What are the recommendations for using a soap suds enema for constipation relief?

Soap Suds Enema for Constipation Relief

Soap suds enemas should only be used as a second-line intervention when oral treatments fail, with a recommended preparation of 1 mL mild liquid soap per 200 mL solution (1:200 ratio) with a total volume of 1000 mL. 1

Indications and Positioning in Treatment Algorithm

• Suppositories and enemas are preferred first-line therapy specifically when digital rectal examination (DRE) identifies a full rectum or fecal impaction 1
• Enemas should generally be used only if oral treatment fails after several days and to prevent fecal impaction 1
• Small volume self-administered enemas are commercially available and often adequate, while larger volume clinician-administered enemas should be administered by an experienced health professional 1

Preparation and Administration

• Soap solution enema should be prepared with 1 mL of mild liquid soap per 200 mL of solution (1:200 ratio) with a total volume of 1000 mL 1
• The primary mechanism of action is to distend the rectum and moisten/soften feces 1
• Patients should be positioned to optimize gravity and comfort during administration 1

Risks and Contraindications

Potential Risks:

• May cause chemical irritation of the mucous membranes 1
• Risks include perforation of the intestinal wall (suspect if abdominal pain occurs), rectal mucosal damage, and bacteremia 1
• Patients on anticoagulation or with coagulation/platelet disorders are at risk of bleeding complications 1

Absolute Contraindications:

• Neutropenia or thrombocytopenia 1
• Paralytic ileus or intestinal obstruction 1
• Recent colorectal or gynecological surgery 1
• Recent anal or rectal trauma 1
• Severe colitis, inflammation or infection of the abdomen 1
• Toxic megacolon 1
• Undiagnosed abdominal pain 1
• Recent radiotherapy to the pelvic area 1

Alternative Options to Consider

• Before using enemas, consider oral laxative options:

  • Osmotic laxatives (PEG, lactulose, magnesium salts) are strongly endorsed in systematic reviews and generally preferred 1
  • Stimulant laxatives (senna, cascara, bisacodyl) are also effective first-line options 1

• For patients with a full rectum, consider trying suppositories before escalating to enemas:

  • Suppositories containing glycerine, bisacodyl, or CO2-releasing compounds can be effective and less invasive 1

• Non-pharmacological approaches that should be tried before enemas:

  • Ensuring privacy and comfort for defecation 1
  • Proper positioning (using a footstool to assist gravity) 1
  • Increased fluid intake and physical activity within patient limits 1
  • Abdominal massage has shown some efficacy in reducing gastrointestinal symptoms 1

Special Considerations

• In advanced cancer patients, best practice is based on a balance between prevention strategies, self-care, and prescribed oral and rectal laxative therapy 1
• For elderly patients, special attention should be paid to ensuring access to toilets, providing dietetic support, and optimizing toileting habits 1
• For opioid-induced constipation, consider specialized medications (PAMORAs) if standard laxatives fail 1

Practical Administration Tips

• Enemas should be administered by an experienced healthcare professional when using larger volumes 1
• Monitor for abdominal pain during administration, which may indicate perforation 1
• Ensure the patient is in a comfortable position that facilitates retention of the enema for the required time 1
• For severe impaction, pre-medication with an analgesic or anxiolytic may be necessary if manual disimpaction is required 1