A Complete Guide to Performing Enemas

Medically Reviewed By Cynthia Taylor Chavoustie, MPAS, PA-C
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An enema is the insertion of a liquid into the rectum or colon through the anus. Your doctor may recommend an enema for therapeutic or diagnostic purposes. Constipation is one of the most common reasons for an over-the-counter (OTC) at-home enema.

Keep reading to learn about the types of enema, their purpose, how they are performed, benefits and risks, how to prepare for one, and more.

What are the different types of enema?

there are enema bulbs against a blue background
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The types of enema include:

  • Therapeutic enema is an enema that can clean out the colon or rectum, relieve constipation, or treat diseases, such as inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
  • Cleansing enema can help to clean out your bowel before a medical procedure, such as a colonoscopy.
  • Detoxification, or detox enema 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.
  • Diagnostic enema is an enema used in conjunction with an X-ray that helps determine the cause of various GI symptoms such as abdominal pain, blood in the stool, and diarrhea.

Discuss all the diagnostic and treatment options with your doctor to understand which options are right for you. There may be alternative diagnostic procedures or therapies to relieve constipation.

Types of enema solutions

Types of enema solutions for constipation include:

  • mineral oil
  • phosphate
  • saline

Some people have reported benefits from using coffee enemas, but scientific research would not recommend its use because its effectiveness and safety are dubious.

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
  • 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 also order an enema before medical procedures. A cleansing enema makes it easier to examine your colon during certain tests, such as a colonoscopy. A cleansing enema can also lower the number of bacteria in your colon and reduce the risk of infection during 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

How is an enema performed at home?

You can give yourself a therapeutic enema for constipation at home. Pharmacies and 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 for constipation:

  • 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: If you are giving a child an enema, check with your pediatrician about the correct type and size of the nozzle to use for the 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 various enema recipes. Normal saline is a common enema recipe, which involves dissolving 1 teaspoon of salt in 1 quart of water, or as your doctor recommends.
  • Lubricant: You will want to apply lubricant on the nozzle before inserting it into the rectum.

Preparing for an at-home enema

• Avoid eating for at least half an hour before using the enema.
• Perform the enema nearby a toilet.
• Make sure you have a comfortable place to lie down on.
• Place a towel underneath you.
• Read the instructions on the kit very carefully.

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 to 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 3 inches (7 centimeters) 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. For a cleansing enema, you will probably feel an urgent need to sit on the toilet and expel the liquid and stool.

Enemas, including those with therapeutic purposes, are generally very safe if you follow instructions closely.

How does a medical professional perform an enema?

The procedure for a therapeutic or cleansing enema is different from a diagnostic enema.

Preparing for a medical enema

  • Answer all questions about your medical history and medications.
  • Completely cleanse 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.
  • Take or stop medications exactly as directed.
  • Tell your doctor if there is any possibility of pregnancy.

Therapeutic or bowel cleansing enema procedure

If a nurse or other healthcare professional 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

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.

When can I go home?

People usually go home and resume their usual 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 an enema. Contact your doctor for questions and concerns between appointments. Call your doctor right away if you have:

Seek immediate medical care if you have any of these symptoms.

Frequently asked questions

Here are some frequently asked questions about enemas.

How long does it take for an enema to work?

Enemas should provide relief very quickly after and sometimes as they are taking place. However, this may depend on your situation and the type of enema. Ask a doctor for more guidance.

Do enemas hurt?

An enema should not be painful when administered properly. During the procedure, you may feel fullness, mild pressure, or brief, minimal cramping. You may also feel like you need to have a bowel movement.

Take a few long, deep breaths to help yourself relax. Stop and contact your doctor if you have pain or discomfort while self-administering an enema.

What happens if you do not poop after an 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 pass only a small amount of stool and still feel constipated.

Can I drink water after an enema?

After a barium enema, your doctor may instruct you to drink extra water for 24 hours to keep your stools soft. Call your doctor if you have constipation for more than 2 days or cannot pass gas.

Summary

Over-the-counter enemas can be a useful way to relieve symptoms of constipation. Some doctors may administer enemas in a clinical setting for treatment or diagnostic purposes. You can also try an at-home enema kit.

Contact your doctor with specific questions about the type of enema you should use, what to expect, and any other points that cause you concern.

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Medical Reviewer: Cynthia Taylor Chavoustie, MPAS, PA-C
Last Review Date: 2022 Aug 19
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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