What is an enema?
An enema is the insertion of a liquid into the rectum or colon by way of the anus. Your doctor may recommend an enema for therapeutic or diagnostic purposes. Constipation is one of the most common reasons for an enema.
Types of enema
The types of enema include:
- Therapeutic enema is an enema that cleans out the colon or rectum, relieves constipation, or treats diseases, such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
- Cleansing enema is a subtype of therapeutic enema. You may need a cleansing enema to clean out your bowel before a medical procedure, such as a colonoscopy.
- Detoxification, or detox enema. This is not a medical term or practice, but many people perform enemas with the idea that the ingredients will help clear the body of inflammation. There are many different ‘recipes’ for a detox enema. Some detox enema advocates claim certain enema ingredients offer health benefits beyond the colon, such as eliminating toxins from the body and increasing “good” bacteria.
- 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.
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. There may be alternative treatments or therapies to relieve constipation.
Why is an enema performed?
An enema may be helpful when there is a problem forming or passing stool. 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).
In some circumstances, due to diet, medical condition, or medication, among other possible causes, your bowel may form stool that is hard to pass easily resulting in constipation. For example, if food moves too slowly through your digestive system, the colon absorbs too much water resulting in dry stool and constipation.
Constipation is when you experience fewer bowel movements than what is normal for you. You may also strain to have a bowel movement. There is no strict definition, but you may be constipated if you have fewer than three bowel movements per week.
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. Doctors also prescribe enemas containing the anti-inflammatory drugs mesalamine or 5-aminosalicylic acid (5-ASA). These are known as topical therapies for colitis.
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.
Alternative reasons people perform enemas, which may not be based on scientific evidence, include:
- Cleansing the body of toxins
- Removing toxins from the colon
- Detoxifying the liver
- Improving immune system function
- Balancing the microbiome
If you are interested in an alternative cleansing enema, first check with your primary care provider for possible harm associated with performing a self-enema, with the ingredients (such as coffee, essential oils, or herbal extracts) in the cleansing enema, or the volume of the enema (some involve very large quantities of enema solution).
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:
- Alternative medicine providers, including naturopaths, acupuncturists, chiropractors, and integrative medicine doctors
- 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 at home?
You can give yourself a therapeutic enema at home. Pharmacies and even grocery stores sell pre-made enema solutions and enema kits. If you want to make your own, you will need to purchase enema supplies at a medical supply store or online from a reputable medical supply company.
At-home enema equipment you may need
If you are not using a store-bought enema from the pharmacy or grocery store, you may need the following enema equipment:
- Enema bottle, bag or bucket: Simple enemas at the pharmacy may consist of a bottle and nozzle with a prepared saline solution. If you are performing a large-volume enema, you will need an enema bucket or bag and tubing. Most enema bags are made of silicone, latex-free materials. Silicone is the right choice if you are preparing an enema containing oil, such as mineral oil.
- Enema nozzle or tip: The nozzle may be part of a kit or purchased separately. There are different types of nozzles. An enema retention nozzle for adults is contoured so that the applicator will more easily stay in the rectum and there is less leakage. There are also inflatable balloon enema nozzles to form a ‘seal’ and keep the solution in the rectum for the specified time. A Foley catheter is commonly used to give a child an enema. A Foley catheter has an inflatable balloon to keep the solution in the rectum. If you are giving a child an enema, check with your pediatrician about the correct size of Foley catheter to use for your child.
- Tubing and clamp: You connect the silicone tubing from the enema bag to the nozzle (or Foley catheter). Clamp the hose until you are ready to dispense the solution.
- Enema ingredients: There are a variety of enema recipes. Normal saline is a common enema recipe—1 teaspoon salt in 1 quart of water, or as prescribed by your doctor. Some enemas contain glycerin, phosphate or soap to help with the bowel movement.
- Lubricant: You will want to apply lubricant on the nozzle before inserting it into the rectum.
At-home enema procedure details
Follow the instructions from your doctor or on the packaging of a store-bought enema.
Generally, giving yourself a therapeutic enema includes these steps:
- Wash your hands.
- If you are not using a store-bought enema, prepare your enema solution using filtered warm water (internal body temperature, so 98-100°F or 37-38°C). Fill your enema bottle, bag or bucket. Clamp the tubing if that is part of your enema system.
- For either type of enema, remove the tip cover from the enema. Often, enema nozzles are lubricated for easier insertion.
- Position yourself to insert the enema. There are 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. Use a lubricant on the enema nozzle to make it glide in easier, about 4 inches into the rectum. Stop if it is hard to insert. Forcing an enema can cause damage.
- Squeeze the store-bought enema bottle—or release the tubing clamp until the liquid has flowed into your rectum or colon. Remove the enema tip/nozzle. Follow your doctor’s directions or the enema kit directions for how long to retain or keep in the enema liquid. It may be 30 minutes or longer for medicated enemas. For a cleansing enema, you will probably feel an urgent need to sit on the toilet and expel the liquid and stool.
Does an enema hurt?
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. If you have pain or discomfort while self-administering an enema, stop and contact your doctor.
How is an enema performed by a medical professional?
The procedure for a therapeutic or cleansing enema is different from a diagnostic enema.
Therapeutic or bowel cleansing enema procedure
If a nurse or other healthcare provider performs your therapeutic enema, some of the steps are the same as an at-home enema.
At the medical office, you will lie on a medical procedure table on your side and pull your knees up to your chest.
Your provider will:
- Prepare the enema.
- Fill the enema bag and connect the tubing.
- Insert the enema nozzle tip into your rectum.
- Control the flow of solution into and out of your rectum.
There will be a toilet in the room or nearby for you to void.
Diagnostic enema procedure
If you need a barium enema (lower gastrointestinal exam, or lower GI exam) for diagnosing the possible cause of intestinal bleeding, pain or other unusual symptoms, you will be in a radiology department of a hospital, outpatient setting, or doctor’s office to have the procedure.
Barium is a substance that shows up very well on X-rays. The barium will highlight the entire rectum and colon, including such abnormalities as colon polyps, diverticula, inflammation, and intestinal blockage. The X-ray machine captures a video of the barium in your colon, so doctors also order barium enemas to evaluate how well the bowel is working in real-time, in addition to still images.
A barium enema generally includes these steps:
- Cleanse your colon as directed the night before or the morning of the barium enema. This may include a combination of food and drink restrictions, at-home cleansing enema, and laxatives.
- At the procedure facility, you will cover yourself with an open-backed patient gown, then lie on an examination table.
- The radiologic technologist will instill the barium mixture slowly into the colon. The barium flows through a small, lubricated enema tip into the rectum.
- There will be a series of painless X-ray pictures.
- Most of the barium will flow out of the colon through the enema tip before the tech removes it.
What are the potential benefits and risks of an enema?
Enemas have been used for thousands of years all over the world as a way to clear out the bowel; deliver herbs, medicines and nutrients; and purge the body of unwanted toxins to cure disease. Humans perform enemas for everything from stomachaches to headaches.
In some parts of Africa, enemas are administered to children multiple times in the first two years of life to clear the bowel and stimulate early development, such as walking.
In contemporary medicine, enema benefits include:
- Relief of constipation. This is especially important for those at higher risk for constipation, including young children and the elderly. A high percentage of elderly individuals in a hospital setting are constipated due to poor fluid and food intake, among other factors.
- Relief of intestinal symptoms. An enema may relieve gas, bloating and abdominal distention associated with constipation and being “backed up.”
- Remission of distal ulcerative colitis (UC). For decades, doctors have prescribed anti-inflammatory enemas for patients with distal UC, which does not extend into the transverse colon, and ulcerative proctitis. UC enemas may contain corticosteroids or anti-inflammatories, specifically 5-aminosalicylic acid or a foam preparation of mesalamine. Studies show improved quality of life for patients on enema therapy for UC.
Other reported enema benefits (depending on the enema) include improvement in:
- Energy level
- Immunity and ability to fight disease (coffee enema, or any enema that claims to rid the body of toxins)
- Peristalsis, which is movement of the intestines that pushes contents through it
- Prostate health (enemas containing frankincense oil and myrrh soap)
- Nausea and pain related to cancer (coffee enema)
- Skin health
Enema risks and complications
Complications after an enema or 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 an enema include:
- Dehydration due to taking laxatives before the procedure
- Puncture of the colon resulting in bleeding and possibly infection
- Rectal necrosis from sodium phosphate enemas, such as Fleet and other brands. The U.S. Food and Drug Administration warns that taking/giving more than one dose of a sodium phosphate drug for constipation can cause life-threatening kidney and heart damage. They also caution to not use rectal sodium phosphate products in children younger than 2 years.
- Toxicity or drug interaction from ingredients in homemade enema recipes
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.
- 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 you are pregnant.
How do I prepare for my enema?
An at-home enema involves as little preparation as buying an over-the-counter enema kit. If you are interested in preparing your own enema solution from varied ingredients, do your research and check with your doctor first before purchasing the ingredients.
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. Perform the enema according to the doctor or nurse’s direction. Do not add additional ingredients, such as herbs.
- 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 an in-office 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 often can I perform an enema at home?
- 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 an 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 your 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 type of enema. Contact your doctor for questions and concerns between appointments. Call your doctor right away if you have:
- Fever (you should not have any fever after an enema)
- Rectal bleeding, bloody stools, or black tarry stools. Seek immediate medical care if you have any of these symptoms.
What are some alternatives to an at-home enema?
Alternatives to an at-home enema for constipation and hard stools include:
- Glycerin suppository
- Laxative—start with a fiber-based or osmotic-based laxative before using a stimulant laxative
- Lifestyle changes, including fresh produce in your diet, drinking more water, and exercising every day to get your bowel moving
- Prune juice
- Stool softener
Chronic constipation can decrease your quality of life and lead to anorectal problems. Contact your doctor or other medical professional if you experience frequent bouts of constipation. Several medicines can cause constipation, so ask your doctor or pharmacist if any of the medications you take can cause constipation.
If self-help measures do not improve your bowel movements, then you may need to decrease or switch medications to reduce the side effect. Do not stop taking your medicine without talking to the prescribing doctor first.