Milk and Molasses Enema

[medicrnohio]

The other night at work I had an order to give a patient a milk and molasses enema. Having never done this before and only heard in nursing school that they used to be given I asked the other nurses about it. No one had really ever given one. The nursing supervisor said they worked great but couldn't tell me why. So here is my question...why and how do they work?

[Indy, LPN, LVN]

Thanks to the microwave the thing is a lot easier to make nowadays. I had to do this without supplies other than a retention bag, a patient fridge, and an old OB nurse to tell me the process. So basically I got like six little cartons of milk (maybe it was 3, I'm not sure)- any kind of milk since we only had 2 of whole milk, and every single packet of pancake syrup I could find that did NOT say "sugar free" on it. Put pancake syrup in a disposable, clean, suction container. We have the kind that don't have a liner, resembles a flowerpot in shape, and it's the right size to fit in a small microwave, plus it doesn't melt in the microwave. Respiratory isn't happy that I used them, but they really didn't want them back either. Put container with syrup only in it, in the microwave for one minute. Then put milk in, stir, put in microwave for another minute. (About the amount of milk: basically you would like approximately one liter of liquid.) Stir until you have brownish gooey milk and you think it's melted, may have to microwave it a little more. Stir, let cool until it's tepid. Hang enema set on IV pole and clamp off. Put mixture in bag, carefully- you may have to have someone hold the bag open so it doesn't make a mess.

Unhook your patient from telemetry and any other "wires" if you are able. Otherwise it's easy to choke the patient in the following process. Lube the end of the enema set (it's rather large), keep it clamped, lie patient on left side, insert enema. Instruct patient to do deep, slow breathing while you slowly, over about 5 minutes, let 250cc or so of the enema flow into patient. Keep it there for another minute. Instruct patient to roll over to their tummy. Repeat the breathing and the 250 cc flow thing, slowly. A minute or so after they have done this and are as relaxed as is possible, have the patient roll to the right side. This is why the tele wires, IV lines, etc. would be a problem (and I haven't even thought to try it on a vent patient). Repeat the whole thing on the right side. Slowly let the rest of the enema flow in and do nothing (else) to make the patient anxious. Remove the enema when it's all been in for a minute and make sure that the patient has a bedside commode immediately next to the bed, like at a right angle. If you have to hook any wires, IV lines, etc. back up, go ahead and do that. Put towels on the floor, anti-slip socks on patient's feet, and have baby wipes nearby. Stay close and open a window if you can, because the unholy smell will knock you down if you don't.

I have given this with success to elderly constipated ladies who sing halelujah at the end of the poop fest, and one old fella with colon cancer whose impactions were in the small bowel near the appendix. It works. The turning over slowly, helps slosh the mixture up in the large intestine and can reach the lowest parts of the small bowel if done right. The cramping from the large bowel does help encourage the small bowel to move along as well. It's safe for CHF and dialysis patients, and I've not seen it adversely affect either blood sugar or fluid balance.

[pggrn]

Indy, I think your success with this procedure evolved around "and an old OB nurse to tell me the process."

I'll tell you right now, the old OB nurses are great at bowel work! If I may editorialize, I would say, "Beyond compare!" In my opinion you can learn more from an OB RN in two weeks than you will learn from a med/surg RN in a year.

But hey, that is just my opinion.

[Indy, LPN, LVN]

You're right. The old OB nurses are it on a stick. They can do more, with less, and more creatively than you'd think. You can't faze them and they will teach you stuff, you just have to show up with your ears on!

[smack1403]

I don't care who invented the Milk and Molasses enema, had to have one last week and within 15 minutes I was one happy camper. The PA in the E/R said the high sugar content in the molasses helps to get things going. After suffering for over 24hrs I didn't care what they did. When I saw the xray and the "ball" that needed to come out I would have done anything. This was the first idea and it was brilliant!! BRAVO to Milk and Molasses!!

[junewhite1119]

I gave one of these on my shift tonight. I had only before given the little prepackaged enemas in the squeezy bottle, never anything I had to mix up and put in an enema bag. WOW. What results.

[applesxoranges, BSN, RN]

There are apparently different formulas. I know one hospital did 8 oz of milk and 8oz of molasses. Another one does 4 oz of milk and 4 oz of molasses and 8 oz of warm tap water.

[NRSKarenRN, BSN, RN]

Evidenced based practice info:

2008 Prevention and Management of Constipation in patients with Cancer - Clinical Journal of Oncology Nursing

Quote

Milk and molasses enema
The sugar in milk and molasses enemas irritates the intestinal lining and produces gas, which distends the intestines and causes pressure, peristalsis, and subsequent evacuation. A low-volume enema less than 300 cc, when given high (12 inches) and held for 20 minutes, produces the best results. Caution: Evaluate intravascular volume status before using enemas with hypertonic solutions (Walker et al., 2003).

Directions: Mix 3 oz powdered milk in 6 oz cup warm water; add 4 oz molasses and mix. Insert enema tube approximately 12 inches into the rectum or until resistance is met, and administer less than 300 cc. After solution is given, clamp the enema tube and leave it in place while the patient lies on his or her right side for 20 minutes to allow solution to go into transverse and ascending colon. Repeat as many as four times per day until the impaction is relieved (Bisanz, 2005).

2015: Safety and efficacy of milk and molasses enemas in the emergency department.

Quote

RESULTS:

There were 2013 enemas given, of which 261 were M&M enemas; 214 were given alone. Success rates defined only as bowel evacuation for M&M enemas alone were 87.9% (188/214) and, when used after other treatment failures, were 82.4% (28/34) successful. Five additional patients improved with the secondary measures (90.2% success). There were 8/261 complications (3.1%), of which four had an increased heart rate, two had decreased blood pressure, one had an increased pain score, and one subsequently developed a fever.

CONCLUSION:

M&M enemas have a low complication rate when used in the ED.

[sweetiepeas]

I use a 3:1 ratio. I warm and mix 3 oz milk with 1oz molasses. Works every time!