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What is Enema?
ENEMA is a solution introduced into the rectum
and large intestine. The action of an enema is to
distend the intestine and sometimes to irritate the
intestinal mucosa, thereby increasing peristalsis and
the excretion of feces and flatus.
TYPES OF ENEMAS
A. CLEANSING ENEMA = are intended to remove feces. They are
given chiefly to:

1. Prevent the escape of feces during surgery.

2. Prepare the intestine for certain diagnostic tests such as x ray
or visualization tests ( e.g. colonoscopy )

3. Remove feces in instances of constipation or impaction.
Cleansing Enema uses a variety of solution :
SOLUTION CONSTITUENTS ACTION TIME TO
EFFECT
ADVERSE EFFECTS
Hypertonic 90-120ml of solution e.g.
sodium phosphate
Draws water into the
colon
5-10 mins. Retention of sodium
Hypotonic 500-1,000 ml of tap water Distends colon,
stimulates peristalsis
and softens feces
15-20 mins. Fluid and electrolyte
imbalance, water
intoxication
Isotonic 500-1,000 ml of normal
saline ( 9 ml to 1,000 ml
water)
Distends colon,
stimulates peristalsis
and softens feces
15-20 mins. Possible sodium retention
Soapsuds 500-1,000 ml soap to 1,000
ml water
Irritates mucosa,
distends colon
10 15 mins. Irritates and may damage
mucosa.
Tap water
Normal saline solution
Soapsuds solution
Hypertonic solution
Common solution for cleansing enemas
B. CARMINATIVE ENEMA = is given primarily to expel flatus. The
solution instilled into the rectum releases gas, which in turn distends the
rectum and the colon, thus stimulating peristalsis. For an adult 60 to 80 ml.
of fluid is instilled.

C. RETENTION ENEMA = introduces oil or medication into the rectum
and sigmoid colon. The liquid is retained for a relatively long period. An oil
retention enema acts to soften the feces and to lubricate the rectum and
anal canal, thus facilitating passage of the feces. Antibiotic enemas are used
to treat infections locally, antihelmintic enemas to kill helminths such as
worms and intestinal parasites and nutritive enemas to administer fluids and
nutrients to the rectum.
D. RETURN FLOW ENEMA = is used occasionally to expel
flatus. Alternating flow of 100 to 200 ml of fluid into and out of the
rectum and sigmoid colon stimulates peristalsis. This process is
repeated five or six times until the flatus is expelled and abdominal
distention is relieved.
Purpose
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.

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 soap is
preferred, and should be used in concentration no greater than
5 cc soap to 1, 000 cc of water.
Description
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: 5001, 000 cc
Adult: 7501, 000 cc

Some may differentiate between high and low enemas.

1. 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.
2. 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 150200 cc of oil is instilled, while in small
children, 75150 cc of oil is considered adequate. Salad
oil or liquid petrolatum are commonly used at a
temperature of 91F (32.8C). 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 34 in (7.510 cm);
for children, approximately 23 in (57.5 cm); and
for infants, only 11.5 in (2.53.75 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 1218 in
(3045 cm) above the bed level, because the fluid is to
be instilled higher into the bowel.
Preparation
The solution used in the procedure is measured,
mixed, add warmed before administration of enema
Aftercare
If necessary, a specimen will be collected for diagnostic
evaluation. If the enema was given to alleviate constipation,
the better approach to combating constipation in the future is
with a high fiber diet (five to six servings of whole grain foods)
and adequate fluid intake (seven to eight glasses of water per
day). Regular exercise and going to the bathroom when
necessary will also help. If constipation is a chronic problem,
medical help should be consulted to determine if there is
underlying disorder.
Risks
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, irregular
heart beat.
Both pregnant women and nursing women have safely
done enemas. Many of them. No known risks are
associated with clean water enema, but if you are
pregnant, you should avoid enema containing herbs
Can I do an enema if I am pregnant or nursing a baby?
Enema bag/bucket must contain:
enema bag (or enema bucket)
enema tube (connecting enema bag with enema nozzle)
tube clamp or stop cock - used for clamping the tube.
enema nozzle or tip (thin plastic, silicone, glass or
stainless steel tube that will be inserted into anus). Nozzle
is usually 5 - 8 cm long (2 - 3 in), and it is as thick as
pencil. You are not suppose to insert the whole length!
enema liquid
What do I need to do an enema?
ASSEMBLE THE MATERIALS NEEDED
POSITION THE CLIENT IN THE LEFT LATERAL POSITION WITH
THE RIGHT LEG SHARPLY FLEXED
PLACE SOLUTION INTO THE BUCKET AND ADD WATER AS NEEDED
LUBRICATE 2
INCHES OF THE
RECTAL TUBE WITH
LUBRICANT
GENTLY AND SMOOTHLY INSERT THE RECTAL TUBE INTO THE
RECTUM
RAISE THE CONTAINER 12 TO 18 INCHES ABOVE THE RECTUM
AND INSTILL 200 CC OF SOLUTION
LOWER THE CONTAINER 12 TO 18 INCHES BELOW THE CLIENTS
RECTUM. OBSERVE FOR AIR BUBBLES AS THE SOLUTION
RETURNS.
CLEAN THE ANAL
AREA TO REMOVE
EXCESS LUBRICANT
A COMMERCIAL ENEMA
POSITION THE CLIENT IN THE LEFT LATERAL POSITION WITH
THE RIGHT LEG SHARPLY FLEXED
ALTERNATIVELY, YOU MAY
POSITION THE CLIENT IN
THE KNEE CHEST
POSITION
AFTER INSERTING THE NOZZLE INTO THE ANUS, SQUEEZE
THE CONTAINER UNTIL ALL THE SOLUTION IS INSTILLED
REMOVE THE NOZZLE AND CONTAINER AND HAVE THE
CLIENT CONTINUE TO LIE ON THE LEFT SIDE FOR THE
PRESCRIBED LENGTH OF TIME. DISPOSE OF THE EMPTY
CONTAINER IN THE TRASH RECEPTACLE