From the Guidelines
Administering laxatives to patients with an ileus is contraindicated and can worsen their condition. According to the evidence from the 2018 study published in the Annals of Oncology 1, enemas are contraindicated for patients with paralytic ileus or intestinal obstruction. This is because laxatives stimulate intestinal motility and increase fluid secretion into the bowel, which can increase pressure behind the obstruction, potentially leading to bowel perforation, worsening pain, nausea, vomiting, and abdominal distension.
Some key points to consider when managing patients with an ileus include:
- Avoiding the use of laxatives, as they can exacerbate the condition
- Focusing on bowel rest, nasogastric tube decompression, and intravenous fluids to manage symptoms
- Addressing the underlying cause of the ileus, which may require surgical intervention
- Using appropriate imaging studies, such as abdominal X-rays or CT scans, to confirm the diagnosis and identify the cause of the ileus
- Considering the type of ileus, whether paralytic or mechanical, to determine the best course of treatment
It's also important to note that prokinetic medications like metoclopramide are contraindicated in mechanical obstruction, and that patients with suspected ileus should receive nothing by mouth until the diagnosis is confirmed and a treatment plan is established 1. Overall, the management of ileus requires a careful and individualized approach, and the use of laxatives is not a safe or effective treatment option.
From the Research
Administering Laxatives to Patients with Ileus
- The administration of laxatives to patients with an ileus (intestinal obstruction) is a complex issue, and the available evidence suggests that it can have both positive and negative effects.
- A study published in 2008 2 found that the use of bisacodyl, a colon-stimulating laxative, accelerated gastrointestinal recovery in patients after colorectal surgery, which may suggest a potential benefit in certain cases of ileus.
- However, other studies have reported cases of intestinal obstruction caused by laxative drugs, such as psyllium 3, which can worsen the condition if not taken appropriately.
- A review of the literature on adverse effects of laxatives published in 2001 4 noted that osmotic laxatives containing poorly absorbable ions can cause metabolic disturbances, particularly in the presence of renal impairment, and should be used with caution in patients with ileus or bowel obstruction.
- Another study published in 2018 5 highlighted the importance of monitoring signs of constipation during treatment with clozapine, which can progress to full-blown ileus, and responding to it with lifestyle advice and laxative treatment.
Key Considerations
- The use of laxatives in patients with ileus should be approached with caution, taking into account the potential risks and benefits.
- Patients should be instructed to drink a good amount of fluids when taking laxatives, such as psyllium, to avoid the development of bowel obstruction.
- The choice of laxative and the individual patient's condition should be carefully considered before administering laxatives to patients with ileus.
- Further research is needed to fully understand the effects of laxatives on patients with ileus and to develop evidence-based guidelines for their use in this context.