Enema
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This 2qt (about 2 liters) enema bag, or "fountain syringe", equipped with a rectal nozzle, is to be filled with water or a solution, then suspended near the patient using the hook. Then, the nozzle (shown equipped) is inserted into the anus and the clamp is released. This bag may also be used for vaginal douches. |
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This rectal bulb syringe may be used to administer small enemas. |
An
enema (plural
enemata or
enemas) is the procedure of introducing liquids into the
rectum and
colon via the
anus. Enemas can be carried out for medical reasons (as a treatment for
constipation), as part of alternative therapies, and also for
erotic purposes, particularly as part of
BDSM activities. In earlier times, they were often known as
clysters. Enemas have even been used to administer beverage alcohol to alcoholics who have developed stomach ulcers.
The main medical usages of enemas are:
* As a bowel stimulant, not unlike a
laxative -- the main difference being that laxatives are commonly thought of as orally administered while enemas are administered directly into the rectum, and thereafter, into the colon. When the enema is complete, and after a set "holding time," the patient expels
feces along with the enema in the
toilet.
* Enemas may be used to relieve
constipation and
fecal impaction, although in many health-care settings their use has been largely replaced by oral laxatives and laxative
suppositories. Bowel stimulating enemas may consist of water, which works primarily as a mechanical laxative, or they may be made up of water with baking soda (sodium bicarbonate) or water with a mild soap dissolved in it;
sodium phosphate solution, which draws additional water from the bloodstream into the colon and increases the effectiveness of the enema, but which can often be rather irritating to the colon, causing intense cramping or "gripping"; or
mineral oil, which functions as a lubricant and stool softener, but which often has the side effect of sporadic seepage from the patient's anus which can soil the patient's undergarments for up to 24 hours. Other types of solutions are available as well. In the past, castile
soap was a common additive to enemas, but it has largely fallen out of use because of the risk of
chemical colitis as well as the ready availability of other enema preparations that are perhaps more effective than soap -- but which are certainly more irritating to colonic tissues.
* Cleansing the lower bowel prior to a medical or surgical procedure such as
sigmoidoscopy or
colonoscopy. Because of speed and so-called "convenience", enemas used for this purpose are commonly the sodium phosphate variety. A more pleasant experience can usually be obtained with gently-administered baking soda enemas; cleansing the lower bowel for colonoscopy and other bowel studies can be effectively achieved with water-based enema administration.
* The administration of substances into the bloodstream. This may be done in situations where it is undesirable or impossible to deliver a medication by mouth, such as
antiemetics given to reduce
nausea (though not all antiemetics are delivered by enema). Additionally, several anti-angiogenic agents can be safely administered via a gentle enema. Medicines for cancer, for arthritis, and for age-related macular degeneration are often given via enema in order to avoid digestion in the normally-functioning digestive tract. Interestingly, some waster-based enemas are also used as a relieving agent for IBS (Irritable Bowel Syndrome) even though it seems counter-intuitive to add medicines to an already-irritated bowel system. Finally, an enema may also be used for
hydration purposes. See also
route of administration.
* The topical administration of medications into the rectum, such as
corticosteroids and
mesalamine used in the treatment of
inflammatory bowel disease. Administration by enema avoids having the medication pass through the entire
gastrointestinal tract, therefore simplifying the delivery of the medication to the affected area and limiting the amount that is absorbed into the bloodstream. There is some discussion in medical circles about using steroids versus using other enema additives such as cayenne pepper.
*
Anesthetic agents (for general anasthesia) for surgical purposes are sometimes administered by way of an enema. Occasionally, anesthetic agents are used rectally to reduce medically-induced vomiting during and after surgical procedures, in an attempt to avoid aspiration of stomach contents.
* A
barium enema is used as a contrast substance in the
radiological imaging of the bowel. The enema may contain barium sulfate powder, or a water-soluble contrast agent. Barium enemas are not as uncomfortable as some patients anticipate, and are often the only practical way to "view" the colon in a relatively safe manner. Undergoing a barium enema examination:
1. Patients must have a clean bowel for a worthwhile test. Feces left in the colon could be misinterpreted as a pathology, requiring repetition of the exam.
2. Use a pre-examination diet of liquids, abstaining from all solid foods. A liquid-only diet may be advised, using water, clear soup or broth, plain (no red or green) gelatin, black coffee/tea without sugar or cream, and fruit juices. A laxative and a suppository; and possibly a cleansing enema will help clean the colon. Do not eat or drink anything on the day of the exam.
3. If there is any possibility that you may be pregnant, please inform the doctor or the technologist BEFORE the examination.
4. The Radiologist may take a preliminary film of the abdomen to insure the cleansing preparations were successful and that no waste material shows up on the X-ray film.
6. Lying on an X-ray table under a fluoroscope, the patient turns on his side so that a lubricated enema tip, specially designed to help hold the liquid in the bowel, can be inserted into the anus.
7. The Radiologist will regulate the flow of a liquid barium mixture into the bowel so the colon can be visualized. If there is difficulty holding it, let the examiners know. While there may be an urge to move the bowels, it is important to retain the barium.
8. During the administration of the barium mixture, which may include slight pressure on the abdomen, the patient moves into different positions and must hold still while the Radiologist watches the colon fill. Any movement can blur the image on the film.
9. Upon completion of the Radiologist's examination of suspected areas, the technologist may take additional films of the entire bowel.
10. When the films are complete, the patient will be allowed to evacuate the barium, followed by another film of the empty bowel.
11. At home, the patient may pass whitish stools for a few days and might be given a laxative to help get rid of the barium in the bowel. Plain water-based enemas may also be used to clear the bowel of any remaining barium.
In certain countries such as the
United States, customary enema usage went well into the
20th century; it was thought a good idea to cleanse the bowel in case of
fever; also, pregnant women were given enemas prior to
labor so as to supposedly reduce the risk of
feces being passed during contractions. Under some controversial discussion, pre-delivery enemas were also given to women to speed delivery by inducing contractions. This latter usage has since been largely abandoned, because obstetricians now commonly give oxytocin to induce labor and because women generally found the procedure unpleasant. In addition, medically-aided labor reduces the physician's waiting time. Unfortunately, there is some concern that any medication given to a pregnant woman can adversely affect the fetus, and caution may be advised.
Many home-given enemas are pre-packaged sodium phosphate solutions in single-use bottles sold under a variety of brand names, or in generic formats. These units come with a pre-lubricated nozzle attached to the top of the container. Some enemas are administered using so-called, disposable bags connected to disposable tubing, although in contrast to their product names, such units can commonly be used for many months or years without significant deterioration.
Patients who want easier, more gently-accepted enemas often purchase Combination Enema Syringes which are commonly referred to as "closed top" syringes, and which can also be used as old-fashioned "hot water bottles," to relieve aches and pains from gentle, heat administrations to parts of the body.
In medical or hospital environments, reusable enema equipment is now rare because of the expense of administering a water-based solution to the patient, and because of the expense and difficulty of disinfecting it. For a single-patient stay of short duration, an inexpensive, "disposable" enema bag can be used for several days or weeks, using a simple "rinse out" procedure after each enema administration. The difficulty comes in from the longer time period (and expense) required of nursing aides to "give" a gentle, water-based enema to a patient, as compared to the very few minutes it takes the same nursing aide to give the more irritating, cold, pre-packaged sodium phosphate unit.
For home use, disposable enema bags or bottles are common, but reusable
rubber or
vinyl bags or enema bulbs may also be used. In former times, enemas were infrequently administered using
clyster syringes.
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A French engraving, ca 1780 shows the long-standing prurient interest in the clyster |
* The
paraphilia directed towards enemas is known as
klismaphilia. Klismaphilia is the enjoyment of enema applications because of the pleasurable sensations which they give to many people.
* In some cities, enemas are available as a service from practitioners in the
sex industry to cater to klismaphiliac desires, and may be used as part of
BDSM activities. Some providers require a physician's prescription before they will give an enema, and others will merely give enemas on request to clients who like or need them.
* A small enema may also be used prior to
anal sex or the
anilingus in order to remove
feces, thus reducing bacterial transmission and risk of infection. Or, some people who enjoy anal sex activities use enemas to enhance their sensations during the act. Finally, some people who enjoy anal sex also use a small enema or two to reduce the possibility of fecal material adhering to the sex tool(s) used by themselves or their partners during sexual activity.
* People who wish to become intoxicated faster have also been known to use enemas as a method to instill beverage alcohol into the bloodstream, absorbed through the membranes of the large intestine.WARNING: Great care must be used as to the amount of alcohol used. Only a small amount is needed as the intestine absorbs the alcohol quicker than the stomach will. Deaths have been known due to alcohol poisoning via enema.
Ritual use
*
Ritual enemas were practiced by the
Maya and many other
Central American and
South American
Indian tribes; some tribes have continued the practice to the present day. Substances used in the enemas include
alcohol,
tobacco,
peyote, and other
hallucinogenic drugs and
entheogens. The Maya used a fermented liquid called balché in their enemas.
Colonic irrigation or
colon hydrotherapy is a large enema which cleanses the whole
colon. It was in vogue for hygienic purposes at the beginning of the
20th century (see
John Harvey Kellogg) and remains popular as an alternative health therapy in many parts of the world. Advocates believe that, when carried out by trained personnel using sterile equipment, it can be a safe and valuable tool for eliminating
toxins from the body and restoring normal muscular activity in the colon. However, there have been cases of intestinal perforation due to improperly done colonic irrigations. The actual medical benefit of colonic irrigation is controversial.
* M. R. Strict,
Intimate Invasion: The Erotic Ins & Outs of Enema Play,
Greenery Press, 2004. ISBN 1890159514.
*
How to Give An Enema Safely
