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What to Know About Enemas

Medically Reviewed by Jabeen Begum, MD on November 24, 2021

Enemas are injections of fluids used to cleanse or stimulate the emptying of your bowel. This procedure has been used for years to treat constipation and similar issues. 

Constipation is a severe condition that slows down the movement of your stool. It also makes the stool hard and difficult to excrete. It can become a chronic problem for many people and requires treatment, such as enema.

Enemas can also treat fecal incontinence, a condition in which the stool leaks from the rectum unexpectedly. 

They are also used to clean the bowel before any test or surgery. 

A professional usually does the enema procedure, but you can also self-administer enemas at home.

Types of Enemas

Some types of enema include:

Cleansing enema. This procedure is water-based. It includes holding the injection in the rectum for a short time to flush the colon thoroughly. Your body then releases the stool within a few minutes.

Cleansing enema is further divided into two types:

  • Large volume enema. It is an effective treatment for constipation as it cleanses a large part of the colon. The fluid amount used in this type is 500-1,000 ml. The doctors may ask you to hold the fluid in your anal opening for a long time to release the stool completely.
  • Small volume enema. It is used to clean the lower part of the colon. The fluid amount used is less than 500 ml. It is recommended to people who are not constipated from the upper part of the colon.

Oil-retention enema. This enema type is for people whose stool has hardened. The oil-retention enema softens the stool. The enemas used in this process usually contain 90-120 ml solution. The doctor may ask you to retain the solution for at least an hour to get effective results. 

Return-flow enema. Also known as Harris flush, a return-flow enema is done on people with trouble pooping due to intestinal gas. In this method, a large fluid volume is used, which is injected in 100-200 ml increments. The fluid is then drawn out along with the flatus (intestinal gas). This process is repeated three to five times until the gas is entirely out. 

Cooling enema. If your temperature is extremely high, the doctor may use a cooling enema to lower your body temperature. It is not a common procedure.

Rectal instillation of medication. Enemas can also be used to insert medications into your colon. Enema relieves the intestinal mucosa, and the medicines balance the electrolytes and fight infections. This procedure is done after cleansing enemas. 

What Are the Different Enema Solutions?

Some commonly-used enema solutions include:

  • Normal saline solution. It is a combination of salt and water. The salt of the mixture sends the body's water into the bowels to make the feces soft.
  • Glycerin. It stimulates the lining of the colon to cause bowel movements.
  • Castile soap. It is a mild soap made of many oils, like olive oil. This mild soap is added to saline solution, which is then inserted through an enema. This solution stimulates the bowel to create movements. 
  • Coffee. It is a mixture of brewed coffee and water, used to remove bile from the colon. 
  • Phosphate solution. A phosphate solution enema attracts water into the bowel to soften the hardened feces. Remember that too much phosphate in your body may cause health risks. So never go for more than one enema a day. Phosphate enema is also not recommended for people with kidney problems.

How to Use an Enema

You can self-administer an enema or give it to your child at home. The steps include:

  1. Always wash your hands before starting the procedure.
  2. Collect all the necessary supplies. These include any type of solution, enema bag, silicone catheter with a balloon, two slip-tip syringes, a catheter-tip syringe, towels, and lubricant. Your doctor will tell you how much solution to use.
  3. Put air in one slip-tip syringe and connect it to the balloon on the catheter. Push the plunger to inflate the balloon and then pull it back to empty the balloon.
  4. Put the tube on the enema bag.
  5. Pour the prescribed amount of solution into the bag.
  6. Open the clamp and let a few drops of fluid out. Now, re-clamp the tube and squeeze the drip chamber until the fluid fills the tube halfway.
  7. Now, lie on your knees with your hand on a pillow and keep your buttocks up. If you are administering an enema to your child, ask them to lie down in the same position. 
  8. Use the lubricant on the balloon end of the catheter.
  9. Put the balloon end of the catheter into the rectum for 4–5 inches. 
  10. Next, fill in 20–30 ml of air in the syringe and connect it to the catheter port. Blow up the balloon by pushing the plunger.
  11. Pull the catheter slowly until you feel resistance. Keep pulling the catheter with gentle hands to prevent the leakage of the enema.
  12. Connect the catheter to the enema bag.
  13. Now, open the tube clamp and allow the enema to flow in for 5–10 minutes. You can close the clamp a little to slow down the enema flow.
  14. Hold the fluid in for 5–10 minutes. Don't detach the fluid tube from the catheter. 
  15. Now, rush to the bathroom and put yourself or your child on the toilet. Allow the air to come out of the balloon. Connect the other slip-tip syringe to the catheter port and pull the plunger back. Allow the catheter to come out. 
  16. Wait for 45 minutes to push out the stool.
  17. When done, clean the bag with water and the catheter via the catheter-tip syringe filled with soapy water.

There are no enema side effects. But, you may experience enema leaks during the procedure. Some people also complain about cramping and discomfort. 

If you are unsure about doing the procedure yourself, ask your doctor for help.

Show Sources

SOURCES:
Clinical Nutrition Research: "Coffee Enema for Preparation for Small Bowel Video Capsule Endoscopy: A Pilot Study."
Canadian Society of International Research: "Enemas."
Intermountain Healthcare, Primary Children's Hospital: "Enemas (Large-volume).
Mayo Clinic: "Constipation."
PEOI: "Fundamentals of Nursing Practice: E-1- Types of Enemas."

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