Is an enema appropriate for a new ostomy (stoma)?

From the Guidelines

Administering an enema to a fresh ostomy is not appropriate and should be avoided. A fresh ostomy is a newly created surgical opening that connects part of the intestine to the abdominal surface, and it requires time to heal properly. Enemas introduce fluid into the intestinal tract under pressure, which could damage the surgical site, cause leakage at the stoma, disrupt the connection between the intestine and abdominal wall, or lead to serious complications such as perforation or infection. During the initial healing period (typically 6-8 weeks post-surgery), the anastomosis and surrounding tissues are particularly vulnerable.

The management of patients with high output stomas, as discussed in the ESPEN practical guideline 1, focuses on parenteral infusions, fluid and electrolyte management, and oral rehydration solutions, but does not support the use of enemas in the management of fresh ostomies. If bowel cleansing or management of constipation is needed for a patient with a new ostomy, alternative approaches should be discussed with the healthcare provider, such as gentle oral laxatives, proper hydration, dietary modifications, or medication adjustments. The type of ostomy (colostomy, ileostomy, or urostomy) also affects management decisions, as each has different considerations for waste elimination and care.

Some key considerations for managing patients with fresh ostomies include:

• Avoiding interventions that may disrupt the healing process, such as enemas
• Managing fluid and electrolyte balance, as discussed in the ESPEN guideline 1
• Using alternative approaches for bowel cleansing or constipation management, such as gentle oral laxatives or dietary modifications
• Consulting with the surgeon or ostomy nurse before attempting any intervention involving a stoma. Always prioritize the patient's safety and well-being, and consider the potential risks and benefits of any intervention, as supported by the strongest and most recent evidence 1.

From the Research

Enema Administration to Fresh Ostomy

• The administration of an enema is a common procedure undertaken in healthcare settings and, if undertaken appropriately, is deemed a relatively low-risk and safe intervention 2.
• An enema may be prescribed for therapeutic purposes, to administer medicines or for diagnostic purposes, with the most common reason being to relieve severe acute or chronic constipation 2.
• There are three main types of enemas commonly used in nursing practice: retention, evacuant and softener enemas 2.

Considerations for Enema Administration

• Administration of an enema is invasive and highly personal, and nurses undertaking this procedure must have the knowledge and skills required to do so safely and work within their level of competence 2, 3.
• The nurse must explain the procedure to the patient and should assist the individual before, during and after the procedure 3.
• The nurse should document all care given 3.

Applicability to Fresh Ostomy

• There is no direct evidence in the provided studies to suggest that an enema is appropriate for a fresh ostomy 2, 3, 4, 5, 6.
• However, the studies do provide general guidance on the administration of enemas and the importance of competent nursing care 2, 3.