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



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