Enema: Definition, Types, Uses, Instructions, Benefits, Contraindications and Precautions

It is the procedure of introduction of liquids to clean the colon through the anus.

The volume of water causes expansion of the lower gastrointestinal tract causing the wall of the intestine to contract by releasing waste from the intestinal wall.

This method can cause an uncomfortable bloating, cramping, strong peristalsis , and a feeling of urgency or need to have a bowel movement.

Enemas can be beneficial in helping to restore normal bowel function in people with chronic diseases, slow digestion, or as a cancer treatment .

The pump in the enema kit pushes the water solution into the intestines and into the colon.

Then rinse the fecal buildup on all sides. Loosening the fecal matter and releasing it to later be expelled in a few seconds or hours.

The intestines and colon are clean and can function better.

Types of enemas

There are many different types of enemas that a person can use. Basically the ingredient is water and then the different compounds and herbs that are used in specific problems.

Cleansing enemas

There are three types of cleansing enemas: the large volume enema, the small volume, and the disposable packaged enema.

Normal saline is normally used for a cleansing enema because it is an isotonic solution and therefore does not cause an electrolyte imbalance, unlike tap water.

The large volume enema

The goal of the large volume enema is to clear as much of the stool from the colon as possible, as an intervention for constipation and “bowel prep” before a diagnostic procedure.

The amount used is 500 to 1000 ml and the bag is lifted to a height of up to 45 centimeters from the anal opening. The patient is instructed to retain fluid as long as possible to induce peristalsis and cause stool evacuation.

The small volume enema

The small volume enema is used to cleanse the lower colon or sigmoid.

This type of cleansing enema is often used for the constipated patient but does not need cleansing of the upper colon.

The amount used is less than 500 ml and the bag does not rise more than 30 centimeters.

The prepackaged disposable enema

This is the most common enema. This enema can also be used for tests and for constipation.

Enema solutions can contain sodium or bizodyl phosphate, which are both rectal stimulants.

The solution is hypertonic and therefore draws fluid into the intestine, softening and loosening the fecal mass.

The hypertonic solution is inappropriate for a dehydrated patient or in a situation where immediate evacuation is desired.

These enemas are available in sizes: 150 ml.

Oil retention enema

If the stool becomes hard, an oil retention enema may be given to soften the stool.

Commercially packaged enemas contain 90 to 120 ml of solution.

The patient must retain the solution for at least one hour for the enema to be effective.

This enema is generally followed by a cleansing enema.

Back flow enema

A backflow enema, or Harris wash, is used to remove intestinal gas and stimulate peristalsis.

A large volume of fluid is used, but the fluid is instilled in 100-200 ml increments.

The fluid is then removed by lowering the container below the level of the intestine. This brings the flatus with the fluid.

Repeat this procedure three to five times or until gas is not returned.

Cooling enema

Occasionally, a cold liquid enema can be used to lower body temperature quickly. This is done only if the temperature is dangerously high.

This is not a common procedure. The temperature should be checked before, during and after the procedure.


Enemas are used primarily for the following reasons:

  • To relieve symptoms of constipation or impaction.
  • To clean the rectum and lower intestines in preparation for an exam.
  • To remove feces to avoid contamination during a surgical procedure.
  • To administer anesthesia or treatments.
  • To stimulate peristalsis.
  • To introduce barium sulfate for diagnostic procedures.
  • To eliminate flatus.

Medicines can be given into the colon through an enema.

The goal of using the enema to administer medications is to soothe the intestinal lining, while other medications correct electrolyte imbalances or fight infection.

It may be necessary to administer a cleansing enema to cleanse the colon before administering the medicated enema.

An enema is generally considered to be a form of laxative to help relieve symptoms of constipation and fecal impaction.

Most enemas consist of a saline solution. However, some may include baking soda, mild soap, and mineral oil.

All of which can increase the effectiveness of the enema, however it can also cause additional irritation, therefore they should be used sparingly.

Fluids that are inserted into the rectum act as an irritant to the lower intestine, stimulating contractions.

These contractions work to expel the impacted stool along with the liquid from the enema.

The occasional use of an enema is a temporary solution for the relief of symptoms associated with constipation. Frequent repeated use of enemas can cause harm.

The colon absorbs some of the liquid from an enema, so repeated enemas can cause an electrolyte imbalance and cardiovascular overload.

If you experience symptoms of vomiting, dizziness and sweating after doing multiple enemas that could be a sign of imbalance.

Inserting anything into the rectum always carries risks.

To limit the risk of punctures or tears when using an enema, it is important to ensure that the tip or tube that is inserted is smooth and flexible.

Lastly, repeated uses of enemas to combat constipation can make the problem worse in the long run. Enemas only temporarily stimulate the walls of the colon and do not strengthen the colon.

If used for long periods of time, enemas can weaken the muscles of the colon.

When those muscles are weak they lack the necessary contractions to keep stool through your digestive system.

Therefore, using an enema to relieve constipation should be a last resort and a doctor is recommended.

Instructions for the application of an enema

You should lie on a towel, preferably in the bathroom.

With olive oil, petroleum jelly or with the lubricant provided in the kit, the tip of the enema should be lubricated to facilitate its insertion. The enema tube should be inserted into the rectum, lying on your back.

The fluid will begin to fill the intestine. It can be prevented from continuing and allowing the fluid to fill it in.

It is likely that at some point you will need to stop the application, you can sit on the toilet to remove the waste.

Then resume the enema until all the liquid has been used up.

Enema benefits for health

  • Stimulates digestive peristalsis in the lower intestines.
  • Eliminate parasites.
  • It stimulates liver function and the elimination of lymphatic waste.
  • Elimination of old toxic waste and heavy metals adhering to the intestinal wall.
  • It promotes the discharge of bile from the bile duct (with coffee enemas) by stimulating the additional removal of waste from the liver, gallbladder and circulation.
  • Improving the function of the immune system.

Bowel enemas are a natural therapy modality used as a natural health procedure for many years.

Barium enemas that are used by hospitals to prepare patients for tests. Epsom salt enemas are used for severe constipation.

Coffee enemas are used to detoxify a person’s liver.

The reason for this is because coffee increases the purgative action of the liver and gallbladder to better remove waste from the body.

Stimulation of the duct that connects the sigmoid colon and the liver causes less reabsorption of waste from feces into the circulation, thus expelling more toxins.

This reaction is caused by the theophylline and theobromine components of coffee.

This increased release of toxins increases the livers’ ability to eliminate a reserve of waste, it also stimulates the production of a powerful antioxidant enzyme in the liver called glutathione.

Yogurt enemas are used to kill bacteria in the colon. This is helpful for colon cancer, hemorrhoids, and irritable bowel syndrome.

Difference between an enema and colonic irrigation

Colonic irrigation is similar to an enema, however it is more invasive and is performed using a hose-like water pressure to push the water higher up the colon.

It should not be used in people with diverticulitis, ulcerative colitis, Crohn’s disease, internal or severe hemorrhoids, or tumors in the rectum or colon.

It should also not be used shortly after bowel surgery (unless directed by your doctor).

Regular treatments should be avoided by people with heart disease or kidney failure.

Colonic irrigations are inappropriate for people with intestinal, rectal or anal pathologies, where their administration contributes to the risk of intestinal perforation.


The use of enemas is not recommended in the following cases:

  • When there is active rectal bleeding.
  • When suffering from arrhythmia.
  • In cases of recent colon, rectal and prostate surgery.
  • Presence of undiagnosed abdominal pain.
  • An increase in intracranial pressure.
  • When you have glaucoma.

Precautions in the use of an enema

General considerations

Edema is not a first-line treatment for constipation.

Electrolytes should be monitored and the number of enemas restricted.

In cases of constipation, it should be taught about dietary and activity measures to prevent it.

Geriatric considerations

Older adults are at increased risk of fluid and electrolyte imbalance, care should be taken when administering enemas.

Geriatric patients also often have difficulty withholding the enema solution.

Pediatric Considerations

The use of an oral stool softener is preferable for constipation in children.

Tap water should not be used in baby enemas.

Unexpected results with the use of enemas

  • Pain and burning during installation.
  • Irritation, swelling, and redness of rectal tissue.
  • Bleeding
  • Presence of severe cramps and abdominal pain.
  • The enema will not flow well in cases of rectal tissue prolapse.

Important things to remember after an enema

  • Probiotics help to re-circulate the intestines with healthy bacteria.
  • Continue with a healthy diet routine with lots of fruits and vegetables, and if you have a tendency to constipation, taking products to avoid it is healthier.
  • Consideration should be given to taking an electrolyte supplement (Magnesium, Potassium, Sodium, Phosphorus, and Calcium) after the procedure.
  • Electrolyte imbalance can often occur due to the large amount of water lost, especially if regular enemas are performed.
  • It is important to ensure hydration, drinking at least 2 to 3 liters of water a day.
  • Begin each day with a small glass of warm water with lemon juice to continue the cleansing effects on the colon.
  • Incorporate herbal teas daily to increase water intake and support digestion.
  • Reduce foods that contribute to a slow bowel system such as breads, cakes, refined and processed food products, sugar, alcohol, tea, coffee, and soft drinks.
  • Making sure to eat foods like fish oils, flaxseed oil, nuts and seeds, olive oil, and avocados helps to lubricate the intestines and keep the stool softer.
  • Improve liver function since a congested liver will produce heat in its attempt to burn waste, this heat contributes to dry intestines and constipation.
  • Increase the intake of bitter foods in the diet to promote liver, gallbladder, bile, and bowel function. Bitter foods are lemon juice, bitter lettuces like arugula, endive, chicory, and apple cider vinegar.
  • Take a herbal supplement that supports gut, liver, digestion, and gallbladder function.
  • For more permanent relief from constipation, you should start with an increase in fiber in your diet. It is recommended to consume 25 to 30 grams of fiber every day. It is recommended that ninety percent of this fiber comes from foods that are consumed daily and only 10% can come from a fiber supplement.