From the Guidelines
No, it is not okay to give a Fleet (bisacodyl) enema to a patient with a possible small bowel obstruction (SBO) or ileus. Administering an enema in these conditions could worsen the patient's condition and potentially lead to serious complications. Bisacodyl is a stimulant laxative that increases intestinal motility and secretions, which can increase pressure in an already compromised bowel. In cases of SBO or ileus, the normal forward movement of intestinal contents is already impaired or blocked, and stimulating additional contractions could increase intraluminal pressure, potentially causing bowel perforation, worsening of the obstruction, or exacerbating pain. Instead, management of suspected SBO or ileus typically involves:
- Bowel rest (nothing by mouth)
- Nasogastric tube decompression
- Intravenous fluids
- Close monitoring while addressing the underlying cause, as recommended by 1 and 1. The diagnosis should be confirmed through appropriate imaging such as abdominal X-rays or CT scans, and surgical consultation may be necessary depending on the cause and severity of the obstruction. Stimulant medications that affect bowel motility should be avoided until the obstruction is resolved, as they may increase the risk of complications, as suggested by the principles outlined in 1. Key aspects of care include fluid resuscitation, correction of electrolyte disturbances, and prevention of aspiration, as highlighted in 1. Given the potential for serious complications, it is crucial to prioritize a cautious approach, focusing on supportive care and careful monitoring, rather than interventions that could exacerbate the condition.
From the Research
Administration of Fleet Enema in Possible SBO/Ileus
- The use of a Fleet (bisacodyl) enema in patients with possible small bowel obstruction (SBO) or ileus is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the management of SBO and ileus typically involves bowel rest, nasogastric decompression, and intravenous hydration 2, 4.
- The insertion of a transnasal ileus tube using the anterior balloon method has been shown to be effective in achieving decompression for adhesive SBO 3.
- Medical resuscitation, including intravenous hydration, correcting electrolyte abnormalities, and nasoenteral suction, is a key component of SBO management 4.
- The use of nasogastric tubes has been associated with an increased risk of pneumonia and respiratory failure, as well as longer time to resolution and hospital length of stay 2, 5.
- There is no evidence to suggest that the administration of a Fleet enema would be beneficial or safe in patients with possible SBO or ileus, and it may potentially exacerbate the condition.
- The focus of treatment for SBO and ileus is on medical resuscitation, decompression, and supportive care, rather than the use of enemas or other interventions that may disrupt the bowel 4, 6.