ENEMA in Relieving Constipation - Essay Example

?ENEMA in Relieving Constipation Introduction According to Johanson, 2007, “constipation is a common gastrointestinal motility disorder that is oftenchronic, negatively affects patients' daily lives, and is associated with high healthcare costs”. In the U.S.A. constipation affects nearly 28% of the population (Johanson, 2007). 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. However, from the perspective of the patients, constipation is market by several symptoms that include straining, hard stools, the feeling of incomplete evacuation, bloating of the abdomen, infrequent defecation, and the lack of productivity when the urge is there. The different definitions and concepts of constipation along with the distinction between acute/occasional constipation and chronic constipation, and the viewing that chronic constipation has led to the lack of proper diagnosis and interventions for managing constipation (Johnson, 2006). Literature Review 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 enemas. Phosphate enemas can be effective in acute constipation, but has to be avoided in patients with renal insufficiency, because of the side effect of elevation of serum phosphate levels. Given the limited utility of enemas in acute situations in chronic constipation, with restrictions due to the possible side effects, enemas can longer be considered an effective solution for alleviation of constipation. This more true when we consider the newly introduced effective pharmacological agents for intervention in constipation. Tegaserod is a serotonin receptor agonist, which has received approval by the FDA for use in patients even above the age of 65 years. Good level 1 evidence supports the use of Tegaserod in chronic constipation with established efficacy in improving the frequency of complete spontaneous bowel movements, straining, stool frequency and consistency in patients suffering from chronic constipation. Another new pharmacological agent is Lubiprostone, which is a chloride channel activator that induces intestinal fluid secretion. The highlight here is that this action does not have the side effect of elevated serum levels as is the case with enemas. High quality studies have lent support to it being effective and safe in improving the frequency of spontaneous bowel movements and relieving many of the other symptoms associated with chronic constipation, like stool consistency and straining (Johnson, 2006). Conclusion Evaluation of the evidence on the efficacy and safety of enema as an interventional strategy in alleviating constipation shows that its efficacy is extremely limited and is accompanied by the possibility of side effects. Relevance of enemas in alleviating chronic constipation is further degraded by the introduction of pharmacological agents with proven efficacy and safety in alleviating constipation. Literary References Bowers, B. (2008). Evaluating the Evidence for Administering Phosphate Enemas. British Journal of Nursing, 15(7), 378-381. Funnell, R., Koutoukidis, G. & Lawrence, K. (2009). Tabner’s Nursing Care: Theory and Practice. Victoria, Australia: Elsevier. Johanson, J. F. (2007). Review of the Treatment Options for Chronic Constipation. Retrieved April 14, 2011, from, Medscape General Medicine Web Site: http://www.medscape.com/viewarticle/550956 Johnson, D. A. (2006). Treating Chronic Constipation: How Should We Interpret the Recommendations? Clinical Drug Investigation, 26(10), 547-557. Lemone, P. & Burke, K. (2008). Medical-Surgical Nursing: Critical Thinking in Patient Care. Fourth Edition. New Delhi: Pearson Education India. Meier, D. E. & Monias, A. (2005). Palliative medicine and care of the elderly. In Derek Doyle, Geoffrey Hanks, Nathan Cherny & Kenneth Calman (Eds.), Palliative Medicine (935-944). Third Edition. Oxford: Oxford University Press, Read More