What is an Enema? How It’s Used and Why

An enema is a procedure in which a liquid solution is introduced into the rectum to stimulate a bowel movement, relieve constipation, cleanse the colon, or administer medication. The type of enema and the ingredients in the fluid depend on the condition being treated. Please continue reading to learn more about why and how an enema is used.

Why would someone need an enema?

Reasons for needing an enema include:

To relieve occasional constipation.
To treat fecal impaction (a large lump of dry, hard stool that is stuck in the intestinal tract).
To administer medication (for example, mesalamine enema for ulcerative colitis).
To cleanse the rectum before examination.
To produce clearer images during an X-ray examination (barium enemas).

How to use an enema?

An enema may be a medical procedure performed by a medical professional, for example, a barium enema. Other types of enemas can be purchased over the counter at a pharmacy, and the enema equipment can be used at home to treat constipation. Here is a step-by-step guide to using an enema at home:

Use a towel or waterproof pad to prevent soiling.
Remove the cap from the enema tip.
Lie down on your left side with your right knee pulled up to your chest. You can also kneel on the floor with your knees pulled up to your chest and your left face resting on the floor on your left arm.
Insert the enema tip into your rectum slowly and gently. The angle of insertion of the enema tube should be such that the tip points towards your navel.
Move your muscles like you would to have a bowel movement. If you experience pain or encounter resistance, stop and talk to your healthcare provider.
After the tip is inside your rectum, gently squeeze the enema bag or bottle to push the enema solution into your rectum. Make sure you follow the instructions on the package (children may only need half a bottle, and adults may not need to use the entire bottle of fluid - if you are using an enema form called a large volume enema, it can have up to 500-1,000 mL of fluid and you may not need to use it all).
Once the enema fluid is in, remove the rectal tube and stay in position until you feel the urge to defecate. This usually happens in about 5 minutes. If you are using a retention enema, the enema solution will stay in your digestive tract for 15 minutes or longer.
The bowel movement you have will consist of feces and the enema solution itself.
After you have finished using the bathroom, wash your hands thoroughly with soap and water.

What is in the enema solution?

The ingredients in enema solutions depend on the types of enemas and the reasons for administering them. They may include:

Sodium phosphate enemas: These are saline enemas (salt water enemas) that are used to treat occasional constipation. They draw water into the large intestine and make stool softer and easier to pass.
Bisacodyl: This is a stimulant laxative that is used to relieve occasional constipation. Bisacodyl may also be present in cleansing enemas that are used before rectal examinations.
Mineral oil: This is a lubricant laxative that makes it easier to have a bowel movement.
Glycerin: These enemas work in the same way as saline, by helping the large intestine absorb more water and acting as a stool softener. They also stimulate muscle contractions and produce an urge to have bowel movements.
Medication administration: Some enemas contain medications to treat digestive tract conditions such as inflammatory bowel disease. Retention enemas (which are held in the bowels for at least 15 minutes) are sometimes used to administer medications.
Barium enema: This type of enema is used before X-ray examinations of the gastrointestinal tract to detect diseases. A barium enema makes the images clearer. However, medical procedures using barium enemas are infrequent now because colonoscopies have become the standard diagnostic tool.

Are coffee enemas safe?

You may have heard about self-administering a coffee enema as a detoxification and cleansing enema. However, coffee enemas and other homemade enemas that contain soap suds, household detergents, Epsom salt, baking soda, hydrogen peroxide, apple cider vinegar, or other household substances are not safe and can be potentially dangerous. Moreover, their health claims are not based on scientific evidence, and they do not have proven benefits.

Health risks associated with homemade enemas include electrolyte imbalances, infections, internal bleeding, rectal bleeding, rectal burns, bowel perforation (tears in the intestinal tract), fecal incontinence, and pancreatitis. Side effects can include nausea, vomiting, diarrhea, stomach cramps, bloating, dizziness, and dehydration.

Frequently Asked Questions

Is it painful to have an enema?

It is not painful to have an enema, but it may be uncomfortable. If you experience pain or encounter resistance to the enema tip, you should stop and talk to your healthcare provider. However, it is common to experience minor discomfort during an enema, especially if you are performing an enema for the first time. Once you are accustomed to enema use, the discomfort should go away.

How do you know when you need an enema?

You may need an enema to relieve constipation. However, enemas are for severe constipation and should only be used when oral laxatives do not work.

Using an enema on a regular basis as a cleansing enema for colonic irrigation is not recommended and does not have any proven health benefits. Do not use an enema if you are not constipated and your healthcare provider has not prescribed an enema.

If you have chronic or recurrent constipation, you should undergo a medical examination. Your healthcare provider will order diagnostic tests to find out the underlying medical condition causing your constipation and prescribe appropriate medical treatment.

When to use an oral laxative vs suppository vs enema?

Oral laxatives are typically used first to treat constipation. Suppositories and enemas work faster, but they are not as convenient as swallowing a pill. Rectal laxatives provide immediate relief within a few minutes, whereas suppositories can take up to an hour to work.

How soon will I have a bowel movement after using an enema?

How soon you have a bowel movement after an enema depends on the type of enema you have used. For example, after using a saline enema, you typically feel the urge to empty your bowels after 5 minutes.

What should I do if I don’t have a bowel movement after an enema? Should I repeat the enema?

You should be medically reviewed if you have not had a bowel movement and no liquid has come out of your rectum after 30 minutes of using a salt water enema. Do not use more than one enema in 24 hours. If you have used enemas for 3 days in a row and did not get relief from constipation, consult your healthcare provider.

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