Enema is a medical procedure in which a therapist introduces a solution into the lower portion of the bowel through the rectum. The solution could be medicinal, an anaesthetic or an investigatory dye.

Evacuant enema and retained enema are the two types of enemas. The temperature of the enema solution can vary from cold to warm and even hot in some cases.

Enema is usually given to a person with constipation or gaseous bloating. A cold enema can also be given to a person with a high fever who has not been responding to medicines. A barium enema can help in examining the rectum and the colon. Barium is a metallic element.

The enema should only be done in a sterile environment by a medical professional and should not be done at home. Improper use of enema can lead to severe damage to the intestines and its microflora (the gut bacteria).

  1. Enema types: evacuant enema and retained enema
  2. Procedure of enema
  3. Benefits of enema
  4. Side effects of enema
  5. Enema during pregnancy and labour

Depending on the absorption of the enema solution, enema is divided as evacuant enema and retained enema.

  • 1. Evacuant enema: When the enema solution exits the body along with faecal waste, it is known as evacuant enema. There are two types of evacuant enemas: simple and medicated.
    • Simple enema: Normal saline (salt solution) is generally used in simple evacuant enemas. These enemas are generally given to treat constipation, relieve urinary retention and to relieve gaseous bloating.

    • Medicated enema: Medicated enemas may involve:

      • Oils: Oils like olive oil and sesame oil (gingelly oil) help in softening of the stool.
      • Purgatives: Purgatives like glycerine and water or glycerine and castor oil are used to improve the peristalsis of the bowel (a squeezing movement of the small intestine that pushes the food forward through the bowel).
      • Astringents: Astringents like 2% silver nitrate solution, tannic acid and alum are used to reduce inflammation, mucous discharge and bleeding from the colon. (Read more: Blood in stool)
      • Carminatives: Milk, molasses, and turpentine are sometimes used for removing stomach gas. Carminative enema is also called an anti-spasmodic enema.
  • Retained enema: When the enema solution is supposed to be retained in the body - to be absorbed by the mucous layer of the body- it is known as a retained enema. The various types of retained enemas are:
    • Stimulant enema: Enema solutions like dantron and buffered sodium phosphate solution increase the peristaltic movement of the bowel.
    • Nutrient enema: This types of enema is very rarely performed and is recommended for people who cannot be fed by any other route, i.e., orally or intravenously.
    • Emollient enema: Emollients like dioctyl sodium sulfosuccinate and dioctyl calcium sulfosuccinate are inserted into the rectum to soften the hard faecal matter and provide easy passage of faeces through the anal canal.
    • Anaesthetic enema: In the cases of investigatory procedures like barium enema examination, the doctor may introduce local anaesthetic through the rectum to reduce the discomfort.

Depending on the temperature of the solution, an enema can be cold, hot, warm or graduated:

  • Cold enema: A cold enema solution is about 10 degrees Celsius to 18 degrees Celsius in temperature. A cold enema helps in reducing body temperature during a high fever. It is also given during inflammatory conditions like dysentery, diarrhoea, ulcerative colitis and haemorrhoids.
  • Warm enema: The temperature of a warm enema solution is between 36 degrees Celsius and 38 degrees Celsius. A warm enema helps in cleaning the bowel and relieving constipation by improving the peristaltic movement (the continuous movement of the bowels for smooth motion of the food) of the bowels.
  • Hot enema: The temperature of the hot enema solution is 40-45 degrees Celsius. It is usually given in the cases of faeces obstruction. Hot water enema helps in relieving irritation, pain and inflammation caused by haemorrhoids. Women suffering from leucorrhoea (excessive white discharge from the vagina) are also given a hot enema. It can help in relieving stomach pain due to intestinal gas.
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Your therapist will use a lubricant, a rectal tube, enema solution and a clamp to perform the enema. Here's what can expect during the procedure:

  • Your therapist will ask you to lie down on your side.
  • Next, he or she will attach the enema solution bottle to one of the ends of the rectal tube, hang the enema solution bottle upside down and clamp the upper part of the rectum tube.
  • Next, the therapist will use a lubricant to lubricate your rectum to about two inches (five centimetres) deep. You can request your therapist to use a water-based lubricant to reduce the chances of allergy to the lubricant. 
  • Your therapist may ask you to raise your buttocks or shift your position slightly, to give him or her a clear view of your anus.
  • From this point on, you should breathe in deeply through your mouth as it would help relax your internal anal sphincter (the muscle that keeps the anal hole closed).
  • The therapist will slowly and gently insert the rectal tube into your anus, directing it towards the naval.
  • The therapist will take the tube three inches to four inches (7.5 cm to 10 cm) deep. (There is bound to be some discomfort, but do let your therapist know if you experience a lot of pain.)
  • Once the tube is in, the therapist will raise the enema solution bottle 12 to 18 inches (30 to 45 cm) above your rectum and open the clamp. This would help in delivering the enema slowly and easily.
  • If you experience pain or fullness during the delivery, ask your therapist to stop the flow by clamping the tube. He or she can restart the flow (by removing the clamp) at a slower pace after 30 seconds.
  • Once the solution is delivered, the therapist will clamp the tube and remove the tube slowly.

An enema is a medical procedure and should not be administered without a therapist present. That said, an enema can help to ease many conditions, including the haemorrhoids of piles. Here are some of the most important benefits of an enema:

  • An enema can soften faecal materials in the rectum and help in easier excretion. This is why an enema is sometimes recommended for relief from constipation.
  • Enema is given to decrease body temperature in the cases of high fever.
  • Enema can be given to relieve gaseous bloating (distention) in the abdomen. 
  • A barium enema is a procedure where barium sulfate (a radioactive substance) is introduced in rectum and colon and thereafter an X-ray is taken. This enema acts as an investigatory tool for the detection of tumours, ulcerative colitis and irritable bowel syndrome.
  • An anti-helminthic enema may be used to introduce deworming medications inside the colon.
  • Sometimes an enema is done before investigatory procedures like colonoscopy, where an endoscope - a specialised camera - is used to see inside the rectum and large intestines.
  • Enemas are sometimes given to women who are about to go into labour to avoid perennial tears during vaginal delivery. This needs to be recommended by the doctor, on a case-by-case basis.

The enema should not be done at home as it can lead to severe medical complications. The side effects of enema are:

  • Stretching during enema delivery can lead to intestinal perforation (puncture).
  • Enema can disrupt the microflora of the bowel.
  • The anal sphincter can get damaged or loose due to improper enema delivery.
  • Improper technique and poorly sterilised equipment can lead to infection of the bowel.
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There has been a constant debate about the use of enema during pregnancy and labour. Some studies have suggested that there was no significant effect of the enema during labour as the pain and duration of the labour were same as in women who did not receive an enema.

However, the World Health Organization says that an enema can help in inducing faster labour thus reducing a delayed delivery. Thus, the use of enema varies for different pregnancies. One should not perform enema at home without a doctor’s advice.

Typically, enema is not advised during pregnancy as it can induce labour - especially in the second trimester of pregnancy and third trimester of pregnancy. Constipation during pregnancy is a common problem. Ask your doctor for alternative treatments like fibre supplementation and which foods to eat and which foods to avoid during pregnancy to ease the symptoms of constipation.

Read more: Ayurvedic treatment and medicines for constipation

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