Flatus Tube (Rectal Tube)

Definition

A flatus tube is a soft, flexible tube inserted into the rectum to decompress the colon by allowing the passage of trapped gas and feces, thereby relieving abdominal distension, discomfort, and ileus-related symptoms.

Indications

1. Gastrointestinal Indications 

• Ileus
• Acute colonic pseudo-obstruction (Ogilvie’s syndrome)
• Severe abdominal distension due to gas
• Chronic constipation with fecal loading
• Partial large bowel obstruction (temporary relief only)

2. ICU & Critical Care

• Abdominal distension impairing:
  • Ventilation
  • Weaning from mechanical ventilation
• Elevated intra-abdominal pressure (IAP) (adjunctive)
• Post-abdominal or pelvic surgery

3. Palliative Care

• Symptomatic relief of bloating and discomfort

Contraindications

Absolute

• Suspected or confirmed bowel perforation
• Peritonitis
• Severe anorectal pathology:
  • Anal fissure
  • Severe hemorrhoids
  • Rectal stricture
• Recent colorectal anastomosis

Relative

• Rectal bleeding
• Neutropenia / thrombocytopenia
• Uncooperative patient

Types of Flatus Tubes

Size Selection

Length

• Standard length: 25–30 cm
• Inserted 10–15 cm beyond anal verge
  ## Excessive insertion increases perforation risk

Procedure: Step-by-Step

Preparation

• Explain procedure to patient
• Obtain consent
• Position: Left lateral (Sim’s position) or supine with knees flexed
• Gloves, lubricant, flatus tube, collection bag/pad

Insertion

1. Lubricate distal 5–7 cm of tube
2. Gently insert into anus
3. Advance slowly without force
4. Stop if resistance or pain occurs
5. Connect to:
   • Open air
   • Drainage bag
   • Water seal (optional)

💨 Flatus Tube Duration — The Correct Concept

There are two different practices, often confused:

1️⃣ Intermittent Rectal Decompression (Short Procedure)

Used for:

• Immediate gas relief

 Duration:

• Insert for 30–60 minutes
• May remain up to 2–4 hours maximum
• Then removed

2️⃣ Continuous Indwelling Rectal Tube (ICU Setting)

Used for:

• Ogilvie syndrome
• Severe colonic pseudo-obstruction
• Intra-abdominal hypertension adjunct therapy

 Duration:

• Usually 24–72 hours
• Daily reassessment mandatory
• Remove once decompression achieved

This is a secured, continuously draining tube, not just temporary insertion.

• Intermittent use preferred
• Prolonged continuous use → ↑ risk of mucosal injury

Complications

Common

• Discomfort
• Tenesmus
• Leakage of stool

Serious 

• Rectal mucosal erosion
• Pressure necrosis
• Rectal bleeding
• Bowel perforation (especially in ischemic colon)
• Infection (with prolonged use)

Role in Ogilvie’s Syndrome 

• First-line conservative management
• Along with:
  • NPO
  • IV fluids
  • Electrolyte correction
  • Stop offending drugs
• If ineffective:
  • Neostigmine
  • Colonoscopic decompression