From the Guidelines
The patient with a bowel obstruction who hasn't had a bowel movement after a fleet enema should be immediately evaluated by a physician for further assessment and potential intervention, prioritizing measures to prevent morbidity, mortality, and improve quality of life. The most recent and highest quality study, 1, published in 2021, suggests that the management of small bowel obstruction, even in patients with no prior abdominal surgery, can often be non-operative, involving bowel decompression, water-soluble contrast agents, and fluid resuscitation. However, the presence of a bowel obstruction that has not responded to initial treatment with a fleet enema necessitates a thorough reevaluation, potentially including abdominal imaging (X-ray or CT scan) to reassess the obstruction's severity and location.
Key considerations in the management of bowel obstruction include:
- The risk of complications such as tissue necrosis, perforation, and sepsis, which can be life-threatening
- The need for pain management with appropriate medications
- The potential requirement for surgical intervention if there are signs of complete obstruction, strangulation, or perforation
- The importance of maintaining hydration, potentially through IV fluids
- The role of nasogastric tube placement for decompression in certain cases
According to 1, pharmacologic management can include opioids, antiemetics (with caution regarding those that increase gastrointestinal mobility), corticosteroids, and octreotide for symptom control. The use of total parenteral nutrition may be considered in select cases where there is an expected improvement in quality of life and life expectancy of months to years.
Given the potential for significant morbidity and mortality associated with bowel obstruction, prompt and aggressive management is crucial, with a focus on preventing complications and improving the patient's quality of life. This approach should be guided by the most recent clinical evidence and tailored to the individual patient's needs and circumstances, as outlined in studies such as 1 and 1, which emphasize the importance of a multidisciplinary approach to palliative care in the management of bowel obstruction.
From the Research
Next Steps for Patient with Bowel Obstruction
- The patient has not had a bowel movement after a fleet enema was administered due to bowel obstruction, indicating that the enema may not have been effective in relieving the obstruction.
- According to the study 2, the administration of an enema should be undertaken by a competent nurse, and the nurse should explain the procedure to the patient and assist them before, during, and after the procedure.
- The study 3 suggests that a combination of sennosides and polyethylene glycol (PEG)-saline solution may be effective in colon cleansing, but it does not directly address the issue of bowel obstruction.
- Another study 4 found that a combination of bisacodyl suppository and 1 L polyethylene glycol plus ascorbic acid is a non-inferior and comfortable regimen compared to 2 L polyethylene glycol plus ascorbic acid for bowel preparation prior to colonoscopy.
- The study 5 found that low-volume PEG (2 L) with bisacodyl demonstrates less nausea, vomiting, and bloating without adversely affecting the bowel preparation, which may be beneficial for patients with bowel obstruction.
- The study 6 suggests that bisacodyl reduces the volume of polyethylene glycol solution required for bowel preparation, which may be helpful in patients with bowel obstruction who have not responded to initial treatment.
Potential Interventions
- Consider administering a bisacodyl suppository to help stimulate bowel movement, as suggested by the study 4.
- Evaluate the patient's response to the initial enema and consider repeating the procedure or using a different type of enema, such as a saline enema, as suggested by the study 2.
- Monitor the patient's condition closely and consider consulting with a healthcare provider to determine the best course of action for managing the bowel obstruction.