Is it safe to use two enemas simultaneously to treat severe constipation in a 92-year-old female patient?

From the Guidelines

No, it is not recommended to use two enemas simultaneously to treat severe constipation in a 92-year-old female patient. This approach could cause serious complications including electrolyte imbalances, rectal trauma, dehydration, or cardiovascular stress 1. For elderly patients with severe constipation, a single standard enema should be used, following package instructions carefully. Some options for enemas include:

• Normal saline enema to distend the rectum and moisten stools
• Osmotic micro-enema containing sorbitol, which works best if the rectum is full on digital rectal examination (DRE)
• Hypertonic sodium phosphate enema, which both distends and stimulates rectal motility Alternative approaches include starting with less invasive methods such as:
• Oral osmotic laxatives like polyethylene glycol (PEG)
• Stool softeners like docusate sodium
• Stimulant laxatives like bisacodyl for short-term use. Elderly patients are particularly vulnerable to complications from aggressive constipation treatments due to their thinner rectal tissues, potential cardiovascular issues, and altered fluid/electrolyte balance 1. If constipation persists after trying a single enema or oral medications, medical evaluation is necessary to rule out more serious conditions like bowel obstruction or impaction requiring manual disimpaction by a healthcare provider. It is essential to prioritize the patient's safety and use the least invasive and most effective treatment option.

From the Research

Treatment of Severe Constipation in a 92-Year-Old Female Patient

• The use of enemas to treat constipation is a common practice, especially in cases of fecal impaction 2.
• However, there is no direct evidence to support the use of two enemas simultaneously to treat severe constipation in a 92-year-old female patient.
• A study on the management of constipation in older adults recommends treating fecal impaction with mineral oil or warm water enemas, but does not specify the use of multiple enemas at once 2.
• Another study compares the effectiveness of enemas and polyethylene glycol (PEG) in treating rectal fecal impaction in children, but does not provide guidance on the use of multiple enemas in adults 3.
• The safety and efficacy of using multiple enemas in older adults is not well established, and further research is needed to determine the optimal treatment approach.

Alternative Treatment Options

• Polyethylene glycol (PEG) is a commonly used osmotic laxative that can be effective in treating constipation, including fecal impaction 4.
• A systematic review of randomized controlled trials comparing PEG to enemas for the management of rectal fecal impaction in children found that PEG was associated with increased defecation frequency, but also increased the risk of watery stools and fecal incontinence 5.
• The use of PEG or other laxatives may be considered as an alternative to enemas, but the choice of treatment should be individualized based on the patient's specific needs and medical history.

Considerations for Older Adults

• Chronic constipation is a common problem in older adults, and its incidence is estimated to be 2-27% in the general population 6.
• Older adults may be more susceptible to the adverse effects of constipation, including fecal impaction, and may require more aggressive treatment.
• The use of enemas or other treatments should be carefully considered in older adults, taking into account their medical history, medications, and overall health status.