Lead author Jackline Wangui-Verry responds:

My first encounter with milk and molasses enemas was an administration order placed in the medical record by a provider on an inpatient unit at a large academic medical center. I had never heard of this formulation before, and the scarcity of information on it piqued my curiosity.

The use of milk and molasses enemas is considered a "sacred cow" practice that is not supported by evidence but is considered routine and above dispute by nurses. The safety profile of these enemas has been a topic of interest in various academic settings, given that they have been, and continue to be, ordered in some health care settings even though there is not a robust research base for their use.

Our study only focused on the safety of milk and molasses enemas in patients who received this type of enema; further research is needed to evaluate its efficacy.

Although my area of focus lies within the community and not at the bedside, the topic of constipation is prevalent across many health care settings. Individuals experiencing constipation may feel embarrassment; thus, the issue goes undiscussed and underreported.

Chronic constipation affects quality of life and creates a financial burden on the health care system. Efforts to educate the public on regular bowel movements and constipation prevention should be employed to raise awareness on constipation and help prevent it and reduce its prevalence. On a recent episode of the TV show Red Table Talk, for instance, the actor Will Smith and his family had an open discussion about bowel movements. Efforts such as these can decrease the stigma surrounding constipation and help normalize conversations about bowel health.

Nisha Lewis, RN

Brooklyn, NY