Local Management of Constipation: Enemas, Suppositories

Abstract

The treatment for constipation should be individualized and dependent on the cause, coexisting morbidities, and patient’s cognitivestatus. Although most cases of constipation respond to conservative treatment, including dietary and life-style changes, or mildlaxatives, some patients still complain of consistent symptoms and need an assessment of defecatory dysfunction. There is insufficientevidence to support the use of enemas in chronic constipation, although many clinicians and patients find them useful andeffective for the treatment of fecal impaction when used with other modalities. In addition, suppositories can be considered as an initialtrial for the treatment of defecatory dysfunction, since they help to initiate or facilitate rectal evacuation. The routine use of enemasis typically discouraged, especially sodium phosphate enemas, although tap-water enemas seem safe for more regular use. Soapsuds enemas are not recommended due to possible rectal mucosal damage.