Enema For Mature Mom ((HOT))

Mrs N.M. is an 88-year-old woman who is new to your practice and is brought in today by her daughter. She would like help regarding constipation, which is not new for her. She states that a few months ago she had gone to the local emergency department with abdominal cramping and bloating. After a thorough assessment and abdominal x-ray scan she was diagnosed with fecal impaction secondary to psyllium fibre supplement use with low fluid intake. She was treated with an enema, instructed to take 17 g of polyethylene glycol 3350 (PEG 3350) daily, and educated on lifestyle changes to reduce constipation. (In this article, PEG 3350 is without electrolytes, unless otherwise stated.)

enema for mature mom

Recommendations for laxatives in older adults are similar to those used in the general adult population.2 Bulking agents (eg, psyllium) are effective in the management of constipation in patients who can drink 1 glass of water with each dose. Mrs N.M. has tried psyllium, which resulted in fecal impaction due to low fluid intake. Treatment of impaction would include manual disimpaction using 2% lidocaine gel to anesthetize and lubricate the rectum and anus.29 A mineral oil enema would be preferred over a sodium phosphate enema. Repeat mineral oil enemas daily, for up to 3 days if required.

If the stool is located higher up in the intestine and manual disimpaction and enemas are ineffective, try 2 L of oral PEG 3350 with electrolytes for 1 to 2 days30 or 1 L of oral PEG 3350 with electrolytes for 3 days.31,32 Additional laxatives (oral or suppositories) or dose adjustments to maintenance therapy might be required. Avoid bulk-forming laxatives in the setting of impaction.

The main thing to know is that the most commonly available form, saline enemas (Fleet is a common brand name), have been associated with serious electrolyte disturbances and even kidney damage. Because of this, the FDA issued a warning in 2014, urging caution when saline enemas are used in older adults.

Frequent use of enemas is really a sign that a person needs a better bowel maintenance regimen. This often means some form of regular laxative use, plus a plan to use a little extra oral laxative as needed, before things reach the point of requiring an enema.

I would hope that your grandmother could be spared daily enemas, unless that is her preference. I have had many patients get good outcomes with the use of MiraLAX as often as daily. It pulls fluid into the bowel and makes the stools easier to pass, and the side effects are few. Best of luck.

Thank you for the informative article on constipation.I am 72 years of age and have constipation due to redundant sigmoid colon. I am taking ducolax and detox every two or three days to have bowel movements. I sometimes supplement with enema when I can feel the urge but cannot poop. 041b061a72