Enema Selection in Dialysis Patients
A dialysis patient should receive a phosphate-free rectal therapy. Microlax (excluding Fleet enema) and glycerin (or bisacodyl) suppositories are recommended as PRN rectal options in chronic kidney disease. [1]
Recommended Safe Options
- Microlax® enema (excluding Fleet enema) is recommended as a PRN rectal option with onset in minutes. [1]
- Glycerin suppository is recommended as a PRN rectal option with rapid onset. [1]
- Bisacodyl suppository is recommended as a PRN rectal option with rapid onset. [1]
Enemas to Avoid in Dialysis Patients
- Fleet enema should be avoided due to phosphorus content. [1]
- Phosphate-containing laxatives (including phosphate preparations) should not be used due to risk of hyperphosphatemia. [1]
- Sodium phosphate enemas should be avoided in chronic kidney disease. [2]
When Rectal Therapies Are Appropriate
- Rectal therapies should be used PRN rather than for chronic use. [1]
- If constipation persists and fecal impaction is a concern, rectal therapies PRN are considered after evaluation for obstruction/impaction. [1]
Practical Safety Considerations
- Rectal therapies should be avoided as a substitute for evaluation when fecal impaction or bowel obstruction is possible. [1]
Timing and Escalation
- If no bowel movement occurs after 3 days, oral osmotic therapy with PEG 3350 without electrolytes or lactulose is recommended as initial treatment in chronic kidney disease. [1]
- If constipation persists with no bowel movement for 7 or more days, fecal impaction and bowel obstruction should be ruled out before further rectal or oral interventions. [1]
Targeting Regular Bowel Motions
- A goal of regular bowel movements is recommended, such as every 1–2 days, to reduce complications such as hyperkalemia risk. [1]