Sarah Lewis, PharmD
What is an enema?
An enema is the insertion of a liquid into the rectum or colon by way of the anus. The colon, also called the large intestine or large bowel, is a long, hollow organ in your abdomen. It plays an important role in digestion by removing water from digested material and forming feces (stool). Your doctor may recommend an enema for therapeutic or diagnostic purposes.
An enema is only one method used to diagnose or treat diseases and conditions of the colon and rectum. Discuss all the diagnostic and treatment options with your doctor to understand which options are right for you.
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Types of enema
The types of enema include:
Diagnostic enema is an enema that helps diagnose certain conditions of the colon or rectum, including abdominal pain, bleeding symptoms, and ulcerative colitis. A barium enema is a diagnostic enema. Barium shows up well on X-rays and allows your doctor to see the colon in detail.
Why is an enema performed?
Your doctor may recommend a therapeutic enema to treat diseases and conditions of the colon or rectum including:
Constipation, hard, dry, infrequent stools that are difficult to pass
Excessive gas, belching, bloating, distended abdomen
Fecal impaction, a large amount of hard stool that is stuck in the rectum
Ulcerative colitis, inflammation and bleeding in the colon. Your doctor may order an enema that contains corticosteroids dissolved in water. Corticosteroids reduce inflammation.
Your doctor may also order an enema before medical procedures. This type of enema (cleansing enema) makes it easier to examine your colon during certain tests, such as colonoscopy. A cleansing enema can also lower the amount of bacteria in your colon and reduce the risk of infection for certain surgeries.
Who performs an enema?
You may give yourself a therapeutic enema at home as prescribed by your doctor. Sometimes, a nurse or technician will administer a therapeutic enema in the hospital setting or a barium enema as part of a diagnostic procedure.
The following specialists often prescribe enemas:
Family medicine doctors provide comprehensive healthcare to adults and children, including acute, chronic and preventive healthcare.
Gastroenterologists are internists who specialize in diseases of the intestines.
Geriatricians are internists who care for older adults and specialize in conditions specific to aging.
Internists provide comprehensive healthcare to adults, including preventing, diagnosing and treating a variety of diseases and disorders.
How is an enema performed?
You can give yourself a therapeutic enema at home. Giving yourself a therapeutic enema generally includes these steps:
Wash your hands.
Remove the tip cover from the enema. Often, enema tips are lubricated for easier insertion.
Position yourself to insert the enema. There a few positions you can try. You can lie on your left side and pull your knees up to your chest in a fetal position. You can lie on your back and pull your knees up to your chest. Or you can kneel with your head lowered and your chest forward until your face nears or rests on the ground.
Relax as much as possible. Relaxing your muscles will ease insertion.
With steady and even pressure, gently insert the enema tip into your anus with side-to-side motions. Stop if it is hard to insert. Forcing an enema can cause damage.
Squeeze the bottle until the liquid has flowed into your rectum or colon. Remove the enema tip. Follow the directions about how long to retain or keep in the enema liquid.
Will I feel pain?
An enema should not be painful when administered properly. You may feel fullness, mild pressure, or brief, minimal cramping during the procedure. You may also feel like you need to have a bowel movement.
Take a few long, deep breaths to help yourself relax. Tell your doctor or care team if any discomfort does not pass quickly. If you have pain while self-inserting an enema, stop and contact your doctor.
What are the risks and potential complications of an enema?
Complications after a barium enema are uncommon, but any procedure involves risks and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or your recovery.
Risks and potential complications of any type of enema include:
- Puncture of the colon
Risks and potential complications of a barium enema include:
Barium impaction, which is an obstruction of the colon caused by the barium. This is a rare event.
Dehydration due to taking enemas and laxatives before the procedure
Puncture of the colon
Small risk of cancer due to radiation exposure. Your care team follows strict standards for X-ray techniques and will use the lowest amount of radiation possible to produce the best images. Your doctor will generally not order an X-ray if you are pregnant due to the danger of radiation to an unborn child. It is important to tell your doctor if there is any chance that you are pregnant.
How do I prepare for my enema?
You are an important member of your own healthcare team. The steps you take before your enema can improve your comfort and help obtain the most accurate tests results for a barium enema.
You can prepare for a barium enema by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Completely cleansing your intestines as directed by your doctor. This may include a combination of enemas, laxatives, and not eating solid foods or drinking on the day or night before the procedure.
Taking or stopping medications exactly as directed. This may include taking your usual medications with a small sip of water.
Telling your doctor if there is any possibility of pregnancy
Questions to ask your doctor
Having a therapeutic or barium enema can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before an enema and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need an enema? Are there any other options for diagnosing or treating my condition?
Can my enema be self-administered?
How long will procedure barium enema take? When can I go home?
When and how will I receive the results of my barium enema test?
What other tests or treatments might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my enema?
Knowing what to expect after an enema can help you get back to your everyday life as soon as possible.
How will I feel after the enema?
A therapeutic enema should provide prompt relief of constipation and hard stools. Call you doctor if you do not pass any stool or if you only pass a small amount of stool and still feel constipated.
You may receive a laxative or enema after a barium enema to wash out any remaining barium. You may pass extra gas that was inserted during the procedure. You should not have pain. Tell your doctor or care team if you have discomfort that does not go away quickly or if you are in pain.
It is normal for you to have white-colored stools for a day or two after a barium enema. You may be instructed to drink extra water for 24 hours to keep your stools soft. Call your doctor if you have constipation for more than two days or if you are unable to pass gas.
When can I go home?
Patients usually go home and resume normal activities and diet immediately after an enema, including a barium enema.
When should I call my doctor?
It is important to keep your follow-up appointments after any