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1. introduction of fluid into the rectum.
2. a solution introduced into the rectum to promote evacuation of feces or as a means of administering nutrient substances, medicinal substances, or opaque material for radiologic examination of the lower intestinal tract; see also barium test. Unless otherwise prescribed, the solution is warmed to 40.5°C (105°F), the patient is placed in Sims' position or knee-chest position, and the rectal tube is inserted. The container of fluid is usually held about 45 cm (18 in) above the buttocks for a cleansing enema. Various types of enema are shown in the accompanying table.
Fleet enema trademark for an enema containing, in each 100 ml, 16 g sodium biphosphate and 6 g sodium phosphate, packaged in a plastic squeeze bottle fitted with a 5-cm prelubricated rectal tube.
phosphate/biphosphate(foss-fate/bye-foss -fate) ,
Fleet Enema(trade name),
Pregnancy Category: C
Intermittent treatment of chronic constipation.Visicol and OsmoPrep: Cleansing of the bowel as a preparation for colonoscopy in adults 18 yr of age or older.
Osmotically active in the lumen of the GI tract.
Produces laxative effect by causing water retention and stimulation of peristalsis.
Stimulates motility and inhibits fluid and electrolyte absorption from the small intestine.
Relief of constipation.
Emptying of the bowel.
Absorption: 1–20% of rectally administered sodium and phosphate may be absorbed; some absorption follows oral administration.
Metabolism and Excretion: Excreted by the kidneys.
Time/action profile (laxative effect)
Contraindicated in: Hypersensitivity;Abdominal pain, nausea, or vomiting, especially when associated with fever or other signs of an acute abdomen;Severe renal or cardiovascular disease;Intestinal obstruction; Obstetric: Not recommended for use at term;Visicol and OsmoPrep—HF, ascites, unstable angina, acute colitis, toxic megacolon, or hypomotility syndrome; Pediatric: Children <2 yr.
Use Cautiously in: Excessive or chronic use (may lead to dependence);Renal or cardiovascular disease, dehydration or concurrent use of diuretics or other drugs known to alter electrolytes (correct abnormalities prior to administration);Dehydration, renal dysfunction, bowel obstruction, active colitis, or concurrent use of diuretics, ACE inhibitors, ARBs, or NSAIDs (↑ risk of acute phosphate nephropathy); Obstetric: May cause sodium retention and edema; Geriatric: May be more sensitive to effects;Visicol—use cautiously within 3 mo of MI or cardiac surgery or in patients with acute exacerbations of inflammatory bowel disease.
Adverse Reactions/Side Effects
Central nervous system
- dizziness (most frequent)
- headache (most frequent)
- arrhythmias (life-threatening)
- cramping (most frequent)
- nausea (most frequent)
- colonic aphtous ulcerations
- ischemic colitis Visicol and OsmoPrep:
- abdominal bloating (most frequent)
- abdominal pain (most frequent)
- vomiting (most frequent)
Fluid and Electrolyte
- sodium retention
- renal dysfunction
Drug-Drug interactionVisicol and OsmoPrep—Concurrently administered oral medications may not be absorbed due to rapid peristalsis and diarrhea.
Route/DosageEach Fleet Enema contains 4.4 g sodium/118 mL
Oral (Adults) Visicol—evening before colonoscopy: 3 tablets every 15 min (with at least 8 oz of water), last dose will be 2 tablets (total of 20 tablets); on morning of colonoscopy starting 3–5 hr before procedure, 3 tablets every 15 min (with at least 8 oz of clear liquids), last dose will be 2 tablets (total of 20 tablets); should not be repeated in less than 7 days; OsmoPrep—evening before colonoscopy: 4 tablets every 15 min (with at least 8 oz of water) for a total of 20 tablets; on morning of colonoscopy starting 3–5 hr before procedure, 4 tablets every 15 min (with at least 8 oz of clear liquids), for a total of 12 tablets; should not be repeated in less than 7 days.
Rectal (Adults and Children >12 yr) 118 mL Fleet Enema.
Rectal (Children >2 yr) ½ of the adult dose.
Availability (generic available)
Enema: 7 g sodium phosphate and 19 g sodium biphosphate/118 mL
Tablets (Visicol): 1.5 g
Tablets (OsmoPrep): 1.5 g
- Assess patient for fever, abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
- Assess color, consistency, and amount of stool produced.
- May rarely cause arrhythmias. Monitor patients with underlying cardiovascular disease, renal disease, bowel perforation, misuse or overdose.
- Lab Test Considerations: May cause ↑ serum sodium and phosphorus levels, ↓ serum calcium and potassium levels, and acidosis. Electrolyte changes are transient, self-limiting, do not require treatment and are not usually associated with adverse clinical events.
Potential Nursing DiagnosesConstipation (Indications)
- Do not administer at bedtime or late in the day.
- Oral: Administer on an empty stomach for more rapid results. Mix dose in at least ½ glass cold water. May be followed by carbonated beverage or fruit juice to improve flavor.
- See Route and Dose section for dosing of Visicol and OsmoPrep. Undigested Visicol tablets may appear in the stool or be visualized during colonoscopy.
- Osmoprep: Do not drink any red—or purple-colored liquids.
- Rectal: Position patient on left side with knee slightly flexed. Insert prelubricated tip about 2 inches into rectum, aiming toward the umbilicus. Gently squeeze bottle until empty. Discontinue if resistance is met, because perforation may occur if contents are forced into rectum.
- Advise patient that laxatives should be used only for short-term therapy. Long-term therapy may cause electrolyte imbalance and dependence.
- Caution patient on sodium restriction that this product has a high sodium content.
- Advise patient not to take oral form of this medication within 2 hr of other medications.
- Encourage patient to use other forms of bowel regulation, such as increasing bulk in the diet, fluid intake, and mobility. Normal bowel habits may vary from 3 times/day to 3 times/wk.
- Advise patient to notify health care professional if unrelieved constipation, rectal bleeding, or symptoms of electrolyte imbalance (muscle cramps or pain, weakness, dizziness, and so forth) occur.
- Soft, formed bowel movement.
- Evacuation of the bowel.