An enema is procedure used for clearing the bowel and colon of fecal matter. The enema introduces liquid, usually water and sodium bicarbonate or sodium phosphate, by means of a bulb or enema bag, into the anus and thus to the bowel and colon. This tends to stimulate the bowel to release fecal matter.
The enema can also mean introduction of any substances into the bloodstream via the anus. People with severe nausea are sometimes given an enema containing anti-nausea medication. Instead of the liquid form of the cleansing enema, this type of substance introduction is usually in the form of a suppository. People with high fevers and nausea may benefit from suppositories containing acetaminophen that can quickly bring down a fever because it reaches the blood stream more quickly. Suppository medications are commonly used in the UK, but are not quite as popular in the US.
An enema can be performed at home. People with bowel impaction or severe constipation might be told to use one. They are often available for purchase at local drug stores. Most people, unless constipation is exceptionally severe, prefer to benefit from using laxatives instead, which also result in clearing the bowel and colon through a much less uncomfortable procedure.
Some enemas still contain mineral oil, and this is not preferred by most people. Mineral oil may cause leakage of the bowel, which cannot be controlled, for up to a day after the enema is administered. The water-based enema is considered just as effective and it is easier to control bowel movements after the enema is given.
Certain medical tests may require the use of an enema. An enema may be standard procedure prior to a colonoscopy, since fecal matter can obscure the test. Also, some tests are performed using a barium enema. An enema containing barium, a radioactive substance, can help visualize the gastrointestinal tract and any possible problems. The barium enema is usually given right before x-rays of the intestines are taken.
It used to be quite common for pregnant women going into labor, or who were past their due date to have an enema. This was thought to provoke greater labor pains and speed labor. It was also thought more sanitary, since fecal matter would not be passed during strong contractions. This is seldom performed now, and was a source of discomfort to many women for numerous years. If any fecal matter is passed during labor and delivery it is simply quickly cleaned up.
Some people believe that occasional cleaning of the bowel through an enema promotes greater health, although there is little evidence that it is necessary as a part of an overall health regimen. This belief became popular at the advent of the 20th century, and some still adhere to it. People may have enemas performed as an alternative medicine procedure, in the belief that it will clear the body of toxins and strengthen the muscles of the colon.
Before administering an enema, ensure the patient's privacy by closing the room door. The patient should be encouraged to empty both bladder and bowels before the procedure. Have the patient undress completely from the waist down. Position the patient on the bed on his or her left side with the top knee bent and pulled slightly upward toward the chin. Place a waterproof pad under the patient's hips to protect the bedding and drape a sheet over the patient covering the entire body except the buttocks. Place a bedpan and toilet paper within quick access. Explain the procedure to the patient. Emphasize the importance of breathing slowly through the mouth to encourage relaxation of the rectal sphincter and to avoid oppositional pressure. Let the patient know that while he or she may feel the urge to defecate, most enemas need time to work and he or she should try to hold the fluid for at least five to 10 minutes after instillation (300 minutes for retention enemas and longer for some medicated enema solutions). Check the medication label if it is a medicated solution to avoid medication errors. Be sure it is the right medicine, the right dose (strength), the right time, the right person, and the right method. Verify the expiration date on the label. Do not use outdated medicine.
Wash hands thoroughly and put on gloves. To prepare for premixed disposable enema instillations, follow the directions on the package. Most premixed disposable enemas come with the tip already lubricated. Shake the solution bottle. Remove the cap from the tip and expel excess air from the apparatus before use. To prepare solutions to be administered using an enema bag, heat the solution to 105°F. Adult solutions are generally 750000cc of solution for a non-retention enema and 15000cc of fluid for a retention enema. Children's solutions are 25000cc of solution for a non-retention enema and 7550cc of solution for a retention enema. Infants' solutions are 15050cc of solution for a non-retention enema. If preparing a medicated solution, follow the physician's orders. Select a rectal tube appropriate to the patient's size (#140 French rectal tube for an adult, #128 for a child, #12 for an infant) and connect it to the tubing from the bag. Fill the enema bag with the solution and open the tubing. Run the solution through the tubing to the tip of the rectal tube to clear air from the line. Clamp the tubing and adjust the bag on an IV pole so that it will hang at the patient's hipline. Put water-soluble lubricant on a clean 4 gauze pad and roll the tip of the rectal tube in the lubricant. Coat all of the rectal tube that will be inserted into the rectum to avoid traumatizing the rectal tissue [3 inches (7.30 cm) for an adult, 2 inches (5.5 cm) for a child, 1 1/2 inches (2.5 cm) for an infant].
After administering an enema, remain near the patient in case he or she needs assistance with the bedpan or to get to the bathroom. Medicated enemas that are expelled immediately may need to be repeated, using fresh solution. Follow the directions or consult with the physician. To assist the patient with retaining an enema after instillation, apply gentle pressure to the rectal opening using a 4 gauze pad or squeeze the buttocks together. Tuck a 4 gauze pad between the buttocks to collect seepage. This maneuver may help the patient feel more secure. Cover the patient after the procedure and instruct him or her to lie still for five to 10 minutes or longer if a medicated solution or retention enema is administered. This will allow time for the solution to take effect. Wash items that might be reused, such as non-disposable enema bags and tubing, in warm soapy water. Rinse and allow them to air dry. Place disposable items, gauze pads, and gloves in a trash bag, then seal and discard it. Assist the patient to the bathroom or with the bedpan after he or she has held the enema solution for the correct amount of time. Hands should be washed after performing the procedure. Note the results of the enema.
Complications of enema administration are not common but can include irritation, swelling, redness, bleeding, or prolapse of the rectal tissue. If any of these symptoms are apparent, or if the patient complains of pain or burning during enema instillation, stop the procedure and notify the physician.
Most enemas, because of their liquid state, are absorbed quickly and work rapidly. Retention enemas will take 300 minutes to achieve full therapeutic effect. Cleansing enemas usually work within 105 minutes to cleanse the bowel and relieve constipation. They may, however, need to be repeated one or two times to thoroughly cleanse the bowel in preparation for a bowel exam or bowel surgery. Medicated enemas, such as antibiotic or anti-inflammatory solutions, may need to be repeated daily over a period of a week or more for full therapeutic effect.