Enema Procedures and Ostomy Care: A Comprehensive Overview
Enema Procedures
An enema is defined as the introduction of a solution into the rectum or the lower colon. The contents are drained by natural means or by artificial stimulation of intestinal peristalsis. Enemas are used to clean and remove solids or gas from the intestine, and to administer solutions to be retained.
According to their purpose, enemas can be classified as follows:
Ordinary Enemas
Ordinary enemas are solutions that are administered and expelled within 10 minutes. The expelled soap solution can be from 500-1500ml (neutral soap) or commercially prepared.
Retention Enemas
These are enemas in which the introduced solution should not be evacuated immediately (holding for 30 minutes).
Cleansing Enemas
Cleansing enemas are voiding enemas without retention. Their purpose is to promote intestinal peristalsis, causing a rapid evacuation of stool, gas, and other substances. The situations in which cleansing enemas are most often used are:
- Constipation
- After the extraction of a fecaloma
- Before childbirth or surgical intervention
- Before a drug or barium enema
- Before an enema of retention
- Before endoscopy
Commercial Enemas
Commercial enemas are disposable. Follow the steps indicated by the manufacturer. They are composed of hypertonic solutions that cause abdominal distention by irritating the mucosa and stimulating the urge to defecate. The patient is placed in the left lateral or left Sims position. The enema is given directly through the cannula of the preparation into the anus. The solution must be retained for 10 minutes. After the evacuation, follow the same pattern as a cleansing enema.
Retention Enema
The management techniques and precautions to be taken into account are the same as for cleansing enemas. In this case, the patient should retain the solution for 30 minutes to promote its purpose.
Types of Enemas
Some of those used today are:
- Oil Enemas: Lubricates the mucosa and softens the stool. In adults, 150-200ml of oil is administered at body temperature. It can also be used with barium salts for contrast radiography.
- Medicated Enemas: They must be absorbed through the intestinal lining to have a local or systemic effect. For example, an antibiotic enema may be applied prior to colon surgery, or anthelmintic, antiseptic, etc.
- Barium Enemas: Its purpose is to diagnose by visualizing the large intestine for radiological study. Commercially prepared enemas usually just require adding warm water.
Care of the Ostomy Patient
An ostomy is defined as the procedure or surgery in which an artificial hole (stoma) is made in the external abdominal surface to facilitate the removal of bowel contents.
Types of Ostomies
- Ascending Colostomy: It is performed on the patient’s ascending colon for conditions like perforated diverticulitis, inoperable tumors of the colon, or trauma. The patient expels watery or semi-solid stools continuously.
- Transverse Colostomy: It is performed on the transverse colon. The indications are the same as for the previous type, but it is used more often. The stools are usually semi-solid.
- Descending or Sigmoid Colostomy: This is indicated in cases of colorectal cancer in this section of the digestive tract, chronic diverticulitis, or trauma. It is the most common and easiest to control. The stools have a certain consistency.
- Ileostomy: It is practiced on the ileum for ulcerative colitis, cancer, or Crohn’s disease. It is important to secure the bag properly to avoid skin damage from the enzymatic drainage of the stoma.
Stoma Complications
- Early Postoperative: Edema, hemorrhages, and hematomas.
- Late Complications: Periostomal dermatitis and hernia.
Stoma Care Aims
- Intestinal emptying of gas, mucus, and feces so that the patient can lead a normal life.
- Teaching the patient to become accustomed to a defecation schedule, respecting their dietary measures.
- Taking into account the physical and psychological aspects of ostomy care. Involve the patient in the care of their ostomy and provide all necessary support.
- Pain management is very important for the patient to accept the problem.
Skin Care
Clean skin abrasions with towels, warm water, and very soft soap. Remove with a towel or gauze, using gentle touches. Remove all soap to avoid irritating the skin. Dry with air. If irritations appear, treat them with a protective paste.
Besides bags, plates or protective rings are used for the stoma. Place these carefully to avoid complications.
Changing the Dressing and the Ostomy Bag
These hygiene procedures prevent infections and provide comfort to the patient. One-piece (disposable) or two-piece bags can be used. The one-piece bags are applied directly to the skin. The two-piece devices can be closed by a ring bearing a protective adhesive disk on which the bag is fixed. They usually contain products that decrease odor. They can be secured with belts.
Colostomy Irrigation
It is defined as the washing of the intestine through the artificial anus to control fecal incontinence, prepare the patient for surgery or intestinal radiology, and pass stool if necessary, prescribing medications for constipation in some cases. It may be contraindicated, such as in colostomies in children, patients with diarrhea, or those receiving radiotherapy.
In ostomy patient care, the nursing assistant works with the nurse in the realization of the different procedures when their help is needed. Everyone involved in comprehensive patient care fosters acceptance and adaptation to the new situation, collaborating on health education and learning self-care.