At-Home Enema: How to Use an Enema at Home, and Is It Safe?

Why use an enema?

Enemas are often used to combat constipation, when bowel movements are infrequent or difficult to pass for several weeks or longer. Generally, if you have fewer than three bowel movements a week, you are likely suffering from constipation. 

Occasional constipation is quite common, but some people experience chronic constipation, which can interfere with their quality of life and ability to function throughout the day.

The treatment for chronic constipation will depend on the underlying cause. However, there are cases where a reason for the condition is never found. 

Elderly people are five times more prone to constipation than young people due to immobility, medication side effects, and the blunted urge to defecate. 

Many people use over-the-counter drugs to help with constipation, but sometimes urgent intervention is required, and a hospital visit may be necessary. A cleansing enema is a popular treatment method for constipation. 

Enemas are also used to clean the bowels before a medical procedure or examination, such as a colonoscopy. 

Fleet enemas use forms of phosphorus, a naturally occurring substance that is important in every cell in the body. This type of enema has two purposes:

• Treating constipation
• Cleaning the bowels before X-rays, colon surgery, or endoscopy examinations

Someone may have an enema to clean their lower bowel, receive medication, or help get gas or stool out of the body. 

Are enemas safe?

Different kinds of enemas work differently. All enemas distend the rectum, which stimulates the colon to contract and eliminate stool. A phosphate enema directly stimulates the muscles of the colon. 

Enemas can be quite effective, but there is a risk of severe adverse effects such as metabolic derangement or perforation. 

A hypertonic sodium phosphate enema can cause serious phosphate nephropathy. Elderly people with a history of chronic renal failure or patients treated with ACE inhibitors are especially prone to phosphate nephropathy from enemas. 

Although rarely reported in medical literature, a cleansing enema can have life-threatening side effects. For example, the most frequent side effect from an enema is perforation from the device tip. 

Enema kits are sold at most drug stores. It’s important to follow the instructions exactly as outlined, and you should never have more than one enema in 24 hours. For most people, enemas are a safe practice. However, there are rare cases when too many enemas can have life-threatening side effects on the heart and kidneys. 

Call your health care provider immediately if you experience any of the following after an enema:

• Little or no ability to urinate
• Drowsiness
• Swelling in the legs, ankles, or feet

Do not use an enema (unless otherwise directed by a health care provider) if you have any of the following conditions:

• Congestive heart failure
• Severe kidney disease
• A perforated bowel
• Megacolon
• Paralytic ileus
• Active inflammatory disease
• A blockage in the digestive tract
• Rectal obstruction
• Dehydration
• Other intestinal disorders

How to prepare an enema at home

Follow these steps to prepare an at-home enema:

1. Warm the enema in a bowl and pull off the nozzle. Make sure to keep the bottle upright so the contents don’t spill. 
2. Lubricate the nozzle. 
3. Lie on your left side on a towel, with your knees bent toward your chest as high as possible.
4. Gently push the nozzle approximately three inches into your anus.
5. Slowly squirt the contents in. Remove the nozzle when you have finished all the liquid and remain lying down.
6. Try to hold the liquid in for (ideally) five minutes. 
7. When you can no longer hold the liquid in and have a strong urge to empty your bowels, go to the bathroom. 
8. It’s best to stay near the toilet over the next hour.
9. Some people experience stomach cramps for a short time after their enema. If you feel dizzy or light-headed, make sure to lie down until you feel better.

An enema should take an hour or less to work. 

Enema solutions

There are a few different options for the liquid solution inside enemas. You can also choose to purchase an at-home enema kit that includes an enema bag. The bag contains the water or solution that will be injected into the rectum. The liquid might be a saline solution or baking soda mixture.

Potential risks of using an at-home enema kit

An at-home enema kit can increase your risks because you probably aren’t as experienced as a medical professional at inserting the device tip. The possible health risks associated with enemas are:

• Perforation
• Metabolic derangement
• Severe phosphate nephropathy (for hypertonic sodium phosphate enemas)
• Harmful side effects to the kidneys or heart from too many enemas
• Injury to the bowels
• An improper fluid in the enema mixture can have adverse effects on your electrolyte balance, bowels, or overall health
• Risk of infection from a nonsterile enema kit
• Enemas with acidic ingredients, such as lemon juice, carry a risk of causing burns, irritation, or inflammation 
• According to one report, children who received a hydrogen peroxide enema reported developing inflammation of the colon, vomiting, bloody diarrhea, and other long-term complications 

Always talk with your health care provider before attempting an enema at home. Most health care providers discourage the use of homemade or DIY enemas.

Enema alternatives

Health care providers will typically recommend diet and lifestyle changes to treat chronic constipation. If that doesn’t work, your health care provider may prescribe medications or surgery. 

Diet and lifestyle changes

Your health care provider may recommend that you add more fiber to your diet, which can increase the weight of your stools and help them work their way through the intestines faster. Foods high in fiber include fruits, vegetables, and whole-grain products. 

Some people see an improvement in their chronic constipation with an increase in physical activity. Regular exercise can increase muscle activity in the intestines. 

Some people with chronic constipation need to learn to give themselves time in the bathroom without feeling distracted or rushed. 

Medication

Many types of laxatives can help make bowel movements easier. Some over-the-counter options include:

• A fiber supplement can add bulk to the stool, which makes it softer and more comfortable to pass. 
• Stimulants can help your intestines contract and pass a bowel movement. 
• Osmotic laxatives help improve bowel movements by increasing the secretion of fluid from the intestines, which allows the stool to move through the colon quickly.
• Lubricants use mineral oil to move stool through the colon. 
• Stool softeners draw water from the intestines to soften the stool.
• Suppositories help move stool through the body by providing stimulation and lubrication.  

If over-the-counter medications don’t work for you, consult with your health care provider about a stronger prescription. Some possible medications include: 

• Medicines that draw water into your intestines to speed up the movement of the stool. Examples include lubiprostone, linaclotide, and plecanatide. 
• Prucalopride is a type of serotonin 5-hydroxytryptamine 4 receptor that helps move stool through the colon. 
• If the constipation is caused by opioid use, peripherally acting mu-opioid receptor antagonists can reverse the effect of opioids on the intestines and keep the bowels moving.

The takeaway

Living with chronic constipation can significantly affect your quality of life and ability to get through the day. An enema is a popular choice for people struggling with constipation. However, there are risks associated with this procedure. Before attempting an enema at home, check with your health care provider to make sure it’s a safe choice for you.