Enema Therapy for Fecal Impaction

Patient Selection and Enema Type

• For elderly patients with recurrent fecal impaction or swallowing difficulties, rectal measures including enemas are the preferred first-line treatment choice, according to the European Society of Medical Oncology 1, 2
• Isotonic saline enemas are the recommended choice for older adults rather than sodium phosphate enemas due to fewer adverse effects in this age group, as suggested by the European Society of Medical Oncology 1, 2, 3

Enema Mechanism and Administration

• Soap suds enemas work through mechanical irritation and stimulation of the rectal mucosa 1
• Lactulose enemas create an osmotic gradient drawing water into the colon, softening stool consistency, and produce 2-3 soft, non-forced bowel movements as the therapeutic goal 4

Safety Considerations

• Do not use soap suds enemas in elderly patients with cardiac or renal comorbidities - isotonic saline is safer, as recommended by the European Society of Medical Oncology 1, 2
• Monitor for dehydration and electrolyte imbalances when using any enema therapy in elderly patients with heart or kidney failure, according to the European Society of Medical Oncology 2, 3