Enema Administration: How to Do It and Why

What is an enema?

An enema is a process where a fluid is injected into the lower bowel by way of the rectum. The purpose of the enema is to help clean the colon and relieve constipation.

Many people suffer from constipation. Elderly people are five times more prone to constipation than young people due to their lack of mobility, side effects of medication, and a blunted urge to defecate. Many people choose to treat constipation with over-the-counter drugs, but sometimes constipation can be so severe that it results in a trip to the hospital. 

The most common medical uses of enemas are bowel cleansing, X-ray preparation, and medication administration.

How does an enema work?

Different types of enemas work in different ways. In cleansing enemas, the rectum distends, which allows the enema to stimulate the colon and cause contractions that eliminate stool. Alternatively, a phosphate enema directly stimulates the muscles of the colon, allowing for the release of bowel movements.

Types of enemas

Contrast enema

Contrast enemas use a special enema solution (or air) that shows up well on X-rays, which can then take pictures of the large bowel or colon. This test shows health care providers if the patient has any abnormalities of the distal small intestines or colon. 

There are two types of enemas used for X-rays:

• A contrast enema uses a specific kind of enema fluid that can show up on an X-ray. There are special preparations you’ll need to make before a health care provider can perform this test. Health care providers often use contrast enemas for people experiencing constipation to check for Hirschprung’s disease. 
• An air contrast barium enema uses a combination of air and barium. This combination shows up on an X-ray and is often used to look for a source of rectal bleeding. Bowel preparation is also required for this test. 

Cleansing enema

Cleansing enemas are most commonly used to treat constipation. The process stimulates the colon to eliminate stool.

Cleansing enemas can be performed at home. Some popular at-home enema types are:

• Saltwater enema — A saline solution made from salt and lukewarm distilled water
• Baking soda enema — A solution of baking soda and water
• Tap water enema — A plain water enema can relieve constipation symptoms 

Health care providers do not recommend using homemade enemas. Always talk with your health care provider before performing an enema at home, and follow their instructions carefully.

How to do an enema

Before attempting the process at home, it’s essential that you know how to use an enema. Here are step-by-step instructions on how to perform an enema:

1. Warm the enema in a bowl of warm water. Remove the cap from the tip and hold the bottle upright so the contents don’t spill out. 
2. Make sure to lubricate the tip of the rectal tube. Lubricate five centimeters of the tip with a water-soluble lubricant. 
3. Pour the precise amount of solution as instructed into the enema bag. 
4. Test that the enema contraption works by unclamping the tubing to allow a small amount of the solution to run into a container. Drop a few drops of the solution on your wrist to test the temperature.
5. Lie on your left side on a towel, with your knees bent up toward your chest as high up as is comfortable. 
6. Clamp the tubing and gently put the nozzle into your rectum pointing towards your belly button. How far the nozzle is inserted will depend on your age. Make sure to follow the instructions given by your health care provider.
7. If there’s any resistance as you insert the tip, slowly remove it and try again at a different angle. If there’s further resistance, stop the process and call your health care provider. 
8. Hold the enema bag about 12–15 inches above your hips. Slowly squirt the solution into the rectum. Breathe deeply through your mouth to help relax your internal anal sphincter.
9. If the solution starts to run out of the rectum, squeeze your butt firmly around the tube. 
10. If you experience cramping, shut off the flow of solution for a couple of seconds by pinching the tubing together and then restart the process when you’re feeling better.
11. When all the solution is done, clamp the tubing and remove it from the rectum. 
12. Remain in the same position until the urge to have a bowel movement is strong. Ideally, you should try to hold in the liquid for as long as possible.
13. When you can no longer hold the liquid, you will feel a strong sensation to empty your bowels. Go to the toilet and stay there for the next hour.
14. Some people experience stomach cramps for a short time after an enema. Additionally, some people will feel faint or dizzy afterwards. If this happens, it’s best to lie down until you feel better.
15. The enema should work within the first hour.

Why use an enema?

If you’re trying to make yourself poop immediately, an enema is often a solid course of action. The most frequent enema solutions are for constipation or bowel cleansing before a medical procedure or examination (such as a colonoscopy). 

Fleet enemas use forms of a naturally occurring substance called phosphorus that’s important to every cell in the body. Fleet enemas are used to treat constipation and clean bowels before X-rays, colon surgery, or endoscopy exams. 

You might get an enema if you’re trying to clean the lower bowel, receive medications, or help clear out gas or stool.

What are the risks of using an enema?

Enemas can be incredibly useful but can result in serious side effects, such as metabolic derangement or perforation. Hypertonic sodium phosphate enemas can be particularly dangerous to elderly patients with chronic renal failure or patients who have been treated with ACE inhibitors. In these patients, phosphate enemas may cause severe phosphate nephropathy. 

The side effects of cleansing enemas are rarely discussed, but the process can be life-threatening. The most frequent cause of perforation comes from the device tip. In some cases, the perforation is due to a weakness of the rectal wall, an obstruction, or the position of the person when the enema was performed. 

You should never use more than one enema in 24 hours. If you don’t see results within an hour of performing an enema, call your health care provider. A fleet enema typically has a shorter turnaround time, and you should see results within 30 minutes.

Typically, enemas are safe, but there are rare cases where too many enemas can have life-threatening effects on the heart or kidneys. 

Alert your health care provider immediately if you perform an enema and feel:

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

Enemas should not be used by patients with:

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

The takeaway

It can be helpful to understand how an enema works, in case there’s ever a time in your life when you or your family member needs one. Performing an enema at home can be safe if you understand what you’re doing. Always talk with your health care provider before you attempt any medical process at home.