Relief from behind: enemas, the back door enforcement to help treating chronic constipation in adults

ABSTRACTIntroduction Chronic constipation is a frequent symptom encountered in the daily clinical practice. The treatment of this condition mainly relies on the use of laxatives. However, patients' satisfaction with this approach is limited, and alternative measures are often added to the treatment. Among these, particularly frequent worldwide is the use of enemas, even though literature data on its scientific validity are scarce.Areas covered In this article, by an extensive online search of Medline (through PubMed), Scopus, Cochrane CENTRAL, EMBASE, and the Science Citation Index, the available literature data on the use of enemas in adult patients with chronic constipation, also in the perspective of available guidelines on treatment of this pathological condition, were analyzed.Expert opinion Although the use of enemas remains a frequently employed method and it is considered as useful by many physicians as an adjunctive support for the treatment of chronic constipation in adults, this practice is not substantiated by rigorous scientific data, and some studies are available only for specific instances (fecal impaction, transanal irrigation). Thus, waiting for more robust scientific data, enemas treatment should be carried out on an individual patient's basis, according to the experience of the caring physicians.KEYWORDS: Adultsconstipationenemafecal impactiontransanal irrigation AcknowledgementThis paper is dedicated to Bree.Article highlights Chronic constipation is a frequent symptom in the general populationThe treatment of chronic constipation is still somewhat unsatisfactory for a certain number of adult patientsUse of multiple therapeutic associations is frequent in these patients, together with alternative optionsOne of the more frequent association/alternative options is represented by the use of enemasAlthough frequently employed and generally considered as safe and discretely effective, the use of enemas to treat constipated patients is not supported by solid scientific evidenceThere is the need for scientifically sound data obtained by rigorous clinical trials to ascertain the real value of enema treatment in constipated adult patientsDeclaration of interestThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.