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Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
A suggested protocol for the management of constipation is shown in Figure 12.2. In constipated older people who are otherwise well and ambulant, a wide range of oral agents could be tried. These include bulking agents, osmotic agents (lactulose, sorbitol and PG) and stimulants (bisacodyl and senna). Suppositories and enemas are an alternative but evidence of benefit is lacking and patient acceptance is likely to be lower. In constipated older people who are functionally impaired, treatment options are determined by the situation. Osmotic agents usually require swallowing a large volume of liquid and are likely to be unsuitable for people with reduced fluid intake. Bulking agents should be avoided in this group and those with impaired swallowing due to a risk of worsening constipation. Stimulant laxatives only require swallowing a small volume. Enemas are useful for people with very little oral intake (i.e. secondary to constipation or resultant delirium) and in cases of faecal impaction. If pharmacotherapy fails to resolve faecal impaction, then, occasionally, manual evacuation becomes necessary.
Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Disadvantages include: Suppository and enema administration is more invasive and embarrassing than oral administration and involves some discomfort, undressing and moving into the correct position.Traumatic and even fatal side effects of enemas, including inflammation, electrolyte imbalance and perforation of the colonic mucosa have been reported (Schmelzer and Wright 1996). Newer, small, pre-packaged enemas aim to prevent such problems. However, enemas should only be used if there is no other alternative.
Management of Labour
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Enema: A low enema to activate the rectum is necessary if the rectum is full. It prevents soiling of the field at the time of delivery and helps in the good progress of labour. An empty rectum and urinary bladder become imperative at a second stage as she will tend to evacuate these organs on the table before the fetus can be pushed out.
Advances in rectal drug delivery systems
Published in Pharmaceutical Development and Technology, 2018
Trusha J. Purohit, Sara M. Hanning, Zimei Wu
Any solution, emulsion or suspension for rectal administration is referred to as an enema, or micro-enema if administration volume is small such as 5–10 ml. These formulations contain either oil, glycerin or low molecular weight macrogol as vehicle (van Hoogdalem et al. 1991). Administration volume may vary from 2.5 ml up to few hundred milliliters and applicators can be used to assist administration such as the Macy Catheter®, a recently FDA-approved medical device for rectal administration of fluids (Lam et al. 2016). Enemas are used for rectal stimulation to initiate defecation before operative procedures (Pittet et al. 2015) and for localized treatments of inflammatory bowel disease or ulcerative colitis (Spencer and McTavish 1995; Matuszyk et al. 2016) or as a medium to deliver contrast agent before radiographic examination. Despite micro-enemas being more advantageous than large volume enemas, the packaging and transportation costs make them a less favorable formulation than large volume enemas (Aulton and Taylor 2013).
The burden of constipation in psychiatric hospitals
Published in International Journal of Psychiatry in Clinical Practice, 2018
Unax Lertxundi, Rafael Hernandez, Sonia San Miguel, Beatriz Corcostegui, Marta Prieto, Unai Gonzalez, Anunciacion Arana, Juan Medrano
The daily defined doses (DDDs) used for individual laxatives were those assigned by the WHO Collaborating Centre for Drug Statistics Methodology, and correspond to the daily mean dose for the main indication of the drug in the adult population (WHO Collaborating Centre for Drug Statistics Methodology 2016). Total laxative use was then calculated as the sum of individual DDD of all laxative drugs divided by the annual hospital stay number. Individual laxative use and its contribution to the total laxative burden were also measured in all hospitals. The use of rectal enemas was studied separately. Total enema consumption was reported as total enema units consumed per 100 hospital stays. Further, the use of supplementary fibre was assessed.
An update on treatment of ulcerative colitis
Published in Expert Opinion on Orphan Drugs, 2019
In patients with mild to moderate activity who are not responding or intolerant to 5-ASA, beclomethasone dipropionate (BDP) or budesonide (BUD) may be used for induction of remission. Both are ‘locally’ acting because of intestinal release with high first pass metabolism and minimal systemic effects. In some countries, they are also available as an enema. Both have no role in the maintenance of remission. In a recent meta-analysis, oral-prolonged release BDP (5 mg/daily for 4 weeks then every other day for other 4 weeks) showed a superior efficacy vs. oral 5-ASA in inducing clinical improvement of mild-to-moderate UC with a similar safety profile, similar efficacy and a trend towards a better safety profile compared to prednisone [20].