Training Your Bowel Post-Colostomy: Irrigation vs. Dulcolax

Hello. I am nearly 2 years out from colostomy surgery due to cancer. I have come across information about using an enema-like irrigation process to train your bowel to release output at a desired time of day—once a day, or for some, every other day. I also came across a discussion using Dulcolax suppositories or tablets instead of the irrigation, however, I can't find which rabbit hole I went down to find that information.

Anyone here have experience with these processes or know anyone who has experience? Emptying only once a day is very appealing to me, and I heard that it really dials back accidents. Some people downsize their bag, or only wear a cap between emptying.

Thanks for any insights!

I've had my colostomy for several years now and finally had it pretty well trained until a couple of months ago when I had colon cancer surgery, and now I'm going to have to start all over again. What I did before was have a late light breakfast consisting of a bagel and a bottle of Ensure, maybe a small snack later in the early afternoon because we eat an early supper around 4:00. That would allow some time for some stool passage before bedtime. Then, about an hour before bedtime, I would take my anti-diarrhea med (Opium of Tincture), which would usually stop any movement of too much stool during the night. Then by morning, it would be active again.
Now, after my recent surgery, I am also trying different times to take Miralax. My stool has changed from being liquid to so pasty that it stays right up at the stomach, and I get the pancake effect, no matter what I try to put in my bag or using a filter sticker. It's a mess in the middle of the night and mornings trying to clean out. Then the next day I have all liquid again, which is fine by me, more controllable. So, I too, am experimenting. If I find a solution that seems to work well for me, I'll let you know. I tried irrigation, but found it too time-consuming, and I don't have the privacy to deal with it.

I've also had a pancaking effect in my colostomy from sticky stool. No amount of adding air, oil, lubricant,  etc makes a bit of difference.  

Adding fiber (I use benefiber) has helped both add a little consistency to the high liquid output and reducing the sticky solid stool. 

My own output is high and all over the place in terms of timing. I can't imagine how I would get it trained to be predictable. But that was true for me before the cancer and surgery so normal for me. It's just more trouble with a colostomy 

Hi.

Can I strongly recommend irrigation? A daily enema—that's what irrigation is—(approximately 40 minutes) and your incontinence is controlled. A water gravity bag is simple and easy to use. Forget drugs; what's not inside you can't come out. If you'd like to know more, send me a message for more info. John

I tried it a few times, could never get the stoma plastic piece to fit inside my stoma. I’m sorry I don’t have the correct terminology for the pieces that came with the kit. Then I couldn’t get the water bag to correctly flow into the stoma once I did get it plugged in. If you can understand what I’m trying to describe, haha! Then just a little flow back out. So, it took me forever, finally gave up. Instructions stated I should leave the plastic irrigation bag on for couple hours! 

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Hi vanestag.

There is a knack to irrigating, and it doesn't happen straight away. Have a full bag of water as high as you can. Your cone should be at a slight downward angle to your left hip. Watch the flow meter like a hawk; small adjustments and the meter will start to move. FREEZE. It might be slow at first, but keep it moving. A full bag takes me about 10 minutes. Don't waggle the cone as it will leak. Try sitting down, which helps. Once you get the knack, it's like riding a bike; every day it just happens. I keep the irrigation sleeve on for about 40 minutes.
Don't give up; it really is worth the effort. Please keep typing. John

I too deal with the pancake effect. I take Miralax every morning now and it definitely helps make the consistency very loose so I don’t get pancaking quite as often. 
I had colon  and rectal cancer surgery August 2023.  It was quite a healing process because of the chemo and radiation I had before surgery . After surgery I had more chemo. Before my following surgery my output was pretty much on time everyday and I scheduled things around it when possible after 9:30 am. Now I’m trying to get there again but there have been many so many changes to my body. 
This past August 2024 I underwent parastomal hernia repair and a perineal hernia repair . There were complications and we didn’t think that I would survive. God has seen me through and now I’m still trying to recover . My stoma changed after this last surgery and is practically flat on one side. I have ordered so many different wafers , seals and bags. I still leak all the time, sometimes, four or five times a day . I’m allergic to the adhesives too. I would like to find ostomy supplies for sensitive skin and also regulate my output again. I would be so grateful for that. 

I can relate to so much of your story.  I spent a year getting radiation and chemo to shrink my tumor enough for surgery to be possible. My surgery was complicated by damage from the radiation and scar tissue left by prior surgeries. I became septic and nearly died due to malnutrition and a small intestine fistula. 

Anyway, I digress.  Everyone is different but I also have sensitive skin. Coloplast sensura mio is working for me. My ostomy nurse has me using a paste that I will post pictures of. I think it has done wonders for keeping my appliances on. I don't know if it will work for you or not but thought it was worth mentioning.  

 

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Thank you for your reply.  Did you initiate the process with your doctor/ostomy nurses, or was it presented by them as an option for your self care? I wonder about ducolax because of a mention on a different forum, but haven’t found any more about it. Taking a laxative each day, resulting in one or two outputs sounds good to me. It also appeals to me because we hope to do some traveling over the coming year or two, and reducing equipment would be nice.

I have observed through online discussions, people in the UK seem to embrace irrigation more than here in the US. My own gastroenterologist has a strange idea of what it is used for.

Thanks,

Gilda

 

Interesting observation about the difference between the US and UK on irrigation. It was never presented to me as an option, and I don't know if that's because it is so infrequently done here or because I'm not a candidate. I'm just reading about it at the moment.

Hi Gilda.

After my colostomy for rectal cancer, my stoma care nurse pretty much bullied me into irrigating. And I'm very VERY glad I did since it gives me almost 100% control. Clean stoma cap on, then 24 hours later clean stoma cap off. In the UK, irrigation is suggested when it's appropriate; it's simple and only requires a daily/two daily routine. I'd recommend anybody who can irrigate to give it a go. It can change your life. John

Gilda, I used Dulcolax for a long time to clear myself out. I took 2 at night, and then for about an hour or more I'd be going to the loo. I have been irrigating successfully and more reliably though. I am in the UK and had to fight to get shown how to do it, but I've never looked back. It seems complicated at first, but it's not. You get used to it quickly. I've irrigated in airports between flights, in hotels; it's easy if there is a private available bathroom. Good luck.

Will I need some kind of hook to hold the bag of water up, or do I hold it up myself? If I have to hold it myself, there will be an issue. I can barely blow dry my hair; my arms get so tired I have to take a break. I'm 70 years old! I don't think my husband would approve of putting a hook up in the bathroom.

You might try a Command brand hook. No drilling and it's removable so not a permanent addition. Your husband might be more ok with that. 

Hi. Try a hook from a shower rail, or if you clip and seal the bottom of your sleeve, try hanging the bag from a curtain rail. You can't hold the water bag; you need at least four to five feet above you to get the water pressure. You must have height, or you'll never irrigate. Be careful of suction hooks as they can fail just when you don't want them to. Suction hooks only on a glass shower screen. John