From the Guidelines
Laxatives should not be given to patients with ileus because they can worsen the condition and potentially lead to serious complications. Ileus is a functional obstruction of the intestines where normal peristalsis (the coordinated muscle contractions that move contents through the digestive tract) is impaired or absent. When a patient has ileus, the intestinal contents already cannot move forward properly, and administering laxatives would only add more volume to an already static system. This can increase pressure within the bowel, potentially leading to perforation, bacterial translocation, or worsening abdominal distension and pain. According to the guidelines for the management of constipation in advanced cancer, enemas are contraindicated for patients with paralytic ileus or intestinal obstruction 1. The appropriate management for ileus typically includes bowel rest (nothing by mouth), nasogastric tube decompression to remove accumulated gas and fluid, intravenous hydration, and addressing the underlying cause of the ileus (such as electrolyte abnormalities, medications, or post-operative inflammation). Prokinetic agents like metoclopramide might be considered in certain cases, but traditional laxatives such as stimulants (bisacodyl, senna), osmotic agents (lactulose, polyethylene glycol), or bulk-forming agents (psyllium) are contraindicated as they can exacerbate the condition rather than provide relief.
Some key points to consider in the management of ileus include:
- Avoiding the use of laxatives, which can worsen the condition 1
- Using bowel rest and nasogastric tube decompression to manage symptoms 1
- Addressing the underlying cause of the ileus, such as electrolyte abnormalities or post-operative inflammation
- Considering the use of prokinetic agents, such as metoclopramide, in certain cases
It's also important to note that the management of opioid-induced constipation (OIC) may involve the use of laxatives, but this is a different clinical scenario than ileus, and the guidelines for OIC management should not be applied to patients with ileus 1. In general, the management of ileus requires a careful and individualized approach, taking into account the underlying cause of the condition and the patient's overall clinical status. The use of laxatives in patients with ileus is contraindicated due to the risk of worsening the condition and potentially leading to serious complications.
From the Research
Why Laxatives Can't be Given to Patients with Ileus
- Laxatives are not recommended for patients with ileus because they can worsen the condition by increasing intestinal motility, which can lead to further bowel distension and potentially cause bowel perforation 2.
- The pathophysiology of ileus is complex and involves multiple factors, including fluid overload, exogenous opioids, neurohormonal dysfunction, gastrointestinal stretch, and inflammation, which cannot be effectively treated with laxatives 3.
- In fact, studies have shown that laxatives, such as osmotic laxatives, may not be effective in preventing or treating ileus, and their use may even be harmful in certain cases 2.
- Instead, treatment of ileus typically involves addressing the underlying cause and providing supportive care, such as fluid and electrolyte management, nasogastric suction, and bowel rest 4, 5.
- In some cases, prokinetic agents, such as metoclopramide or erythromycin, may be used to help stimulate bowel motility, but their effectiveness is uncertain and they are not recommended for routine use 3, 4.
- Enhanced Recovery After Surgery (ERAS) protocols, which include measures such as early enteral nutrition and minimally invasive surgical approaches, have been shown to be effective in reducing the incidence and severity of postoperative ileus 5.