From the Guidelines
The preferred first-line enema for a post-operative patient with constipation is a sodium phosphate enema (Fleet enema). For adults, a standard 4.5 oz (133 mL) Fleet enema is typically used, while pediatric patients may receive a 2.25 oz (66 mL) dose. The enema should be administered rectally with the patient lying on their left side with knees bent. The solution should be retained for 2-5 minutes before evacuation. Sodium phosphate enemas work by drawing water into the bowel, softening stool and stimulating peristalsis, which helps relieve constipation quickly, usually within 5-15 minutes. These enemas are preferred post-operatively because they are effective, work rapidly, and are less likely to cause significant fluid shifts compared to larger-volume enemas. However, sodium phosphate enemas should be used cautiously in patients with renal impairment, heart failure, or electrolyte abnormalities, as noted in the guidelines 1. If contraindicated, alternatives include saline enemas or mineral oil enemas.
Some key points to consider when using enemas for post-operative constipation include:
- The patient's medical history and current medications should be reviewed to ensure the chosen enema is safe and effective 1.
- The patient should be instructed on proper administration and retention of the enema to minimize discomfort and maximize efficacy.
- Preventative measures should be implemented to reduce the risk of constipation, including adequate hydration, early mobilization, and consideration of oral stool softeners or laxatives 1.
- The use of suppositories and enemas may be perceived as invasive by patients, but they can be effective for short-term treatment of constipation, especially when a full rectum or fecal impaction is present 1.
It is essential to weigh the benefits and risks of each enema type and consider the individual patient's needs and medical status when selecting a first-line enema for post-operative constipation.
From the FDA Drug Label
Use for relief of occasional constipation (irregularity) this product generally produces bowel movement in 15 minutes to 1 hour Purpose Stimulant Laxative
The preferred first-line enema for a post-operative patient with constipation is bisacodyl (PR), a stimulant laxative.
- It is used for relief of occasional constipation.
- It generally produces a bowel movement in 15 minutes to 1 hour 2.
From the Research
Preferred First-Line Enema for Post-Operative Constipation
- The preferred first-line enema for a post-operative patient with constipation is not explicitly stated in the provided studies, but we can infer some information from the available data.
- A study from 2008 3 suggests that sodium phosphate enemas, such as Fleet enema, may not be the best choice for high-risk patients due to the potential risks of hyperphosphatemia and hypocalcemic coma.
- The same study 3 recommends the use of alternative enema preparations, such as simple tap water or saline solution enemas, which can prevent fatal complications in high-risk patients.
- Another study from 2021 4 discusses the use of bisacodyl, a stimulant laxative, for the treatment of constipation, but it does not specifically address the use of enemas in post-operative patients.
- A study from 2003 5 compares oral sodium phosphate with water enemas combined with bisacodyl as bowel preparation for elective colonoscopy, but it does not provide information on the use of enemas in post-operative patients with constipation.
- A study from 2024 6 reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards, but it does not specify the use of enemas as a treatment option.
Enema Options
- Based on the available data, simple tap water or saline solution enemas may be a safer alternative to sodium phosphate enemas for post-operative patients with constipation, especially for high-risk patients 3.
- However, more research is needed to determine the preferred first-line enema for post-operative constipation.