This topic is about a person who has had a colostomy since 1983 and has been successfully using colostomy irrigation to manage their output. However, over the past year, they have encountered difficulties with the water and stool not returning as expected during irrigation. This change has affected how long they can wear their wafer. They are seeking advice on what might be causing this issue and how to address it.

Here are some helpful suggestions and insights:

1. Check for splash-back instead of true inflow:
- Clamp the sleeve while adding water to see if the water is backing up into the sleeve rather than entering the stoma.
- Fill the irrigation bag to its maximum capacity and aim for about 1,400 cc to enter the stoma, reserving the last 500–750 cc to rinse the sleeve.

2. Consider physical obstructions:
- A hernia near the stoma might partially block the flow. It’s a good idea to have a stoma nurse or surgeon evaluate this possibility.
- If there was a full blockage, nothing would move in either direction, so a partial obstruction is more likely.

3. Review equipment and technique:
- Ensure the cone fits well by lubricating it and gently dilating the stoma before inserting the cone. Keep the cone in place to prevent water loss.
- Kneeling in front of the toilet during irrigation can help with positioning. If there’s little or no return after 30 minutes, try lying on the left side over a shallow dish to use gravity to your advantage.
- Stick to a consistent daily schedule, as many find irrigating every 24 hours at the same time yields the best results.

4. Adjust diet and stool consistency:
- Fiber supplements like Metamucil can help soften stool, making it easier for water to travel and return.
- Certain foods, such as boiled onions or oatmeal, have helped some people with sluggish output.

5. Re-examine medications:
- New medications, especially for the heart, can affect peristalsis and the irrigation process. Discuss any changes with your doctor.

6. Consider alternative or custom irrigation gear:
- There are commercial kits available, such as those from Hollister, Convatec, and Coloplast, as well as high-capacity irrigators from Braun.
- DIY options include using a battery-powered camp shower, a modified garden sprayer, or an enema bottle that can deliver about 1,500 cc of warm water.
- Larger capacity or pressurized systems might be needed if splash-back is severe or if a hernia makes cone entry difficult.

7. Safety and training suggestions:
- If you’re new to irrigation or trying new equipment, consider having an ostomy nurse guide you through the first session.
- YouTube tutorials, manufacturer helplines, and ostomy forums can provide practical demonstrations and may offer sample caps with filters.

8. Benefits and end goals:
- Successful daily irrigation can significantly reduce daytime output, allowing many to switch from a drainable pouch to a small filtered cap or just a dressing with Tegaderm film, which can improve odor control and social confidence.