Colostomy irrigation (part 2): contraindications, barriers to uptake, adherence and nurse education

Abstract

Colostomy irrigation (CI) involves instillation of water via the stoma into the colon, where it stimulates peristalsis, causing expulsion of stool and water from the stoma. CI allows colostomates to regain controlled evacuation and faecal continence. The first article considered the impact of CI on colostomates' quality of life, including flatus, odour and peristomal skin health, as well as psychological wellbeing. This second article explores the potential barriers to successfully adopting CI. The uptake of CI in the UK remains relatively low. CI is contraindicated in active disease, and there is debate about whether it is suitable in colostomates with stoma-related complications and of different ages. Barriers to uptake among stoma care nurses include misconceptions about safety, physician consent and cost, as well as issues relating to commencement time and the setting and pace of postoperative education. For colostomates, barriers to adherence include short-term issues that can be resolved with nursing support, as well as the time taken to perform irrigation and changes related to older age. Many of these barriers could be overcome with robust education programmes.