ENEMA in Relieving Constipation.
There is no single universally acceptable definition for constipation. From a clinical perspective constipation us characterized by the reduction of the frequency in bowel movement. …
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An enema is the introduction of a solution into the rectum and sigmoid column. And is a common clinical practice by nursing to promote the evacuation of feces in patients complaining of constipation (Funnell, Koutoukidis & Lawrence, 2009). Bowers, 2008, in the evaluation of evidence on the use of phosphate enema as an intervention for constipation, points out that though phosphate enemas are routinely used in clinical practice for relieving constipation, there is no clear evidence to support the continued use of phosphate enemas. This finding stems from the limited evidence available in support of enemas, as a more effective intervention in constipation, over the other medication and treatment strategies available in the management of chronic constipation, though phosphate enemas have useful for some diagnostic bowel investigations. This lack of evidence of efficacy on enemas is further compounded by two factors, reducing the potential use of enemas as an intervention in constipation. The first factor lies in the detrimental complications in the patient that could arise from the use of enemas in the management of constipation. The second factor pertains to the need to avoid the use of phosphate enemas in patients with certain underlying conditions (Bowers, 2008). The findings of Bowers 2008, in the evaluation of phosphate enema is strongly supported by the body of knowledge on constipation and its treatment, which can be extended to the use of enemas in the interventions to alleviate constipation. Based on the history of the patient and the duration of symptoms, it is possible to differentiate constipation into occasional constipation (Johnson, 2006). Using enemas is known to interfere with normal bowel movement and enemas are not recommended in simple constipation. Enemas should not be considered as a means to alleviate constipation when there is obstruction of the bowel and the cause of the obstruction is still to be diagnosed. Additionally, enemas are not an option when the constipation is accompanied by abdominal pain, rectal fissures, and ulcerated hemorrhoids. This is because evidence shows that in all these cases enemas can lead to mechanical damage and perforation of the bowel (Lemone & Burke, 2008). Evidence points to use of enemas only in the case of significant or chronic constipation, particularly, when the constipation arises from fecal impaction. The general rule in the use of enemas is that it be employed in acute situations and that too only on short term basis. Phosphate enemas are efficient is such situations through its ability to draw fluid into the bowel and irritate the mucosa, causing evacuation of the bowel. However, repeated use of enemas is known to cause impaired bowel function and fluid and electrolyte imbalances. This is particularly true in the case of phosphate enemas and tap water enemas (Lemone & Burke, 2008). Meier & Monias, 2005, point out a further restriction in the use of phosphate en
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