What is an enema?

An enema is a procedure during which a liquid is injected into the rectum to expel the waste matter and clean the rectum.

Are there different types of enema?

A cleansing enema is used to treat constipation or to clean the rectum before an operation, an endoscopic procedure [such as anoscopy, proctoscopy, sigmoidoscopy, or pouchoscopy], or in preparation for an XRAY procedure. Other types of enema are used to introduce a medication to treat inflammation in the rectum. The most common cleansing enema is a Fleet enema [Figure 1] or warm tap water enema. Medication enema is typically used in patients with inflammatory bowel disease or radiation proctitis.

Figure 1

How to administer an enema?

#1) Cleansing enema prior to a procedure or for constipation

On the day of your test you need to perform 2 enemas in the comfort of your home. Unless told otherwise, purchase Fleet enema. For adults and children [age > 12 years], use the adult size enema (133 ml). For children between age 2 and 11, use the Children Fleet enema (59 ml). Follow the instructions on the package. If you are on a sodium restricted diet, have kidney disease, are pregnant or breastfeeding, let the doctor know.

Typically the enema takes 1 to 5 minutes to work. Start the enema procedure 1 hour prior to leaving your home unless instructed otherwise. Remove the protective shield covering the enema tip before inserting. You can use the left side position (if you are left handed, the right side position). Alternatively, you can use the knee chest position [Figure 2]. You can lubricate the enema tip with K-Y jelly or liquid soap with warm water before inserting. Slowly insert the enema tip into the rectum and apply steady pressure until the tip is inside the rectum. Gentle bearing down as if you are having a bowel movement can help with the insertion. Once the tip is inside, squeeze the bottle until nearly all liquid is gone. Wait in this position until you feel the urge to go and then sit on the toilet. Once finished with the first enema, repeat the same process.

If you use an enema regularly to relieve constipation, it is best to use warm tap water enema. Buy a reusable enema bottle (available in some medical supply stores or online). Fill with warm water and administer 1 or 2 times as needed using the same position above. If you have more severe constipation, read the section on Rectal Irrigation.

Figure 2

#2) Medication enema

A medication enema is used to deliver a medication inside the rectum. Such enema is often prescribed once or twice a day to treat rectal inflammation. If possible, it is best to insert it after having a bowel movement so that the medication is delivered into a clean rectum. If prescribed a medication enema once daily, it is best to administer in the evening before going to bed so that the medication can sit in the rectum overnight. Remove the protective shield covering the enema tip before inserting. You can use the left side position (if you are left handed, the right side position). Alternatively, you can use the knee chest position [Figure 2]. You can lubricate the enema tip with K-Y jelly or liquid soap with warm water before inserting. Slowly insert the enema tip into the rectum and apply steady pressure until the tip is inside the rectum. Gentle bearing down as if you are having a bowel movement can help with the insertion. Once the tip is inside, squeeze the bottle until nearly all liquid is gone. After instilling the enema, avoid getting up or sitting on the toilet. Remain flat on your back for a few minutes then rotate on your right side, stomach, and finally the left side to allow the medication to coat the entire rectum.

Any questions? Contact Dr. Maher A. Abbas’ office nurse here.