An enema shouldn’t cause pain. But if you’re performing an enema for the first time, you may experience some minor discomfort. This is typically a result of your body getting used to the sensation and not the enema itself.

Severe pain may be a sign of an underlying problem. If you begin to experience pain, stop what you’re doing and call your doctor or other healthcare provider.

Read on to learn more about how it feels, how to minimize discomfort, and more.

An enema can be uncomfortable. Inserting a lubricated tube into your rectum and filling your colon with fluid isn’t the most natural act, but it shouldn’t be painful.

You may feel “heavy” in your abdomen and lower gastrointestinal (GI) tract. That’s the result of the influx of fluid.

You may also experience mild muscle contractions or spasms. This is a sign the enema is working. It’s telling the muscles of your GI tract to push what was impacted stool out of your body.

Enemas can be used for several situations or conditions. These include:

Constipation. If you’ve tried other constipation remedies unsuccessfully, your healthcare provider may suggest an at-home enema. The flow of fluid through your lower colon may stimulate the muscles to move the impacted stool.

Pre-procedure cleanse. Your healthcare provider may ask you to do an enema in the days or hours before a procedure like a colonoscopy. This helps ensure that they’ll have an unobstructed view of your colon and tissues. It will make spotting polyps easier.

Detoxification. Some people promote enemas as a way to cleanse your colon of impurities, bacteria, and buildup that may make you sick. However, there isn’t any scientific evidence to support the use of enemas for this reason. Your colon and other GI tract structures efficiently clean themselves — that’s why you produce waste.

Two primary types of enemas exist: cleansing and barium.

Cleansing enema

These water-based enemas use other ingredients to help move impacted bowels along more quickly. They are used to treat constipation and are available over the counter. Fleet is a popular brand of these types of enemas.

A typical solution may include:

  • sodium and phosphate
  • mineral oil
  • bisacodyl

Your doctor or other healthcare provider can tell you which formulation to use based on your needs.

Barium enema

Unlike cleansing enemas, barium enemas are typically performed by your doctor or radiologist for imaging studies.

Your provider will insert a metallic liquid solution (barium sulfate mixed in water) into your rectum. After the barium has had time to sit inside and coat your distal colon, your doctor will perform a series of X-rays.

The metal shows up as bright contrast on the X-ray images. This gives your provider a better view of what’s happening inside your body.

Coffee enemas Although coffee enemas have gained popularity as a way to rid your body of impurities, there isn’t any research to support these “detoxifying” claims. Your body is designed to naturally clean itself, and unless you’re ill, it should be fully capable of that.

A cleansing enema can be done as a do-it-yourself procedure. You can purchase everything you need for an enema over the counter (OTC) in a drugstore or pharmacy.

A colonic is also known as colonic hydrotherapy or colon irrigation. It’s a medical procedure that is typically performed by a healthcare professional, a colonic hygienist. They use specialized equipment to irrigate your colon.

A cleansing enema is intended to reach only your lower colon, usually just to the point of constipated stool near the rectum. A colonic may be able to affect more of the colon, as a colon irrigation typically uses a much higher volume of water than a cleansing enema.

You should always follow the directions provided with your enema kit. Ask your healthcare provider for clarification if you’re unsure.

Every kit is different. General guidelines suggest:

  1. Fill the enema bag with the solution you choose to use or the mix provided in the kit. Hang it on a towel rack, shelf, or cabinet above you.
  2. Heavily lubricate the enema tubs. Larger amounts of lubricant will make inserting the tube into your rectum more comfortable and easier.
  3. Place a towel on your bathroom floor. Lie on your side on the towel, and pull your knees under your abdomen and chest.
  4. Gently insert the lubricated tube up to 4 inches into your rectum.
  5. Once the tube is secure, gently squeeze the contents of the enema bag or allow it to flow into your body with gravity’s help.
  6. When the bag is empty, slowly remove the tube. Dispose of the tube and bag in a trash can.

You may be able to minimize discomfort by keeping the following tips in mind:

Relax. It’s normal to be nervous if you’re doing an enema for the first time, but nervousness may make your rectum muscles tighter. Try listening to calming music, practicing deep breathing, or first soaking in a hot bath to ease your muscles and your mind.

Breathe deeply. As you’re inserting the tube, inhale for a count of 10. Focus on your breath. Exhale for a slow count of 10 after the tube is in place. While the fluid is going into your rectum, you may keep practicing these breathing beats to keep you distracted and focused.

Bear down. If you have difficulty inserting the tube, bear down, as if you were trying to pass a bowel movement. This may relax the muscles and allow the tube to slide further into your rectum.

Discomfort may happen. Pain should not. Pain may be the result of hemorrhoids or tears in the rectal lining.

If you experience pain when inserting the enema tube or pushing the fluid into your colon, stop the enema immediately and call your healthcare provider or local medical services.

If you know that you have hemorrhoids, tears, or other sores, wait for them to heal before administering an enema.

Once the bag is emptied and the tube is removed, continue lying on your side until you feel the need to use the restroom. This typically takes a few minutes, but you should carefully get up and go to the toilet as soon as you feel the urge.

In some cases, your healthcare provider may instruct you to perform a retention enema. This requires you to hold the fluid for 30 minutes or more. This may help increase the odds of success.

If you don’t have specific instructions, move to a toilet the moment you feel the need to relieve yourself. Stay near the bathroom for the next few hours. You may find yourself needing to use the restroom several times.

You may also want to hold off on lifting heavy objects for several hours. The increased pressure on your GI tract could cause accidents.

If you don’t pass an impacted stool within the next few hours, or if you start to have significant related symptoms, contact your provider.

You should be able to return to normal activity within 24 hours.

Although they may be uncomfortable, enemas are generally safe. You should always follow the instructions included with your kit or as told to you by your healthcare provider.

Enemas are generally one-time tools to help ease constipation or clear out your colon for a test or procedure. They shouldn’t be performed regularly.

If you’re frequently constipated, don’t rely on enemas to ease the situation. Instead, talk with your healthcare provider to diagnose and treat the underlying cause.