Recent Hospital Enema

I have been reading for years that patients struggle for constipation relief in the hospital. I was recently hospitalized after extensive shoulder surgery, and had prepared myself for the great Laxative Vs Enema debate. What I found was, an enema was easy to get if you just ask for one. Kind of went like this, after a sleepless night and serious narcotic pain medication I just decided that I wanted an enema. The nurse's response was that it's too soon to intervene to force a poop, wait one more day. One more day went by and the conversation was "I feel very constipated and would like an enema before discharge." "Have you been taking the stool softeners?" "No, they don't work and give me a stomach ache." "your're right, I will get the enema ordered in the morning." The story is far more detailed, but I will save that for when I can type with both hands. Let me say, it was genuinely an experience to remember!

My last hospital stay of 2 weeks while being on morphine becam quite constipated. I too also hate lavatives but they gave them to me anyway (Marilax). All it seamed todo to me was give me cramps without working. I started to ask for an enema to get things going and the nurse said she would get one ordered. I never received one that day or the next. I had my wife bring in my red enema bag into the hospital and give me an enema, which she did. She had to give me two enemas to get things going. I had her leave the bag hanging in the bathroom to dry. When the nurse came into my room I told her I finally had a BM and my bedside commode needed to be emtied. She went to empty it and asked what the enema bag was doing in the bathroom and I said I needed an enema so my wife gave me one. I told the nures that I asked for one two days ago and never recieved one. The nurse was quite upset and had the head nurse come in to talk to me. She started to tell me that enemas need to be ordered by a doctor. I told her I take them at home without a doctors order, that I needed relief without a hassel. The head nurse was going to get a doctors order for a soapsuds enema when ever needed. The next afternoon I asked for a large volume enema and received it within the next hour. It should never be a hassel to get an enema in a hospital just because of time and budget constraints...

Since July of 2005 I have been in the hospital five times. My surgeon knows my bowel condition and always write the order for "sse (hi-volume) enemas 'til clear"......and then also for the Visiting Nurse Service when I'm sent home. --like novnot 01 says you have to ask initially.

the boxcar

Nice to hear that they still do enemas in hospitals. I have been fortunate enough to have not had any hospital stays, but if I do, know what to do in case of need! I too have slow bowels and does not take much for them to slow down or stop working. Nice to know I have options!!

It is interesting to find out that the holdup in nitehwk's case was administrative- the doctor had to order the enema before the nursing staff could give one. I am not a medical professional, but I would imagine the nursing staff has more independence in giving a laxative without getting it cleared with the doctor thus they go down the path of least resistance. Knowing this really does shed light on getting enemas in hospitals. All it may come down to is that you simply have to ask for an enema and you probably can get one unless there is medical reason for not getting one.

I will keep that in mind as I will no doubt need to go in for some reason hopefully not anytime soon. In the meantime, I will be administering my own enemas on a regular basis 😃

I am so happy in reading this thread. We as nurses are here for the patients to get better and be comfortable while in the hospital. I am so happy you guys insisted on what you wanted. The nurses can only follow orders if the patient insist we have to go to the head nurse and tell her. She will have to ask doctor and you should be able to get your enema if you speak up.

I would think that if an enema is ordered for a patient in the hospital , it would be a "fleet" enema and not a SSE.

I would think that if an enema is ordered for a patient in the hospital , it would be a "fleet" enema and not a SSE.

I think that is probably true but I have also noticed disposable bags by fleet in the store so I assume hospitals would have them too.

It is not quite as clear cut as it may seem. For a bit of background the insurance company pays about $2.00 for a stool softener capsule. The cost paid by the insurer for the nurse ordering the capsule from the pharmacy and administering it is nominally about $10.00 to $15.00. Compare that to a suppository which depending on if it is glycerin or bisacodyl will be reimbursed at $2.00 to $8.00. The bill for nurse administering the suppository will be reimbursed at about $15.00 - $20.00. The Fleet or other brand of disposable enema will be reimbursed at about $10.00 - $ 12.00 and the reimbursement for the nurse administering the enema will be about $60.00. The disposable bag for a SSE will be reimbursed at about $10.00 and the nurse's time for preparation and administration will be in the $200.00 to $250.00 range. The prices above are based on what has been observed as paid by the insurer in Explanation of Benefits claims' statements and corresponding bills detailing what the hospital actually charged compared to what the insurer negotiated with the hospital.

The insurer will resist paying for a SSE without justification. That usually includes a progressive record of use of stool softeners such as Colace and Miralax, then glycerin or bisacodyl suppositories. In many cases they will want proof of an X-Ray showing severe constipation before authorizing payment for a SSE enema.

This means the doctor has to set down, review the nurses' notes of progressive intervention and then provide a ‘justified’ diagnosis based on the prior efforts. In some cases the doctor has to call the insurer prior to the administration of an enema either Fleet or SSE for authorization or the insurer will kick the claim back.

Pushback varies from insurer to insurer.

That makes sense and could be the reason bag enemas are almost never used!

It's just amazing that they charge $200 to give an enema. Where does this money go to?

One nurse did mention to me that they do not like to do enemas because of the time that it takes. The biggest drawback in their minds was the fact the patient has to be given a bedpan( as they are hooked up to tubes and machines) and no on likes to clean those.

It's just amazing that they charge $200 to give an enema. Where does this money go to?

Depending on where you are located the state requires an enema to be administered by a licensed nurse which in most cases is an RN.

While the RN's pay may be $40.00/hour on the pay stub the actual per hour cost is much closer to $100.00 to $150.00 because of expenses not listed on the paycheck stub. The added expenses are items like the employers part of healthcare premiums, workman's comp premiums, employers part of Social Security Tax (6.2% of employee's pay), Medicare Tax (1.45% of employee's pay), unemployment tax (both State and Federal, usually runs about another 10%), overhead expenses such as admin costs (someone has to pay for the accounting expenses of tracking the employee's cost and submitting the collected taxes and fees to each agency), as well as liability insurance, power, water etc.

Terms such as “Fully Burden Rate” (what the business calculates its cost per hour to retain an employee) get tossed around and by the time the beancounters are done attributing an expense to an employee it is not unusual for a $40.00 an hour employee to cost $120.00 to $250.00 an hour to have on staff.

Victoria, your explanations in two of your above posts were both comprehensive and interesting. Years ago I worked with institutionalised special needs people and found the nursing staff averse to using effective remedies for constipation because of the time and effort involved. I am not sure if the financial situation outlined in your posts was also a factor here in Australia.

@Victoria1951 I'm well aware that the total hourly cost of an employee exceeds what the employee is actually paid. However, one does not take 1 hour to give an enema.

Also, the employee is getting paid regardless of whether they are giving enemas or sitting at the nurse’s station. Goodness Sakes! Come on… if they got paid for everything they did they would be rich.. gee wiz

@Victoria1951 I'm well aware that the total hourly cost of an employee exceeds what the employee is actually paid. However, one does not take 1 hour to give an enema.

Actually administering the enema, no. That is maybe 10 minutes tops.

But to administer the enema the nurse has to document your request or the need. Standing orders for SSE enema as far as I know are no longer the norm so the nurse has to enter in the notes the patient needs intervention beyond laxatives, suppositories, and Fleets. The hospitalist will review the nurses notes and either authorize the SSE or decline. As insurers loathe more expensive procedures the usual path involves the doctor calling the insurer to gain their approval to pay for the SSE. The Hospitalist's time is part of the fee trail for the $250.00 enema. If the insurer approves, then the authorization is entered in the notes and the nurse will soon begin preparing the needed supplies. Most likely she will have to call supply for an enema bag. The courier delivering the bag as well as the stock room clerk's time become part of the fee for the enema. The nurse then prepares the solution and fills the enema bag. The condition of the patient is entered into the notes in detail (more nurse's labor) and then she may proceed to administer the enema. Once in the room with the patient she will place disposable pads under the patient (also recorded for billing), explain the procedure to the patient and obtain signed informed consent. (More paper work which is billed) The enema will then be administered. In most cases the nurse will be accompanied by a nurses aid or tech to assist with positioning the patient. Once the enema is administered there is the clean up and discard of the enema supplies. It is biohazard waste and that becomes another billable item. The nurse will remain with the patient to insure instructions are followed and to observe that the patient is protected from falls. Older patients particularly will bolt if the urge to evacuate is intense and often will experience fecal incontinence. There is nothing more slippery than stool, soap suds enema solution and a linoleum floor. Slippery floor, bare feet and old bones are a guaranteed hip fracture.

Once the patient is seated on the bed side commode or the bathroom toilet the nurse continues to maintain vigil. She is still on the clock providing care for the patient. Once the patient finishes evacuating the nurse and an aid will insure the patient's skin is clean and if needed, lotion applied to protect against breakdown. The patient is returned to the bed. Vital signs are taken to assure the patient is not experiencing low blood pressure or heart rate changes due to the vagal nerve. The nurse will then view the results of the enema. Once assured the patient is in bed and comfortable, an aid is left for about another 15 to 30 minutes just in case there is a second round on the toilet or commode. The nurse returns to the desk and documents the patient's vitals and results of the enema.

While you and I can prepare an enema and administer it in ten to fifteen minutes and leave the person to deal with the enema effects, staff in the hospital follow a choreographed routine dictated by management, beancounters, hospital counsel, liability insurers etc. All that detail and documentation costs money and that is why you can run into the $650.00 enema on the floor. As an aside, an enema in the ER can leave you with an even higher bill. Much higher.

While you and I can prepare an enema and administer it in ten to fifteen minutes and leave the person to deal with the enema effects, staff in the hospital follow a choreographed routine dictated by management, beancounters, hospital counsel, liability insurers etc. All that detail and documentation costs money and that is why you can run into the $650.00 enema on the floor. As an aside, an enema in the ER can leave you with an even higher bill. Much higher.

And there, in a nutshell, is what is wrong with medical practice in the United States today.

And there, in a nutshell, is what is wrong with medical practice in the United States today.

I'd rather be in the US than elsewhere. Sometimes you just can't get treated. In the USA it might be expensive but you won't die waiting for treatment.

I'd rather be in the US than elsewhere. Sometimes you just can't get treated. In the USA it might be expensive but you won't die waiting for treatment.

Fun fact, that's actually propaganda spread by a former insurance big wig. He's since apologized for the irreparable damage he's done to the idea of an actual good medical system here.

I'd rather be in the US than elsewhere. Sometimes you just can't get treated. In the USA it might be expensive but you won't die waiting for treatment.

It’s not just the expense. It’s the fact that medical practice in the US is not controlled by the medical professionals, but by insurance companies, accountants, lawyers, etc. that suck money out of the system that could be better employed to improve medical care. Too many stories of people being denied care or m dictations their doctors deem necessary, that others, who control the flow of funds, do not.

Fun fact, that's actually propaganda spread by a former insurance big wig. He's since apologized for the irreparable damage he's done to the idea of an actual good medical system here.

You might not die waiting for treatment, but you might die because the insurance industry has denied coverage for procedures or medications that could have saved your life.

When the CEO of UHC is making 20K an hour either twiddling his thumbs of pulling his pud while underlings decide / deny your health care, and if you live or die is ridiculous. Strike that !!!! BS !!!

Why ??? Maybe look at all the politicians taking $$$ from the insurance lobbyists.

WHY are WE the LAST in industrial nations that don't have single payer health care?

Duh??? See above !!!!

I was hospitalized last summer with an acute UTI. They gave me Miralax, etc. I had not had a bm in four days. I asked the nurse to get me a bagenema and she did. I went into the bathroom and gave one to myself. I was in the VIP section of the hospital and that may be why she was so accommodating

Cleanout lover….. Avoiding the politics…..yup!!??!!

You might not die waiting for treatment, but you might die because the insurance industry has denied coverage for procedures or medications that could have saved your life.

I've had a lot of medical issues the last 10 years and occasionally it has been denied. In most instances I have appealed it or had the doctor explain why it was needed and it always got done. Insurance is a pain, especially when you are old enough to need it. My brother's in laws are both around 90 and they are a hot mess but he can still get them everything they need including surgery so I think US Healthcare is the best in the world. Sorry for the rant.

In most instances I have appealed it or had the doctor explain why it was needed and it always got done.

I'm glad that has been the case for you, but unfortunately it isn't like that for everyone. Or if the appeal is successful, the delay in treatment can still have consequences for the patient. We could also talk about step therapy, which forces patients to try other (cheaper) medications before the insurance will pay for the medication their doctor prescribed. That also has consequences. It is all around a very messed up system. People's lives shouldn't be used for profit.

It is all around a very messed up system. People's lives shouldn't be used for profit.

Is it really? Right now if you present at the local Emergency Room, are uninsured and need a CAT Scan due to sudden renal colic, you will receive the CAT Scan, receive medical treatment and if necessary admitted to the hospital. If you go to your doctor with debilitating lower back pain, he will likely order a X-Ray and/or CAT Scan which will happen that day in most cases. Within a few hours he will know precisely what is causing your pain and refer you to an orthopedic spinal surgeon if appropriate. A diagnosis of Spinal Stenosis leads to corrective surgery scheduled within 24 to 48 hours with the surgery scheduled within one to two weeks. Friends in Canada tell me they have to see their primary care first after the emergent hospital visit, who issues a referral to see an orthopedic spinal surgeon that is three to six months out. The surgeon orders the CAT Scan or MRI which you have to get into the queue and wait another six to twelve months. This is not a one off case in Canada, it is the norm. Other single payer nations where the government funds and controls health care have similar systems. For all the warts the US system of private insurers has, it is infinitely better than other places I have traveled.

In the US Medicaid is now widely available, covering children, disabled adults and elderly who have not worked and do not qualify for Medicare. Medicare is available for Social Security retirees.

What we have is not perfect, but the last thing I want is Uncle Sam collecting premiums, commingling the premiums in the General Fund and spending it wontly on political friends' special programs.

Is it really? Right now if you present at the local Emergency Room, are uninsured and need a CAT Scan due to sudden renal colic, you will receive the CAT Scan, receive medical treatment and if necessary admitted to the hospital. If you go to your doctor with debilitating lower back pain, he will likely order a X-Ray and/or CAT Scan which will happen that day in most cases. Within a few hours he will know precisely what is causing your pain and refer you to an orthopedic spinal surgeon if appropriate. A diagnosis of Spinal Stenosis leads to corrective surgery scheduled within 24 to 48 hours with the surgery scheduled within one to two weeks. Friends in Canada tell me they have to see their primary care first after the emergent hospital visit, who issues a referral to see an orthopedic spinal surgeon that is three to six months out. The surgeon orders the CAT Scan or MRI which you have to get into the queue and wait another six to twelve months. This is not a one off case in Canada, it is the norm. Other single payer nations where the government funds and controls health care have similar systems. For all the warts the US system of private insurers has, it is infinitely better than other places I have traveled.

In the US Medicaid is now widely available, covering children, disabled adults and elderly who have not worked and do not qualify for Medicare. Medicare is available for Social Security retirees.

What we have is not perfect, but the last thing I want is Uncle Sam collecting premiums, commingling the premiums in the General Fund and spending it wontly on political friends' special programs.

Thank you very much.

Thank you very much.

Ditto. Well done indeed.