An enema is the insertion of a solution into the rectum and lower intestine.
Enemas may be given for the following purposes:
- to remove feces when an individual is constipated or impacted,
- to remove feces and cleanse the rectum in preparation for an examination,
- to remove feces prior to a surgical procedure to prevent contamination of the surgical area,
- to administer drugs or anesthetic agents.
The rectal tube used for infusion of the enema solution should be smooth and flexible to decrease the possibility of damage to the mucous membrane that lines the rectum. Tap water is commonly used for adults but should not be used for infants because of the danger of electrolyte (substance that conducts electric current within the body and is essential for sustaining life) imbalance. The colon absorbs water, and repeated tap
water enemas can cause cardiovascular overload and electrolyte imbalance. Similarly, repeated saline enemas can cause increased absorption of fluid and electrolytes into the bloodstream, resulting in overload. Individuals receiving frequent enemas should be observed for over-load symptoms that include dizziness, sweating, or vomiting.
Soap suds and saline used for cleansing enemas can cause irritation of the lining of the bowel, with repeated use or a solution that is too strong. Only white soap should be used; the bar should not have been previously used, to prevent infusing undesirable organisms into the individual receiving the enema. Common household detergents are considered too strong for the rectum and bowel. The commercially prepared castile soap is preferred, and should be used in concentration no greater than 5 cc soap to 1, 000 cc of water.
Cleansing enemas act by stimulation of bowel activity through irritation of the lower bowel, and by distention with the volume of fluid instilled. When the enema is administered, the individual is usually lying on the left side, which places the sigmoid colon (lower portion of bowel) below the rectum and facilitates infusion of fluid. The length of time it takes to administer an enema depends on the amount of fluid to be infused. The amount of fluid administered will vary depending on the age and size of the person receiving the enema, however general guidelines would be:
- Infant: 250 cc or less
- Toddler and preschooler: 500 cc or less
- School-aged child: 500–1, 000 cc
- Adult: 750–1, 000 cc
Some may differentiate between high and low enemas. A high enema, given to cleanse as much of the large bowel as possible, is usually administered at higher pressure and with larger volume (1, 000 cc), and the individual changes position several times in order for the fluid to flow up into the bowel. A low enema, intended to cleanse only the lower bowel, is administered at lower pressure, using about 500 cc of fluid.
Oil retention enemas serve to lubricate the rectum and lower bowel, and soften the stool. For adults, about 150–200 cc of oil is instilled, while in small children, 75–150 cc of oil is considered adequate. Salad oil or liquid petrolatum are commonly used at a temperature of 91°F (32.8°C). There are also commercially prepared oil retention enemas. The oil is usually retained for one to three hours before it is expelled.
The rectal tube used for infusion of the solution, usually made of rubber or plastic, has two or more openings at the end through which the solution can flow into the bowel. The distance to which the tube must be inserted is dependent upon the age and size of the patient. For adult, insertion is usually 3–4 in (7.5–10 cm); for children, approximately 2–3 in (5–7.5 cm); and for infants, only 1–1.5 in (2.5–3.75 cm). The rectal tube is lubricated before insertion with a water soluble lubricant to ease insertion and decrease irritation to the rectal tissues.
The higher the container of solution is placed, the greater the force in which the fluid flows into the patient. Routinely, the container should be no higher than 12 in (30 cm) above the level of the bed; for a high cleansing enema, the container may be 12–18 in (30–45 cm) above the bed level, because the fluid is to be instilled higher into the bowel.
The solution used in the procedure is measured, mixed, and warmed before administration of the enema.
If necessary, a specimen will be collected for diagnostic evaluation. If the enema was given to alleviate constipation, the better approach to combatting constipation
Habitual use of enemas as a means to combat constipation can make the problem even more severe when their use is discontinued. Enemas should be used only as a last resort for treatment of constipation and with a doctor's recommendation. Enemas should not be administered to individuals who have recently had colon or rectal surgery, a heart attack, or who suffer from an unknown abdominal condition or an irregular heartbeat.
Eller, D. "Spring Cleaning from the Inside Out." Remedy May/June 1997. 28 May 1998 <http://thriveonline.oxygen.com>.
Weiss, R. "Enhancing the process of elimination." Washington Post Health. 29 Nov. 1994. 28 May 1998 <http://thriveonline.oxygen.com>.
Kathleen D. Wright, RN
Electrolyte—A substance that conducts electric current within the body and is essential for sustaining life.
Intestine—Also called the bowels and divided into large and small intestine, they extend from the stomach to the anus, where waste products exit the body. The small intestine is about 20 ft (6.1 m) long and the large intestine, about 5 ft (1.5 m) long.
Rectum—The portion of bowel just before the anus. The prefix recto is used with a variety of words in relation to conditions that affect the rectum.