Enema Selection / Comparison Table A short guide for choosing which enema to order depending on the clinical situation and important contraindications to consider when treating constipation and impaction. Sodium Phosphate “Fleet” Enema: - Volume: 118 mL - Mechanism: Hyper-osmotic - Notes: Fastest onset (if safe), low volume - Contraindications: CKD (phos ↑), CHF (Na ↑), ascites, electrolyte derangements, hypovolemia Soap Suds Enema: - Volume: 5 mL Castile soap + 0.5-1L H2O - Mechanism: Stretch, chemical irritant - Notes: Low fluid/electrolyte shifts - Contraindications: Colitis, IBD, recent biopsy or surgery Mineral Oil Enema: - Volume: 118 mL - Mechanism: Lubricant - Notes: Hard, dry impaction → follow with cleansing enema - Contraindications: ↑ Aspiration risk in neuro impaired, avoid concurrent use with docusate Tap Water Enema: - Volume: 0.5-1L - Mechanism: Stretch - Notes: Low fluid/electrolyte shifts - Contraindications: SIADH, Hyponatremia Lactulose Enema: - Volume: 300 mL + 700 mL H2O or NS - Mechanism: Osmotic - Notes: Typical used in hepatic encephalopathy - Contraindications: Galactosemia Docusate “Colace” Enema: - Volume: 5-25 mL - Mechanism: Surfactant stool softener - Contraindications: Avoid concurrent use with mineral oil #Enema #Comparison #Table #Fleet #SoapSuds #MineralOil #Gastroenterology #Constipation #Management #Impaction #Pharmacology
