Can suppositories be given to a patient with a colostomy and no output for 3 days?

Management of Suppositories in a Patient with Colostomy and No Output for 3 Days

Suppositories can be used in patients with a colostomy who have no output for 3 days, but they may not be effective without an additional device to hold the suppository in place due to difficulty retaining the suppository in the stoma. 1

Assessment of Colostomy Output Issues

• Normal colostomy output is typically formed stool occurring once daily, while no output for 3 days indicates constipation that requires intervention 2
• Constipation in colostomy patients presents as prolonged periods between bowel movements, passage of pasty or hardened fecal effluent, and associated symptoms such as abdominal discomfort, bloating, flatulence, and pain 3
• Before administering any treatment, exclude other causes of output issues such as:
  • Partial/intermittent bowel obstruction 4
  • Intra-abdominal sepsis 4
  • Stomal stenosis 3

Treatment Options for Constipation in Colostomy Patients

First-Line Approaches (Before Suppositories)

• Dietary modifications should be the first intervention as they are successful in approximately 60% of colostomy patients with constipation 3
  • Increase dietary fiber intake 3
  • Increase fluid intake 3

Medication Options

• If dietary interventions fail, consider:
  • Psyllium-based bulk-forming agents 3
  • Osmotic stool softeners 3
  • Probiotics 3
  • Prokinetic agents such as metoclopramide 3

Suppository Use in Colostomy

• Glycerin suppositories can be considered for controlled colostomy emptying 1
• However, research shows that suppositories may not be effective due to their failure to remain in the bowel for an adequate amount of time 1
• An adjunct device or method to hold the suppository in place may be needed for successful results 1

Colostomy Irrigation as an Alternative

• Colostomy irrigation is a procedure that allows patients to achieve bowel control and can help address constipation 5
• Benefits of colostomy irrigation include:
  • Improved quality of life and confidence 5
  • Reduced odor and flatus 5
  • Prevention of peristomal skin irritation 5
  • Alleviation of constipation 5

Monitoring and Follow-up

• Regular assessment of stoma output volume is essential for early detection of abnormalities 2
• Document the following characteristics of colostomy output:
  • Color (normal brown or abnormal black, green, or red) 6
  • Consistency (formed, semi-formed, loose, or liquid) 6
  • Volume 6
  • Presence of unusual odor or abnormal components 6

Important Considerations and Cautions

• The use of parenteral and transdermal routes and suppositories should be considered in patients with limited intestinal absorption 4
• However, drug absorption from the gastrointestinal tract may be considerably impaired in patients with short bowel syndrome or other conditions affecting absorption 4
• When using suppositories in colostomy patients, be aware that research has shown limitations in their effectiveness without additional methods to ensure retention 1