From the Research
A rectal tube is beneficial for patients experiencing severe gaseous distention, discomfort from excessive flatus, or those with acute colonic pseudo-obstruction (Ogilvie's syndrome). This intervention is particularly useful for postoperative patients with abdominal distention, those with ileus, or individuals with neurogenic bowel dysfunction who cannot effectively expel gas 1. The tube works by providing a controlled pathway for gas to escape from the rectum, bypassing the anal sphincter and reducing abdominal pressure.
Key Considerations
- Rectal tubes should be inserted no more than 10-15 cm into the rectum, secured properly to prevent dislodgement, and generally left in place for short periods (usually 20-30 minutes at a time, or intermittently for up to 48-72 hours in severe cases) 2.
- Regular assessment for rectal mucosa irritation or bleeding is essential, as complications such as massive rectal bleeding can occur, particularly in patients receiving therapeutic doses of anticoagulation and antiplatelet drugs 3.
- This intervention is typically temporary while addressing the underlying cause of gas accumulation, and should be discontinued once the patient can pass flatus normally or when abdominal distention resolves.
Patient Selection
- Patients with fecal incontinence, particularly the elderly, may benefit from an initial medical evaluation, including the exclusion of fecal impaction, and selected patients may benefit from biofeedback and surgical intervention 4.
- Cognitively impaired patients may benefit from habit training, while others may require more specialized management strategies, such as those outlined in expert consensus documents on the evaluation of anorectal function 1.
Important Notes
- The use of rectal tubes and other management strategies for fecal incontinence and constipation should be guided by the most recent and highest quality evidence, taking into account the individual patient's needs and underlying conditions 5.
- A thorough evaluation, including digital rectal examination and other diagnostic tests, is crucial in determining the best course of treatment for patients with defecatory disorders 2.