CE: Original Research: Are Milk and Molasses Enemas Safe for Hospitalized Adults? A Retrospective Electronic Health Record Review.

UNLABELLED: : Background: Constipation in hospitalized patients is common. As a treatment of last resort for unresolved constipation, a milk and molasses enema is often used by nursing staff. But there has been little research investigating the safety and efficacy of this approach.

PURPOSE: The purpose of this retrospective study was to evaluate the safety of milk and molasses enemas for hospitalized adults with constipation that remained unresolved after standard treatment options were exhausted.

METHODS: Data were extracted from the electronic health records (EHRs) of 615 adult patients who had received a milk and molasses enema between July 2009 and July 2013 at a large midwestern academic medical center. Data analysis occurred for a random subset of this group.Participant characteristic variables included age, sex, admitting diagnosis, diet orders, medications, laxatives and enemas administered before the milk and molasses enema, and laboratory values. Serious complication variables included bacteremia, bowel perforation, electrolyte abnormalities, allergic reaction, abdominal compartment syndrome, cardiac arrhythmia, dehydration, and death.

FINDINGS: The final sample of 196 adults had a mean age of 56 years; 61.2% were female and 38.8% were male. Of 105 admitting diagnoses, the most frequent (9.7%) was abdominal pain, unspecified site. Of the 14 discharge dispositions, the most frequent was home or self-care (50.5%). A laxative order was present for 97.4% of patients and a stool softener order was present for 86.2%. Sodium and potassium levels remained within normal limits during hospitalization. For the subset of patients who had these values measured within 48 hours before and after milk and molasses enema administration, no significant changes were found. No cases of nontraumatic abdominal compartment syndrome or other serious adverse enema-related events were documented in the EHR.

CONCLUSIONS: No safety concerns were identified from this retrospective EHR review of hospitalized adults who received a milk and molasses enema for constipation relief. The findings indicate that this treatment is safe, although further study examining its efficacy in this population is needed.