, product suggestions, diet ideas, and general guidance on what to expect.

Here are some helpful insights and advice:

1. **Irrigation Technique & Equipment**
- Use a gravity kit to instill water and wait about an hour for returns. Most people find they are clear for 24 to 48 hours.
- For cone insertion, lubricate and relax the stoma first. Some people use a gel-covered fingertip to open the lumen.
- Typical water volumes range from 1,000 to 1,500 cc. Those with hernias might use up to 3,000 cc with a portable camping-shower pump or a pressurized garden sprayer as a DIY alternative.
- Replace the kit’s plastic clip with ordinary wooden clothespins to reduce blow-outs.
- It may take 1 to 2 months before you fully trust irrigation. Wear a pouch until you have proven "no output" days.
- Evening sessions can help you sleep without output and avoid early-morning schedule conflicts.
- Daily irrigation usually provides the most reliable 22- to 24-hour continence, though some can stretch to every 48 hours after training.

2. **Diet & Medication**
- A low-residue, high-protein, low-fiber diet (similar to Atkins) can lengthen the time between irrigations.
- Sample day: Breakfast with bacon or sausage and eggs; lunch with meat, cheese, and an Atkins® bar; supper with a small lettuce/cucumber salad and meat or fish.
- Avoid bread, pasta, bulky vegetables, fibrous fruits, and caffeine. Consider a daily multivitamin without iron and half-strength loperamide (Imodium®) if needed.
- Reducing carbohydrates can drastically cut down on gas.

3. **Pouching After Irrigation**
- Popular caps and covers include the Hollister 1796 stick-on cap with a micro-pouch (available in the USA) and the Coloplast Conseal stoma plug (available in Europe).
- Alternative covers can be gauze with Tegaderm™ film or a waterproof stoma cap.
- Two-piece systems like ConvaTec and Coloplast SenSura Mio allow you to leave the flange in place for 5 to 11 days and swap pouches or caps as needed.
- Flushable disposable liners (Attiva/OstoSolutions) fit the SenSura Mio 2-piece, shortening emptying time and reducing odor. These liners are biodegradable and toilet-safe.

4. **Seal & Skin-Care Products**
- Eakin Cohesive® seals can provide added security.
- Unisolve™ adhesive remover wipes are recommended.
- Supply sources include Edgepark and Mega Medical, with Liberator Medical (Bard) for plugs. BCBS, Medicare, and AARP plans are discussed for coverage.

5. **Cautions & Differing Opinions on Plugs**
- A colorectal surgeon warns that plugs or tampons can cause backup or blockage and recommends using only purpose-made porous stoma plugs after consulting with a stoma nurse.
- Long-time plug users report no problems when used after thorough irrigation, as plugs help keep the tract open and vent gas.

6. **General Encouragement**
- Many describe irrigation as "life-changing" and a "path to freedom," noting it is far less messy than frequent pouch changes.
- Be patient, as colon "house-training" takes practice, and early accidents are normal.
- The community is ready to answer new questions and share photos of DIY setups or products.
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