How to administer a Fleet (sodium phosphate) enema?

From the Guidelines

To use a Fleet enema, it is essential to follow proper instructions to minimize risks and maximize effectiveness, as outlined in the most recent guidelines 1. When using a Fleet enema, first wash your hands thoroughly and remove the protective shield from the enema tip. Lie on your left side with knees bent and arms at rest, or alternatively, use a knee-chest position (kneeling with chest touching the surface). Gently insert the lubricated tip into your rectum, aiming toward your navel. Squeeze the bottle steadily until nearly all liquid is expelled, then remove the tip while maintaining pressure on the bottle. Try to hold the liquid inside for 2-5 minutes before using the toilet. Fleet enemas typically contain sodium phosphate or saline solution that works by drawing water into the bowel, softening stool and stimulating bowel contractions. This process usually produces a bowel movement within 1-5 minutes after expelling the liquid. Some key considerations when using Fleet enemas include:

• Do not use more than one enema in 24 hours unless directed by a healthcare provider, as overuse can cause electrolyte imbalances 1.
• If you experience severe cramping, dizziness, or weakness, contact a healthcare provider immediately.
• Fleet enemas should not be used regularly for constipation management as they can create dependence.
• Enemas are contraindicated for patients with neutropaenia or thrombocytopaenia, paralytic ileus or intestinal obstruction, recent colorectal or gynaecological surgery, recent anal or rectal trauma, severe colitis, inflammation or infection of the abdomen, toxic megacolon, undiagnosed abdominal pain or recent radiotherapy to the pelvic area 1. It is crucial to weigh the benefits and limitations of using Fleet enemas, considering the potential for electrolyte imbalances and other adverse effects, as discussed in the guidelines 1.

From the Research

Using Fleet Enema

To use a fleet enema, follow these steps:

• Read the instructions on the packaging carefully before use 2, 3.
• Prepare the enema by shaking the bottle well and removing the protective cover from the tip 2, 3.
• Lie on your left side with your knees bent and insert the tip of the enema into your rectum, squeezing the bottle to release the contents 2, 3.
• Remain in this position for a few minutes to allow the enema to take effect 2, 3.
• You may feel a strong urge to have a bowel movement, which should occur within a few minutes to an hour after using the enema 2, 3.

Precautions and Interactions

When using a fleet enema, consider the following precautions and interactions:

• If you have any underlying medical conditions, such as kidney disease, consult with your doctor before using a fleet enema 4, 5, 6.
• Be aware of potential interactions with other medications, such as anticoagulants, oral iron supplements, non-opioid analgesics, antihistamines, and opioid analgesics 4, 5, 6.
• Fleet enemas may not be suitable for everyone, especially those with certain medical conditions or taking specific medications, so it is essential to consult with a healthcare professional before use 4, 5, 6.

Potential Benefits for CKD Patients

For patients with chronic kidney disease (CKD), fleet enemas may have potential benefits, including:

• Restoring the intestinal barrier and microbiota-gut-kidney axis balance to alleviate CKD symptoms 2.
• Regulating the production of short-chain fatty acids, which can improve the intestinal barrier damage in CKD 3.
• Reducing inflammation levels and improving kidney pathology 2, 3.