An enema introduces liquids through a tube inserted into the bowel. Enemas are used to treat severe constipation and to introduce fluids in patients who can't receive them intravenously, as well as to administer certain drugs in liquid suspension. Done correctly, an enema is safe, effective and a natural alternative to laxatives and purgatives. Following are the steps for giving an enema.
Preparing for the Enema
1Decide where the enema will be given. The three most common places to give an enema are on a bed, on the bathroom floor or in a bathtub.
2Place the supporting hook at the right height. The hook should be from 18 to 24 inches (45 to 60 centimeters) above the surface where the recipient of the enema will be lying, so that the enema bag is suspended 12 to 18 inches (30 to 45 centimeters) above the recipient's anus. This is high enough so that the enema solution will gradually flow out of the enema bag.
- Suspending the enema bag too high will increase the incoming pressure and thus the enema recipient's discomfort. Suspending the bag too low will cause the fluid to flow back into the enema bag, leaving little fluid to reach the colon
3Prepare for spills or leakage. If giving an enema in the bedroom or bathroom floor, place a thick absorbent pad or towel where the recipient will be lying. If giving the enema in the bathtub, an absorbent towel is unnecessary, although you may wish to wipe spills off the recipient's buttocks or legs.
Preparing the Enema Solution
1Choose the right water temperature. Most enemas should be given at close to human body temperature, or between 98 and 105 degrees Fahrenheit (37 to 40.5 degrees Celsius). Enemas may be given with water as cool as 86 degrees Fahrenheit (30 degrees Celsius) or as hot as 113 degrees Fahrenheit (45 degrees Celsius). Using water colder than 86 degrees Fahrenheit may cause cramping, while using water hotter than 113 degrees Fahrenheit can scald the rectal area.
2Add the necessary solute for the purpose of the enema. While tap water is sufficient for most enemas, it may be necessary to add something to make the enema more effective, or if the enema is intended for something other than colon cleansing.
- Mild soap is added to the enema solution when the enema is intended to relieve constipation. Enema soap is specially formulated to be mild enough for infants but able to handle the most severe constipation. Enema soap is available in packets in most medical supply stores or may be ordered by a local pharmacist. One packet is sufficient. (Liquid dishwashing detergent should not be substituted, as it will irritate the colon and may cause colitis.) If enema soap is not available, baking soda may be substituted.
- Salt is added to enemas that are designed to soften impacted stools rather than trigger the bowel to expel them. Generally, one teaspoon of salt should be added per pint of water (10 milliliters/cubic centimeters of salt per liter of water). Mineral oil also softens stools and lubricates the colon, but it may seep out of the anus for up to 24 hours after the enema is given.
- Sodium phosphate is added to commercial enema solutions designed to clean out the colon prior to a colonoscopy or sigmoidoscopy. Sodium phosphate draws water from the bloodstream into the colon, but often triggers intense cramps in the process.
- Certain drugs that penetrate the body faster without going through the digestive tract, such as some cancer, arthritis and macular degeneration medicines, as well as a few anti-nausea drugs, can be added to the enema solution.
- Barium solution is used in enemas that are to be retained long enough to enable the colon to be displayed on an X-ray.
3Fill the enema bag or syringe. The amount of enema solution the recipient will be able to accept varies according to the size of the recipient's colon and how much fecal matter is inside it. A child 11 years old or older has the same colon capacity, on average, as an adult.
- If using a pre-measured enema solution, a child aged 5 to 10 years can be given a full bottle of a child-sized enema, while a child aged 2 to 4 years needs only half a bottle.
4Connect the bag to the tubing.
Administering the Enema
1Coat the tubing nozzle with a lubricant.
2Let enough enema solution flow through the tubing to force air out of it. This will reduce cramping when the enema is administered.
3Lubricate the anus and rectal area. The lubricant should be applied generously to the exterior of the anus and as far up the rectal area as possible to both make the tube easier to insert and protect the skin around the rectal area. Afterward, wipe off your finger with a tissue. (Alternatively, you can put on rubber or latex gloves before applying the lubricant.)
4Get the recipient into position. While there are several positions the enema recipient can be in, the 3 most common positions are Sims' position, the knee-chest position and lying on the back with knees bent.
- Sims' position can be used whether receiving an enema from someone else or giving an enema to yourself. To assume Sims' position, lie on your left side with your left leg straight and your right leg bent at the knee. Place your left arm behind your back and your right hand under the pillow at your head. If administering the enema to yourself, the flow regulating clamp should be placed where your left hand can reach it.
- Knee-chest position may be more comfortable for someone receiving an enema from someone else, particularly if the recipient is pregnant, and may also be called for in cases of severe constipation. In this position, the recipient gets on hands and knees, places 1 or more pillows under the chest and leans on them while turning the face sideways and resting it on another pillow his or her arms are wrapped around. It does not lend itself to controlling the enema flow if you're giving it to yourself, however.
- Use the lying on the back with knees bent position if giving yourself an enema while lying on the bathroom floor or in the bathtub. Put a pillow under your head and make sure you can reach the flow regulating clamp before you start.
5Insert the tube into the rectum. Twist the tube back and forth while inserting it to make it easier to go in. The tube should be inserted no more than 3 to 4 inches (7.5 to 10 centimeters) into the rectal area without forcing. Having the enema recipient "bear down" as though having a bowel movement may help the insertion process.
6Let the enema solution flow into the colon slowly. A suggested flow rate is 4 to 8 ounces (118 to 236 milliliters) per minute. Have the enema recipient take slow, deep breaths; the recipient may feel the stomach expand somewhat while receiving the enema, and the stomach and abdomen may also appear fuller. Stop the flow at the first sign of cramping and have the recipient take quick, shallow breaths, then resume the flow when the discomfort passes. Interrupt the flow as often as necessary for the enema recipient's comfort. Allow up to 15 minutes to administer a large-volume enema.
7Massage the abdomen slowly and deeply in a counter-clockwise direction. This will work the enema solution higher into the colon and also help dislodge fecal material from the colon walls. Start from the lower left side of the body, work up to the rib cage and then work back down the right side.
8Clamp off the tube once the enema is stopped. This will prevent backflow into the bag when it is time to evacuate the bowels.
9Give the enema time to do its job. On average, the enema should be held between 5 to 15 minutes before evacuating, with the longer times desired for relieving constipation. If the recipient feels the urge to go before this time, have him or her take deep breaths by mouth to relax.
Evacuating the Enema
1Get to the toilet. If the recipient is having trouble holding the enema in, either press the buttocks together or press a folded washcloth against them to help retain it.
2Remove the enema tube.
3Have the recipient squat over the toilet. Squatting causes the thighs to push against the abdomen, helping to expel more of the enema solution at a given time. If squatting is too difficult, then let the recipient sit on the toilet as for a normal bowel movement.
- To further aid in expelling the enema solution, massage the recipient's abdomen in a clockwise direction.
4Expel the enema. The enema solution, and any waste matter, should come out within a few minutes. If not, have the enema recipient lie down in the Sims or knee-chest position, wait until the urge to evacuate returns, and try again. In any case, it will likely take several evacuations to clear out all the enema solution.
I have tried an enema with a funnel and a rubber hose, but I can't seem to get much water inside me. What am I doing wrong?
- You need more pressure, which can be achieved with a longer hose or bigger funnel. It's also quite difficult to do it by yourself. If you can get someone to help, it's far easier. When all you have to do is lie down and relax, you'll have better results.
- If administering a series of enemas, only the first should have anything added to the water. Subsequent enemas should be tap water only, to rinse out any soap or other chemical solution that the first enema was treated with and prevent irritation of the colon.
- Do not use distilled water, as it will draw out more of your bodies electrolytes through the colon.
- Too many enemas can lead to electrolyte imbalance; overuse of sodium phosphate enema solutions may injure the anal cavity.
- Enemas are not recommended for people at risk of bowel perforation, or for those with ulcerative colitis, diverticulitis, Crohn's disease, internal hemorrhoids or rectal or colon tumors.
- An improperly given enema may lead to ruptures of the bowel or rectum, triggering internal bleeding. Anyone who suspects such a rupture should immediately seek medical attention.
Things You'll Need
- Enema bag or can
- Colon tube
- Tube clamp
- Enema soap, salt or baking soda (optional)
- Skin lubricant (K-Y jelly, petroleum jelly, vegetable oil or cold cream)
- Rubber or latex gloves (optional)
- Bag hanger (IV stand), hook or nail
- Heavy, absorbent pad or towel
- Distilled water (in areas with water purity issues)
Sources and Citations
Categories: Intestinal and Digestive Health
In other languages:
Español: hacer un enema, Português: Aplicar um Enema, Italiano: Praticare un Clistere, 中文: 做灌肠, Русский: ставить клизму, Français: administrer un lavement, Čeština: Jak provádět klystýr, Bahasa Indonesia: Memberikan Enema, Deutsch: Wie man einen Einlauf verabreicht
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