Female enema stories

Added: Wojciech Skelly - Date: 06.01.2022 03:52 - Views: 44971 - Clicks: 3911

Try out PMC Labs and tell us what you think. Learn More. Constipation is a common complaint, frequently treated with cleansing enema. Enemas can be very effective but may cause serious adverse events, such as perforation or metabolic derangement. Our aim was to evaluate the outcome of the use of cleansing enema for acute constipation and to assess adverse events within 30 days of therapy.

We performed a two-phase study: an initial retrospective and descriptive study infollowed by a prospective study after intervention, in According to the of the first phase we established female enema stories for the treatment of constipation in the Emergency Department and then used these in the second phase.

There were and cases of severe constipation in the first and second periods of the study, respectively. There was a Adverse events and especially, the perforation rate and the day mortality in patients with constipation decreased ificantly in the second phase: 3 1. Enema for the treatment of acute constipation is not without adverse events, especially in the elderly, and should be applied carefully.

Female enema stories

Guidelines for the treatment of acute constipation and for enema administration are urgently needed. Constipation is a common complaint and is associated with ificant health care costs. Most patients self-medicate to treat constipation, usually with over-the-counter OTC drugs, but some need urgent intervention and are referred to the Emergency Department ED.

Many of these patients are demented, have cognitive deficits, or suffer from a female enema stories disorder. The communication between the treating team and these patients may be impaired, and the proper feedback about pain or the side effect of treatments is not optimal. Acute constipation requires urgent and comprehensive assessment because a serious medical condition may be the underlying cause. A careful medical history, investigation of medications that can cause constipation, and physical examination including rectal examination are important in all patients with severe constipation, in order to define the type of constipation and direct the physician to the correct diagnosis, treatment, and intervention.

Rectal examination can assess sphincter tone and tenderness, and may uncover a palpable mass, fissure, or mucosal prolapse. Cleansing enema is a popular method for treatment of constipation. The function of enema is dependent on several different mechanisms. By distending the rectum, all enemas stimulate the colon to contract and eliminate stool.

Other mechanisms, such as that employing phosphate enemas, directly stimulate the muscles of the colon. The most frequent cause of perforation in patients who underwent enema has been reported to be the device tip; other causes are related to localized weakness of the rectal wall, obstruction, or the position of the patient when the enema was performed.

Our aim was to evaluate the outcome of using cleansing enema for severe, acute constipation, in patients referred to the ED of Rabin Medical Center, Beilinson Hospital and to assess the adverse events within 30 days of therapy. A retrospective first phase study was conducted between January 1, and December 31, We studied all the patients that were referred to the ED on an emergency basis because of severe constipation. We included all patients referred, without exclusion. The data collection included: gender, age, medical history, the of physical examination, the of imaging procedures, the type of treatment for constipation, and the outcome assessment, including treatment effectiveness and discharge or hospitalization.

We also looked at return visits to the ED female enema stories 1 week and day mortality. A prospective, interventional second phase study followed between March 1, and Feb 29,using the same methods, after having developed, distributed, and implemented the use of clinical guidelines for the treatment of constipation. An expert committee was convened that included experienced physicians from the departments of Surgery, Gastroenterology, Geriatrics, Nephrology, and Emergency Medicine, and experts from the Risk-Management Unit and Pharmacy.

The literature was reviewed, and the of the retrospective study were discussed. Clinical guidelines for the diagnosis and treatment of acute constipation were written and distributed in the medical center. An implementation program was carried out in the ED, over a period of 2 months. Categorical data were described proportionally using descriptive statistics. The level of ificance adopted was 0. There were 97, and 99, visits to the ED at Beilinson Hospital, Rabin Medical Center, in the first and second phases of the study, respectively.

The of patients with constipation was similar, 0. Female enema stories of the patients were older than 65 years. There was no statistically ificant difference in age and gender between the groups. The length of stay in the ED was ificantly shorter in the second period of the study. The abdominal examination was normal in most of the patients in both study periods, and the physical s were also similar between the groups.

A rectal digital examination was performed in Fecal stones were found in 37 patients and a rectal tumor in five.

Female enema stories

Hemoglobin, white blood cell count, and creatinine levels were similar in both periods. More X-ray studies were performed in the second period. Paralytic ileus was demonstrated in four patients and was suspected in 12 patients. Cleansing enema was performed in Age, renal function, blood pressure, or drugs including ACE inhibitors and ACE antagonists were not taken into consideration before treatment with Fleet Enema. A combination therapy of cleansing enema and oral laxative was used in more patients during the first period of study; laxative with no additional enema was used in more patients during the second period.

Reassessment before discharge from ED was performed in The perforation rate and the day mortality were ificantly higher in the first than in the second period studied. The causes of death are given in Table 5. One patient in the first period of the study died after Fleet Enema because of hyperphosphatemia and phosphate nephropathy. The rate of return visits was also higher in the first period. The guidelines included instructions for diagnosis and the treatment of acute constipation in the ED, the identification of enema risk factors, description of the method of female enema stories administration and follow-up, and recommendation for the specific enema type.

X-ray study is indicated according to the clinical picture.

Female enema stories

The use of Fleet Enema phospho-soda is forbidden due to the danger of hyperphosphatemia and phosphate nephropathy. Cleansing enema should be performed carefully with another product, and the volume should not exceed mL. Administration of the enema is done with a rectal tube, by experienced personnel.

Female enema stories

Perforation should always be anticipated and suspected if abdominal pain appears. Cleansing enema is contraindicated in patients with fecal stones, rectal obstruction by tumor or rectal prolapse, active coronary heart disease, and in comatose or noncompliant patients. In addition, enema should be avoided in cancer patients under chemotherapy and in other immunocompromised patients, especially those with severe neutropenia. Before patient discharge from the ED, reassessment of the clinical status should be performed and includes physical abdominal examination and measurement of vital s.

Instructions about adverse events or complications that could occur should be discussed. The patient is instructed to return immediately to the ED if rectal bleeding occurs or if abdominal pains appear. Quality and risk management processes are an essential part of our daily work, in order to improve patient management and safety. We believe that these processes should be based on evidence and good clinical research.

In this study, we looked at a female enema stories common complaint of constipation, after an anecdotal impression of a high incidence of perforation and mortality. Constipation is increasingly found in the elderly population and is becoming an important cause of morbidity. In our daily practice we encountered cases of perforation and mortality after cleansing enema but could trace only case reports or small cohort studies in the literature; we could not find any study looking at the incidence of enema complications or adverse events.

Two case series from Israel described elderly patients that had perforation after cleansing enema. Gayer et al 11 described 14 cases of rectosigmoid perforations that were picked up from the CT scan database in a period of 6 years.

These patients were older, with an average age of 80 years. Since these articles did not mention the total of patients that were hospitalized during the studies, the incidence could not be calculated. Because enema is freely available and largely self-administered, with no or little inspection, we could not estimate the true rate of adverse events related to its use.

Our study is the first to demonstrate the incidence of adverse events and the day mortality rate after cleansing enema performed by a nurse, in acutely constipated patients treated at an ED. We found three cases of rectal perforation and one case of hyperphosphatemia in the first period of the study compared with no cases in the second period, and this may be due to the new comprehensive guidelines that were established and implemented by the physicians and nurses.

The main difference in clinical behavior between the periods of the study was the preference for oral laxatives over enemas and the careful reassessment of the female enema stories prior to discharge, shown in the second period.

Female enema stories

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