Am i doing irrigation wrong???

[sassie]

When i try to irrigate with my wafer on, with the cone inserted I get water under the wafer right away making the wafer useless , Also gets my skin wet etc. so its useless to leave the wafer on because i can not wear it after i'm done anyhow.

So i just put the hollister sleeve on my bare skin using my stoma belt pulled really tight and no water or poop get out, bad thing is i use new wafers after each irrigation,I irrigate every other day. And read others that irrigate are getting 3 to 5 days from there appliance, What am i doing wrong??





TIA sassie

[sassie]

Can anyone tell how they hook up to irrigate and still wear there wafer while doing irrigation...

[steiconi]

I use a Convatec durahesive wafer, with no other products like paste or rings or cavilon. Wafers usually last until I change at six days, and have gone eight when I forgot to change. They didn't last as long when I used other products, and would leak during irrigation after 4 or 5 days.

Make sure the cone is firmly inserted so the water goes into the stoma and not between skin and wafer.

Have you considered wearing a stoma cap instead of wafer and pouch? You change them every time you irrigate. I use a wafer because I get leaks when I irrigate if I go commando.

You can get a plastic thingie (I forget what it's called) to snap onto the sleeve when irrigating commando. It helps, but I still had leaks. YMMV.

I believe the folks that get five days between irrigations often use medication to stop things up and get them flowing, as well as following a low-residue diet. I feel bloated after the first day, and have never tried to go more than 48 hours.

It's different for each 'gator, you have to learn what your body will do.

[Mikem]

Hi Sassie,

I do not stop by very often and missed your story.

What you describe is not normal. You should be getting as much as a week or more out of flanges (wafers).

Did you receive formal training from a WOCN about how to irrigate? If not you might want to see if you can get some supervised time to make sure you are using correct procedure. There could be many causes but they are mostly related to improper fitting or seal of the flange. Correctly fitted and sealed flanges will not let water between the skin and flange either while injecting or during returns. It sounds like there is a procedural problem.

I did not see if you announced your appliance brand but as you found out you do not need a flange attached for irrigation. I use Hollister and I would use an unpeeled flange with a stoma sleeve and it worked fine. Other brands have sleeve attachments to get a better seal (without a wafer) then with just the sleeve and belt. That is when you will transition straight to a cap or bandaid. But that was back when I did not need an appliance after finishing. Now I get late returns for a longer period and often use an attached appliance.

Do you use a storma paste to seal your appliance?

Do you hold the cone firmly pressed to your stoma so no water is leaking out?

If not these would likely help with preventing water getting under the appliance but should not be necessary, even with leakage (and discharge) from the stoma it should still not get next to the skin. That is just uncomfortable.

The correct procedure, which I think is posted to the top of the forum, discusses technique. Not sure if you reviewed that or have any questions about it.

Basically the beginner procedure is:
1. Correctly fitted and sealed flange.
2. Correct sleeve attached and belted.
3. Irrigation bag and cone filled to correct amount, correct temperature, correct height.
4. Guzzle 16 oz of water. You must be well hydrated.
5. Calm and relaxed position, usually seated below irrigation bag.
6. Carefully but firmly insert cone into stoma and release water.
7. …. wait for correct amount of infusion and then shut off water and remove cone. This is usually the most difficult part of the procedure to get used to. I assume you can correctly infused based on some of your posts I saw.
8. Wait up to 30 minute for discharge but wear a large appliance for an extended period in case of late returns.

There are a lot of other details and techniques which could be mentioned (and found in the archives) but everyone pretty much develops their own in short order.

There are also YouTube posts which can help.

Good luck, let us know if work out okay.

MikeM

[sassie]

thanks mike, i also use hollister products and have a hernia but my flange holds on well but when i insert the cone it pushes the stoma inwards and allows a gap and with a hernia it may take a few trys to get the flow going , during that part is when water will get out and leak into the flange gap, the stoma caps from hollister have a large hole and it leaves at least 1/2 inch bare skin around the stoma and when my stoma leaks out mucus that can get onto the exposed skin which would eat my skin awful, in order to wear hollister stoma caps i have to put gauze around the stoma before placing the cap on, i just ordered a sample from coloplast as there caps can be cut to size and hoping that works , all i need is a cover between irrigations i have only had one late return and that was my own fault as i rushed it... thanks all for responses..

[ot dave]

I have the same issues. I have a hernia, and a "dip" at 9:00 from a failed hernia repair, so it is an easy spot for water to get under. I'm using the Hollister New Image 2 piece appliance system where I remove a night time mini pouch to sleep in to irrigate with the sleeve, and them place a full drainable pouch on for the day's use. My irrigation is not always 100%, so I continue to wear a full pouch during the day.
Currently, my hernia has adjusted, and I'm having a lot of trouble getting the water into the colon as the "bend" is almost completely closed off when I'm sitting to irrigate, and it does the same thing if I stand.
The water rushes out of the cone and gets under the wafer, but I try to manage the pressure by removing the cone some when I feel a rush of water coming. That allows the water to go around the cone instead of me holding the cone in place, creating back pressure that gets under the flange.
That said, I live with a small area at 9:00 where the flange is always off of the skin. But, without output during the day (which is the whole point of irrigation), that spot is not an issue as there is nothing to get under and break the remaining seal, allowing me those 7 days between changes.
What I'm saying is that as long as you don't have a total breach of the flange, a small area that does not adhere to the skin is not to troublesome, especially with how well controlled your movements are with a successful irrigation session.
I hope that made sense...sometimes explaining stuff here is like telling someone how to tie shoes!

David

[Mikem]

Thanks for the clarification Dave, I understand Sassie's problem a little better.

I do not have this problem but would ask again if you use stoma paste with a thicker application at the problem area. I can guess you tried that with no significant improvement. I would also try direct pressure at the flange to try to keep a tight seal.

Last year I ended up with some convex flanges even though I do not have concave stoma. I had no problem using them and they might help with the issue.

Taking a 90 degree turn on the subject to hernias, has anyone ever tried to manipulate their hernia back into the abdomen? I recall from my pre- ostomy days of having the surgeon manipulate the hernia back into the abdomen while waiting for my surgery date.

Recently (2 weeks ago) my stoma was swollen and slightly painful for a couple of challenging irrigations. I finally noticed that the stoma bulge appeared more pronounced and the normally soft belly was stiff. Thinking it might be a hernia protrusion I gently manipulated the area around the stoma in the hopes that it would push the hernia back inside. I have no real idea if this is what the problem was or if I had any impact on fixing it, but pain relief was almost immediate and irrigations returned to normal.

Does anyone have an idea if this possible or have had similar experiences?

Mike

[ot dave]

I think it's possible... I have to move and adjust my abdomen during irrigation to find the "right" spot in order for water to go in, and sometimes it's not very successful. This morning for instance, I didn't have much luck. I was able to get some water in with resultant output, but my colon is no where near empty, and I'll probably have some small movements overnight tonight. Yesterday, I found the sweet spot and had a good session...
I need to have it repaired again, but I think I will wait a few more years. I'm right in the middle of coaching baseball, trap shooting, going hunting, being a Boy Scout leader, etc. Until I slow down physically, I'm afraid I'll just keep causing hernias...

David

[NorthwoodsLynn]

I have been irrigating for about 2 weeks, and really am enjoying the freedom of not having an output when I am in a meeting or at an event, and then having to find a bathroom to empty! I am doing irrigation every other day, however, yesterday I encountered some issues. My stoma had "retreated" and I could not really find a good place to place the cone. I was only able to get about 100 ml into my stoma and did have some output, but I know that I will be having more output today. I decided to stay the course to every other day instead of trying to irrigate this morning. Before I irrigated I did have some output and wonder if that was"blocking" the water from going into my colon?

[sassie]

When i watch the water stop entering i massage and lean back , move the cone around etc etc etc until it starts to flow again , i do not worry much about late returns, it would be directly after i irrigate as my colon does not poop on its own,so i wait a while before unhooking stuff, a nurse told me why she thinks it don't poop and maybe i'd like to consider having my colon removed totalty and having a ilo i said NO thank you, irrigation works 97% of the time and until it don't,, i'm doing nothing..as far as the hernia goes, seems to me ppl who get there's repaired ,just get another ,so unless i'm blocked/strangled or im in unbareable pain, i will also keep that...

I started irrigating as I can't stand the taste of milk of mag any longer and its been a journey but worth the trials, at least i feel in control of something,lol
I also irrigate every other day and that works well for me as well, unless "Alice" my stoma insist on more ,that's my routine.

She can get bossy at time, grins "female"

sassie

[NitaET]

Try lying down to instill the water with a parastomal hernia - this will reduce the hernia. Many people also stand to instill the water.
Also, it's important to know which direction your intestines go, your stoma nurse should have taught you this initially - you can digitalize your stoma with a lubricated gloved finger - knowing this direction will help you POINT the cone in the right direction. You must hold the cone firmly in the stoma to prevent water from leaking out.
For those of you using a 2 piece system - you should be using a sleeve that matches the coupling to your barrier. But if you are getting water under the barrier while filling - obviously the water is not going in ... Insurance doesn't cover 30 barriers per month .. so I would definitely switch to closed end 1 piece pouches (60 per month allowable).
Suggest - irrigate naked with just a sleeve and belt (Hollister makes sleeves for this procedure with either 2" or 3" openings) and switch to a one piece closed end pouch if you can't manage a stoma cap.
If you are having breakthrough poo .. try using more water to irrigate - average is 1 liter
Also, irrigate same time of day - don't decrease frequency until you have trained the bowels to empty on command with irrigation and have no leaks...
Not everyone is successful at irrigation - but it does take 4-6 weeks to Train the Bowels for Irrigation to be successful...
Hope this helps, I'm in the process of writing a new guideline so have been doing lots of research.

Anita Prinz, RN, MSN, CWOCN

[sassie]

I know the direction its appx 1 o'clock but when the hernia is blocking i need to massage etc to get around that, I also use hollister sleeve with just a belt, that works well for me, i never have been able to irrigate with a barrier on and maybe because my stoma is very small " not tall" maybe 3/8 sticks out if i'm lucky but its workable....its very successful for me.. i just wondered how others were doing it and keeping a barrier on, i guess the smallness is why..

[ot dave]

Irrigating standing up is doable, but tricky. Irrigating lying down is a no go...I can't see how that would work logistically or functionally. There are very limited real world scenarios where it would be functional to irrigate while supine...

David

[sassie]

yea i agree, laying down would never work for me, i'd not be able to see and it would just be a mess, a person needs to see what there doing 4 sure, if your in a hospital then a nurse would be doing it with you laying down, heaven forbid i ever have to go back,lol i'll do it the way i have been and waste the caps, thanks for all the input in this thread, i'm sure others beside myself will learn lots...

sassie

[NitaET]

Regarding irrigating supine - Where there is a will there is a way... if you are on FB, join the Colostomy Irrigation-ers group and you will see loads of people who irrigate lying down.
Sassie - if your stoma is really small and you have trouble using the cone, ask your stoma nurse about using a red robbin catheter. Good luck