CONTROLLED DOCUMENT
Guidelines for the Bowel Care of Patients with a
Colostomy or Ileostomy
CATEGORY:
Procedural Document
CLASSIFICATION:
Clinical
PURPOSE
The purpose of these guidelines is to
provide practical guidance for the
provision of bowel care for patients
with a colostomy or ileostomy
Controlled Document
Number:
TBC
Version Number:
1 draft 3
Controlled Document
Sponsor:
Controlled Document
Lead:
Executive Chief Nurse
Approved By:
Executive Chief Nurse
Clinical Nurse Specialist Functional
Bowel Service
Executive Medical Director
On:
Review Date:
Distribution:

Essential Reading
for:
All Nursing, Medical and Allied Health
Care Professional staff involved in
direct patient care which involves
stoma care

Information for:
All clinical staff
To be read in conjunction with the following document:
CD ref 345: Bowel Care Guidelines for Adult Patients aged 16 years
and over
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Contents
Page
1.0 Colostomy
 Colostomy output
2.0 Ileostomy
 Ileostomy output
3.0 Constipation
Constipation patients with a colostomy
 Colostomy irrigation
 Enema administration via a Foley catheter
 Who can perform colostomy irrigation and enema
administration via a Foley catheter
No output in patients with an Ileostomy
4.0 Diarrhoea / high output
4.1 High output in patients with an ileostomy
 Causes of high ileostomy output
 Signs and symptoms of patients with a high ileostomy
output
 Patient assessment for high ileostomy output
 Treatment of high ileostomy output
 Stoma management during an episode of high ileostomy
output
4.2 High output in Patients with a colostomy
 Stoma management during an episode of high colostomy
output
5.0 Monitoring of the Guidelines
References
Appendices
Appendix 1:
Flowchart: Guidelines for the management of constipation for
patients with a colostomy
Appendix 2:
Procedure: The administration of colostomy irrigation
Appendix 3:
Appendix 4:
Appendix 5
1.0
Procedure: The administration of an enema via a Foley
catheter.
Colostomy Irrigation: Criteria for competence and evidence
of supervised practice
Administration of an enema via a Foley catheter : Criteria
for competence and evidence of supervised practice
2
3
3
3
3
3
4
4
5
5
6
6
6
6
6
7
8
8
8
8
9
11
12
15
17
20
Colostomy
A colostomy is an opening into the colon and is formed:
 When the distal part of the colon is removed (e.g. abdomino-perineal
excision of rectum).
 When there is trauma to the lower rectum and/or anus.
 To defunction an obstructed colon
 To rest an acutely inflamed bowel (e.g. Crohn’s disease)
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy

1.1
To promote cleanliness and healing of distal bowel (e.g. rectovaginal or
rectovesical fistulas).
(Breckman, 2005)
Colostomy Output
Colostomy Type
Output
Right sided or transverse
colostomy
Fluid or semi-solid faeces
Left sided colostomy
Formed faeces
2.0
Ileostomy
An ileostomy is an opening into the small intestine and is formed when the
colon is either:
 removed (e.g. panproctocolectomy for Crohn's disease).
Or
 effluent is diverted from it (e.g. anterior resection and loop ileostomy for
rectal cancer (Black 2005).
2.1
Ileostomy Output
Ileostomy
Output
all small bowel in circuit
600 mls in 24 hrs porridgy consistency
If part of the small bowel has been resected, or if the stoma is positioned
higher in the small bowel, a shorter absorbable length of bowel (short gut) is
created. The shorter the absorbable length of bowel, the greater the
ileostomy output will be.
A drainable pouch is the appliance of choice for all ileostomy patients
and can remain in position for 3-4 days.
3.0
Constipation
3.1
Patients with a Colostomy
The majority of patients that have a colostomy will have a sigmoid
colostomy. The output from this will normally be a formed motion and it will
act once or twice a day.
Patients with a colostomy who present with constipation should be assessed
and treated in accordance with the Guidelines for the Management of
Constipation in Patients with a Colostomy (Appendix 1). An assessment of
the patient’s normal bowel function must be undertaken and documented in
the patient’s records. A record of bowel movements or lack of movements
must be made on the Prescribing Information and Communication System
(PICS) at least daily.
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Please refer to the Trust’s Bowel Care guidelines (current version) for
additional information regarding use of laxatives.
If the patient remains constipated contact the Colorectal Clinical Nurse
Specialist (CNS) Team for advice and management.
The following procedures may be considered.

Colostomy Irrigation

Enema Administration via a Foley Catheter
3.2
Colostomy Irrigation (see Appendix 2 for procedure)
Colostomy irrigation is the installation of water into the colon via the stoma.
The purpose of irrigation is not to wash out the entire colon but to induce a
reflex which brings about a peristaltic wave and evacuates faeces from the
distal colon (Karadağ et al 2005).
Indications for Colostomy Irrigation
Colostomy irrigation may be performed in the following situations:

As a management procedure performed by some patients to control their
faecal output.

As a method of preparing the colon for surgery or investigative
procedure.

To relieve constipation in patients who have an established colostomy.
(Pringle, 2005)
Contraindications for Colostomy Irrigation
Registered nurses must not undertake colostomy irrigation when:

The registered nurse has not demonstrated competence in colostomy
irrigation.

The patient has capacity and does not give consent for the procedure.

The patient has cardiac or renal disease, as fluid overload may occur.

The stoma is stenosed, prolapsed or herniated.

The patient’s bowel is obstructed.

The patient is in the immediate post-operative period when lack of stomal
output may be due to paralytic ileus.

The patient is under 16 years of age.
3.3
Enema Administration Via a Foley Catheter (see Appendix 3 for
procedure)
A Medical Devices Alert (MDA/2010/001) stipulated that devices should only
be used for the purpose for which they were intended, i.e. a Foley catheter for
urine drainage. However, as there is no other means of introducing enema
fluid into the colon via a colostomy and a Trust risk assessment has been
undertaken, it is acceptable that a Foley catheter is used for this purpose.
Indications for Administration of an Enema via a Foley Catheter
Enema administration via a Foley catheter is usually undertaken for
constipation in the post-operative period.
Exclusions and Contraindications for Administration of an Enema via
a Foley Catheter
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Registered nurses must not undertake administration of an enema via the
colostomy when:
 The registered nurse has not demonstrated competence in enema
administration via a colostomy.
 The patient has capacity and does not give consent for the procedure.
 The stoma is stenosed, prolapsed or herniated.
3.4
Who can Perform Colostomy Irrigation and Enema Administration via a
Foley Catheter
A registered nurse who has undertaken education and training and can
provide evidence of competence can perform the following procedures:
 Colostomy irrigation (Appendix 4)
 Enema administration via a Foley catheter (Appendix 5)
The supervised practice and assessment of competence will be undertaken
by a practitioner who is competent in the performance of colostomy irrigation
and/or enema administration via a Foley catheter. The number of supervised
practices required to achieve competence will be determined by the registered
nurse and supervisor, taking into account the registered nurse’s own learning
needs.
A registered nurse who can demonstrate competence in the procedures of
colostomy irrigation and/ or enema administration via a Foley catheter, can
delegate these procedures to carers or patients as appropriate, ensuring their
competence is assessed and reviewed as necessary (NMC 2010).
The registered nurse is responsible for informing his/her manager if he/she
does not feel competent in these procedures and for identifying any training
needs.
3.5
Training Requirements for the Performance of Colostomy Irrigation and
Enema Administration via a Foley Catheter.
Before undertaking the procedures of colostomy irrigation and/ or enema
administration via a Foley catheter, registered nurses must ensure they are
competent in the following areas:

Understanding of the anatomy and physiology of the lower gastrointestinal tract.

Identification of possible causes of constipation.

Knowledge and understanding of the various treatment options for
constipation.

Planning nursing care to prevent and treat constipation.

Knowledge and understanding of the indications and contra-indications
for colostomy irrigation and enema administration.

Working knowledge of the Mental Capacity Act (2005) and the Trust’s
Consent to Examination or Treatment Policy and Procedure (current
versions)
3.6
No output in patients with an Ileostomy
Patients with ileostomies CANNOT become constipated (Burch 2005).
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
An ileostomy is an opening into the small bowel and the faeces by its
nature is of a liquid consistency. Therefore patients with an ileostomy
must not be prescribed laxatives.
If an ileostomy stops working and the patient has symptoms of
abdominal pain, nausea and vomiting it could signify small bowel
obstruction due to recurrent disease, mechanical obstruction or a food
bolus (Lawson 2003) and should be fully investigated. Refer to the patient’s
consultant and the Colorectal Clinical Nurse Specialist (CNS) for advice.
4.0
Diarrhoea/ High Output
For guidance regarding stool sampling refer to the Trust’s Infection
Prevention and Control Policy and associated Procedures (current
versions) http://uhbpolicies/assets/ClostridiumDifficileProcedure.pdf
4.1
High Output in Patients with an Ileostomy
High output in patients with an ilesostomy can be caused by:
 A short gut (this will require long term fluid and electrolyte replacement)
 Diet (e.g. oranges, figs, prunes, chocolate and beer) – many people can
tolerate these if taken in small quantities.
 Medication – including antibiotics and drugs which increase gut motility
 Disease and/or obstruction (e.g. Crohn’s disease, cancer) and their effect
such as sub-acute obstruction.
 Food poisoning
 Abdominal infections and abscess
 Viral infections
 Malabsorption
 Anxiety
 Chemotherapy/ radiotherapy.
(Black, 2000; Breckman, 2005; Lawson, 2003)
4.1.1 Signs and Symptoms of Patients with a High Ileostomy Output
 Listlessness
 Irritability
 Weight loss
 Dry mouth
 Crampy abdominal pain
 Decreased urinary output
 Nausea and vomiting may occur.
Dehydration and electrolyte imbalance can occur rapidly, requiring urgent
treatment (Breckman 2005).
4.1.2 Patient Assessment during an episode of High Ileostomy Output
This must be documented in the patient’s records, and an accurate volume of
output recorded on the fluid balance section on PICS
 History of onset
 Consistency and colour and amount of faeces
 Symptoms associated with diarrhoea
 Recent lifestyle changes, emotional disturbances or travel abroad
 Dietary history
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy




Normal medication (recent antibiotics)
Significant past medical history
Hydration status
Peristomal skin integrity
(Taylor 1997, Hogan 1998)
4.1.3 Treatment of High Ileostomy Output
The first step is to prevent or correct dehydration by:
Fluid replacement
The hospital pharmacy will make up and supply a rehydration solution in
accordance with the World Health Organisation (WHO) formulation (BNF
2011).
If the rehydration solution is not available, a simple rehydration solution is St
Mark's Electrolyte Mix. This can also be made up at home by the patient:



Six level 5ml spoonfuls Glucose
(20g)
One heaped 2.5ml spoonful of
Sodium Bicarbonate (2.5g)
(Bicarbonate of Soda).
One level 5ml spoonful Sodium
Chloride (3.5g) (table salt)
Dissolved in one litre of
tap water.
The quantity of rehydration solution required in a 24 hour period will be
determined by the volume of loss from the ileostomy. The solution must be
made up freshly each day (UKMi 2014).
Dioralyte® or other ‘over the counter’ rehydration solutions do not contain the
equivalent balance of electrolytes as contained in the WHO or St Mark’s
Solution. Therefore they are not appropriate for use in patients with a high
ileostomy output.
The patient can be encouraged to consume food or drink to help replace lost
salt and potassium. For example; Oxo and tomato juice both replace salt and
fruit juice replaces potassium. A list of foods containing potassium and
sodium can be obtained from the hospital dietitian.
Intravenous fluids and electrolytes may be indicated if symptoms persist
(Black 2000).
Medications
Medication can be used to reduce a high ileostomy output in the following
ways:
 To reduce gut motility (e.g. loperamide, codeine phosphate). Infective
causes of a high output must be excluded before these drugs are
commenced
 As bulking agents (e.g. ispaghula husk; Fybogel® /Isogel®)
(Breckman 2005)
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Foods that Help to Thicken Ileostomy Output
 Porridge
 Shredded wheat
 White rice
 Smooth peanut butter
 Stewed apple
 Marshmallows
 Jelly babies
 Root vegetables , especially potatoes
 Under ripe bananas
 Brown bread
 Cream crackers
(Black 2000)
4.1.4 Stoma Management during an Episode of High Ileostomy Output
 The application of a urostomy pouch attached to a continuous drainage
bag will avoid frequent emptying of a conventional ileostomy pouch.
 High output pouches, which also attach to continuous drainage bags, are
available on request from the colorectal CNS team or ward 728.
 If the skin is excoriated, calamine lotion should be applied and allowed to
dry before applying the stoma pouch. Avoid the use of barrier creams and
films as this may reduce adherence of the pouch.
 For further advice please contact the colorectal CNS.
4.2
High Output in Patients with a Colostomy
Causes, presenting factors, assessment and treatment of diarrhoea in
patients with a colostomy are the same as that for an ileostomy patient.
Foods That Help To Thicken Colostomy Output
 Ripe bananas
 Boiled rice
 Tapioca
 Peanut butter
 Instant mashed potatoes
(Fittleworth, undated)
4.2.1 Stoma Management during an Episode of High Colostomy Output
 If the patient normally uses a closed pouch then a drainable one may be
more appropriate enabling regular emptying.
 If the skin is excoriated, calamine lotion should be applied and allowed to
dry before applying the stoma pouch. Avoid the use of barrier creams as
this may reduce adherence of the pouch.
 For further advice please contact the Colorectal CNS.
5.0
Monitoring of the Guidelines
The controlled document lead will lead the audit of the guideline with
support from the Practice Development Team. The audit will be undertaken
in accordance with the review date and will include:
 Any untoward incidents related to stoma care
 Skin integrity around the stoma
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy

Number of staff trained and as assessed as competent in administration of
an enema via a Foley, and the number of staff trained and assessed as
competent in colostomy irrigation.
All audits must be logged with the Risk and Compliance Unit.
References
Black P K (2000) Holistic Stoma Care Balliere Tindall and RCN. Edinburgh
Breckman B (2005) Problems in Stoma Management. In Breckman B (ed)
Stoma Care and Rehabilitation. Elsevier Churchill Livingstone London.
Burch J (2005) Caring for the older person with a stoma. Nursing and
Residential Care. Vol. 7, no.4,pp. 162-166
Dougherty, L. Lister, S (Eds) (2011) The Royal Marsden Hospital Manual of
Clinical Procedures (8th Edition). Blackwell Publishing, Oxford.
http://uhbhome/Policies/R/RoyalMarsden.html [accessed 15.07.14]
Fittleworth, (undated) Dietary advice for colostomists. Patient advice leaflet.
Karadağ A, Bülent Menteş B, Ayaz S (2005) Colostomy irrigation: results of 25
cases with particular reference to quality of life. Journal of Clinical Nursing
Volume 14, Issue 4, p 479–485
Lawson A (2002) Complications of stomas in Stomas: Elcoat C, (ed) (2003)
Stoma Care Nursing. London
Medicines and Healthcare Products Regulatory Agency (2010) Medical Device
Alert: Medical devices in general and non-medical products
(MDA/2010/001), MHRA, London. http://www.mhra.gov.uk/home/groups/dtsbs/documents/medicaldevicealert/con068160.pdf [accessed 10.09.14]
Mental Capacity Act 2005, http://www.legislation.gov.uk/ukpga/2005/9/contents
[accessed 15.07.14]
Pringle W (2005) Irrigation In Breckman B (ed) Stoma Care and Rehabilitation.
Elsevier Churchill Livingstone London.
UK Medicines Information ( UKMi) (2014) Q&A 88.4 What is St Mark’s
Electrolyte Mix (solution)? London Medicines Information Service
http://www.evidence.nhs.uk/search?q=%22What+is+St+Mark%27s+Electrolyte+
mix%22 [Accessed 05.09.14]
University Hospitals Birmingham NHS Foundation Trust (current version) Bowel
Care Guidelines for Patients, aged 16 years and over (CD ref: 345).
University Hospitals Birmingham NHS Foundation Trust
University Hospitals Birmingham NHS Foundation Trust (current version) Policy
for consent to examination or treatment, University Hospitals Birmingham
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NHS Foundation Trust http://uhbpolicies/Microsites/Policies_Procedures/consentto-examination-or-treatment.htm [accessed 15.07.14]
University Hospitals Birmingham NHS Foundation Trust (current version)
Procedure for consent to examination or treatment, University Hospitals
Birmingham NHS Foundation Trust
http://uhbpolicies/Microsites/Policies_Procedures/consent-to-examination-ortreatment.htm [accessed 15.07.14]
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Appendix 1
Guidelines for the Management of Constipation in Patients with a Colostomy
When did the
patient last have
bowels open?
Yes
Is this ‘normal’
for the patient
Monitor daily
 document in nursing records
IDENTIFY POSSIBLE CAUSES:
No
General
 Inadequate fluid and fibre intake
 Immobility
 Pregnancy
Drugs
 Antacids (containing aluminium and calcium)
 Anticholinergics (as used for treating Parkinson's
Disease)
 Antidepressants
 Antihistamines
 Calcium antagonists
 Cough suppressants (e.g. codeine and pholcodine)
 Iron preparations
 L-dopa
 Monoamine-oxidase inhibitors (MAOIs)
 Opioid analgesics (e.g. codeine, dihydrocodeine,
morphine dextropropoxyphene)
Colorectal
 Painful rectal disease (e.g. haemorrhoids, fissures)
 Irritable bowel disease
Neurological
 Any illness causing immobility
 Neuropathies
Metabolic
 Hypercalcaemia
 Hypothyroidism
Cognitive impairment
 Learning disability
 Confusion
 Dementia
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
EDUCATE THE PATIENT
 Increase dietary fibre (contact dietitian for
advice).
 Increase mobility where possible.
 Ensure adequate fluid intake (2L a day if not on
fluid restriction), especially if on bulk-forming
laxatives or high fibre diet.
 Increase fluid intake in hot weather
When all has been done to rectify the potential
causes; consider treatment with laxatives*:
* see Trust ‘laxative treatment guidelines’
(Appendix 2)
Bowel movement
No bowel movement
Refer to Colorectal CNS for advice. An
enema administered via a Foley
catheter or stoma washout may be
indicated.
Consider
 Digital examination of colostomy.
 Abdominal X-ray
Appendix 2
Procedure for the Administration of Colostomy Irrigation
Equipment
 Irrigation set, containing a graduated
water bag, plastic tubing with regulating
clamp, cone tip, irrigation sleeve.
 Paper tissues.
 Bowl of warm water.
 Rubbish bag
 Stoma pouch/cap.
 Non-sterile jug.
 1 litre of tepid water (36 – 38ºc)
 Deodorant aerosol.
 Disposable gloves and apron
 Peg
No
1.
Rationale
To obtain consent and co-operation
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Action
Explain the procedure to the
patient
Prepare the bathroom/toilet where
irrigation is to take place.
Ensure privacy
Wash and dry hands, prepare
equipment for the procedure and
put on gloves and apron
Fill a non-sterile jug with 500 ml of
tepid (36 – 38ºc) tap water
Pour the tepid water into the water
container and release the
regulating clamp to prime the
plastic tubing
Hang the water container on a
hook behind the toilet pan. The
base of the bag should be at
shoulder height when the patient
is sat on the toilet
Prepare equipment for a change
of stoma pouch/cap. Warm water,
paper tissues, rubbish bag, stoma
pouch/cap
Instruct the patient to sit on the
toilet pan, removing relevant
clothing. Cover the legs with a
blanket
Remove the stoma pouch and
wipe excess faeces from stoma
and peristomal skin
Wash the stoma and skin with
warm water and tissues and dry
thoroughly
To ensure a comfortable acceptable
environment
To avoid unnecessary embarrassment to
patient.
Although this is not a sterile procedure, care
should be taken to avoid unnecessary
contamination.
As the bowel is not sterile there is no need
to use sterile water. If the solution is too
warm mucosal damage may occur; if it is
too cold unnecessary cramps may occur
To allow the tubing to be primed and filled
with water thus preventing entry of air into
the colon
To allow the water to gravitate into the
colostomy. If the bag is positioned any
higher, abdominal cramps may occur
To allow free access to the colostomy. To
ensure dignity
So that the stoma and skin are clean and
clearly visible
To promote cleanliness and prevent skin
excoriation
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
No
Action
12.
Fit the irrigation sleeve over the
stoma. The bottom end of sleeve
is placed between the patient’s
legs into the toilet pan
At the time of the first irrigation,
wearing a disposable glove,
perform a gentle digital
examination of the stoma (it is not
necessary to do this on every
occasion)
Through the top opening of the
irrigation sleeve, insert the
irrigation cone gently into the
stoma so that a dam is made
between the stoma and cone.
Open the regulating on/off clamp
and allow the water to flow into
the colon – this will take 4-5
minutes
When all the water has been
instilled, remove the cone from
the stoma, fold the top of the
irrigation sleeve over and secure
with a peg
Wait for a period of 20 minutes.
Water and faeces will be
evacuated from the stoma at
varying intervals
Clean the lower end of the
irrigation sleeve; fold up and clip
the top end of the sleeve
After a further 10 minutes, when
there is no further action and
abdominal cramps have stopped,
remove the irrigation sleeve and
leave it hanging over the side of
the toilet pan
Clean the stoma and peristomal
skin with tissues and warm water
and dry
Apply a clean stoma pouch/cap
To ensure a water tight seal around stomal
area
Clean the irrigation sleeve (if
using a reusable one) by holding it
over the toilet pan and pouring
warm water from a jug into it. A
shower head attachment fixed to
an adjoining washbasin could also
be used
To clean any faeces and mucus from the
irrigation sleeve
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Rationale
To determine the direction of the lumen of
the colon and relax the stoma
To ensure that the water, when instilled, is
retained in the colon
To allow water to run into the colon
To ensure that there is no leakage from the
tip of the irrigation sleeve
To allow peristalsis to take place causing
evacuation of faeces and water
To allow the patient to leave the toilet and
pursue other toilet activities
To promote cleanliness and prevent skin
excoriation. The appliance will adhere more
securely to dry skin
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
No
Action
23.
Hang the sleeve (if using a
reusable one, water container and
tubing to initially drip dry then dry
thoroughly and store in a cool, dry
place
Dispose of soiled tissues. The
contents of the stoma pouch
should be flushed down the toilet
and the bag wrapped in a plastic
or paper bag and placed in a
plastic rubbish bag
Wash hands thoroughly
To prolong the life of the plastic
Spray toilet area with deodorising
aerosol
To eliminate any odour
24.
25.
26.
Rationale
Faeces should be disposed of down the
toilet as it is a potential source of infection
To reduce cross-infection
Pringle 2005
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Appendix 3
Procedure for the Administration of an Enema via a Foley Catheter
into a Colostomy*.
Equipment
 Size 14 Foley catheter*
 Phosphate Enema
 Water soluble lubricating gel
 5ml syringe
 Water for injection
No
 Spigot or blue clamps
 Tissues
 Bowel of water
 Stoma bag
 Disposable gloves and apron
Action
Rationale
1.
Explain the procedure to the patient
To obtain consent and co-operation
2.
Prepare the bed space
3.
Warm the enema to the required
temperature by immersing in a jug of hot
water, testing with a bath thermometer. A
temperature of 40.5–43.3°C is
recommended for adults. (Royal Marsden
Manual)
Ensure privacy
To ensure a comfortable acceptable
environment
Heat is an effective stimulant of the nerve
plexi in the intestinal mucosa. An enema
temperature of body temperature or just
above will not damage the intestinal
mucosa
4.
5.
6.
7.
8.
8.
9.
10.
11.
12. .
13.
To avoid embarrassment to the patient
Wash and dry hands, prepare equipment
for the procedure and put on gloves and
apron
Lubricate the Foley catheter with water
soluble lubricating gel
Draw up 5mls of water for injection into
syringe
Remove stoma bag and clean stoma and
peristomal skin
To prevent cross infection
Position the patient comfortably on their
right side
Perform a gentle examination of the
stoma
Insert the Foley catheter through the
lumen of the stoma approximately 16-20
cms
Attach the nozzle of the enema container
to the Foley catheter and gently squeeze
the enema fluid into the colon
Inflate the balloon on the Foley catheter
with 5mls water
To enable the enema to flow into the right
side of the colon
To detect the presence of faeces in the
distal colon
To enable the enema to flow into the colon.
Remove the enema container and spigot
the end of the Foley catheter
For ease of administration
So that the stoma and skin are clean and
clearly visible
To prevent the Foley catheter becoming
dislodged and to prevent backflow of
enema fluid
To prevent backflow of enema fluid.
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
No
Action
Rationale
14.
Leave the patient lying on their right side
for 10 minutes
To allow the enema fluid to draw water into
the colon and soften the faeces
15.
Turn the patient onto their left side and
leave for 10 minutes
16.
Withdraw the water from the balloon of
the Foley catheter and remove the
catheter
Clean and dry peristomal skin and apply
clear drainable bag
Dispose of waste into suitable receptacle
in accordance with Trust policy and
procedures for waste management
Wash hands thoroughly
To enable the enema fluid to pass into the
left side of the colon and draw water into
the bowel to soften the faeces
To enable easy removal of the catheter
17.
18.
19.
20.
Document procedure and outcome in the
patient’s notes and on their fluid chart
To observe output from the colostomy.
To reduce cross-infection
To ensure communication between the
multidisciplinary team and a record of care
given
*NB
A Medical Devices Alert (MDA/2010/001) stipulated that devices should only be used
for the purpose for which they were intended. i.e. a Foley catheter for urine drainage.
However, as there is no other means of introducing enema fluid into the colon via a
colostomy and a risk assessment has been undertaken, it is acceptable that a Foley
catheter is used for this purpose.
Medicines and Healthcare Products Regulatory Agency (2010) Medical Device Alert:
Medical devices in general and non-medical products (MDA/2010/001), MHRA,
London. http://www.mhra.gov.uk/home/groups/dtsbs/documents/medicaldevicealert/con068160.pdf
Page 16 of 22
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Appendix 4
(page 1 of 3)
UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST
CRITERIA FOR COMPETENCE
END COMPETENCE:
Colostomy Irrigation
Date(s) of Education and supervised practice: ………………………………………………..
Name of Registered Nurse (print): ………………………………………………..
Name of Supervisor (print): ………………………………………………..
Designation:……………………………………………
Element of Competence To Be Achieved
Date
Achieved
Discuss and identify
 indications
 contraindications
for colostomy irrigation
Demonstrate knowledge of relevant anatomy
Demonstrate knowledge and understanding of why it is essential to
follow the manufacturer’s instructions for the specific irrigation device
Demonstrate a working knowledge of the Trust’s policy for consent to
examination or treatment
Demonstrate a working knowledge of the Mental Capacity Act
Demonstrate accurate provision of information pre and post the
procedure in a way that the patient understands
Demonstrate maintenance of the patient’s privacy and dignity
throughout the procedure
Demonstrate the correct procedure of colostomy irrigation to include:
 Preparing the equipment
 Maintaining skin hygiene around stoma
 Performing a digital examination of the stoma
 Fitting the irrigation sleeve
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Registered Nurse
Sign
Supervisor Sign
Element of Competence To Be Achieved
Date
Achieved
Registered Nurse
Sign
Appendix 4
(page 2 of 3)
Supervisor Sign






Inserting the irrigation cone
Performing the irrigation
Observing and maintaining skin integrity
Recording faecal output
Cleaning of reusable irrigation sleeve (if used)
Disposal of waste in accordance with Trust Waste Policy and
associated procedural documents (current versions)
Demonstrate safe infection control practices throughout the
procedure. To include:
 Standard precautions
 Isolation procedures
Demonstrate knowledge and understanding of when to refer the
patient to an appropriate medical practitioner
Demonstrate accurate record keeping
Discuss any health and safety issues in relation to this procedure
Demonstrate an understanding of the incident reporting process
Demonstrate a working knowledge of the NMC Code: Standards of
conduct, performance and ethics for nurses and midwives (2008)
I declare that I have expanded my knowledge and skills and undertake to practice with accountability for my decisions and actions.
I have read and understood the guidelines for Colostomy Irrigation
Signature of Registered Nurse: ……………………………………………………Date:
…………………………………………………….
I declare that I have supervised this registered nurse and found her/him to be competent as judged by the above criteria.
Signature of Supervisor:
……………………………………………………Date:
………………………………………………….
A copy of this record must be placed in the registered nurse’s personal file, a copy must be stored in the clinical area by the line
manager and a copy can be retained by the individual for their Professional Portfolio.
Page 18 of 22
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Appendix 4
(page 3 of 3)
UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST
EVIDENCE OF SUPERVISED PRACTICE
To become a competent practitioner, it is the responsibility of each registered nurse to undertake supervised practice in order to
perform Colostomy Irrigation in a safe and skilled manner.
Name of Registered Nurse ………………………………………………….
DATE
DETAILS OF PROCEDURE
SATISFACTORY
STANDARD MET
COMMENTS
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Page 19 of 22
Document index no: TBC
Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
PRINT NAME,
SIGNATURE &
DESIGNATION
Appendix 5
(page 1 of 3)
UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST
CRITERIA FOR COMPETENCE
END COMPETENCE: Administration of an Enema via a Foley Catheter into a Colostomy
Date(s) of Education and supervised practice: ………………………………………………..
Name of Registered Nurse (print): ………………………………………………..
Name of Supervisor (print): ………………………………………………..
Designation:……………………………………………
Element of Competence To Be Achieved
Date
Achieved
Registered Nurse
Sign
Discuss and identify
 indications
 contraindications
for administration of an enema via a Foley catheter into a colostomy
Demonstrate knowledge of relevant anatomy
Demonstrate knowledge and understanding of why a risk it was
necessary to perform a risk assessment for the use of a Foley
catheter for this purpose
Demonstrate a working knowledge of the Trust’s policy for consent to
examination or treatment
Demonstrate a working knowledge of the Mental Capacity Act
Demonstrate accurate provision of information pre and post the
procedure in a way that the patient understands
Demonstrate maintenance of the patient’s privacy and dignity
throughout the procedure
Demonstrate the correct procedure of enema administration via a Foley catheter to include:
 Preparing the equipment
 Warming the enema to the correct temperature
 Positioning of the patient
 Maintaining skin hygiene around stoma
Page 20 of 22
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
Supervisor Sign
Element of Competence To Be Achieved
Date
Achieved
Registered Nurse
Sign
Appendix 5
(page 2 of 3)
Supervisor Sign






Performing a digital examination of the stoma
Inserting the Foley catheter to the correct depth
Instilling the enema
Inflating the Foley catheter balloon
Removing the Foley catheter
Disposal of waste in accordance with Trust Waste Policy and
associated procedural documents (current versions)
Demonstrate safe infection control practices throughout the
procedure. To include:
 Standard precautions
 Isolation procedures
Demonstrate knowledge and understanding of when to refer the
patient to an appropriate medical practitioner
Demonstrate accurate record keeping
Discuss any health and safety issues in relation to this procedure
Demonstrate an understanding of the incident reporting process
Demonstrate a working knowledge of the NMC Code: Standards of
conduct, performance and ethics for nurses and midwives (2008)
I declare that I have expanded my knowledge and skills and undertake to practice with accountability for my decisions and actions.
I have read and understood the guidelines for the Administration of an Enema via a Foley Catheter into a Colostomy
Signature of Registered Nurse: ……………………………………………………Date:
…………………………………………………….
I declare that I have supervised this registered nurse and found her/him to be competent as judged by the above criteria.
Signature of Supervisor:
……………………………………………………Date:
…………………………………………………….
A copy of this record must be placed in the registered nurse’s personal file, a copy must be stored in the clinical area by the line
manager and a copy can be retained by the individual for their Professional Portfolio.
Appendix 5
(page 3 of 3)
Page 21 of 22
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST
EVIDENCE OF SUPERVISED PRACTICE
To become a competent practitioner, it is the responsibility of each registered nurse to undertake supervised practice in order to
perform enema administration via a Foley catheter in a safe and skilled manner.
Name of Registered Nurse ………………………………………………….
DATE
DETAILS OF PROCEDURE
SATISFACTORY
STANDARD MET
COMMENTS
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Page 22 of 22
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Guidelines for the Bowel Care of Patients with a Colostomy or Ileostomy
PRINT NAME,
SIGNATURE &
DESIGNATION