How do enemas treat constipation. What are the potential side effects of using enemas. Which safer alternatives exist for constipation relief. When should enemas be considered as a treatment option. How to properly administer an enema for maximum benefit.

The History and Mechanism of Enemas for Constipation

Enemas have been utilized for thousands of years as a method to alleviate constipation. This ancient practice predates the development of oral and intravenous medications, making it one of the oldest remedies for bowel irregularity. In recent times, some public figures have promoted enemas as a means to “detoxify” the body, but such claims lack scientific merit and can potentially be harmful.

How do enemas work to relieve constipation. Enemas function by introducing fluid into the intestines through the rectum. This process aids in softening and breaking down stool, facilitating easier passage. Dr. Bryan Curtin, a gastroenterologist and director at the Melissa L. Posner Institute for Digestive Health and Liver Disease, explains that various types of enemas exist, including:

• Tap water enemas
• Sodium phosphate enemas (e.g., Fleet)
• Saline enemas
• Glycerin enemas
• Soap suds enemas
• Mineral oil enemas

While phosphorus-based enemas are traditionally considered the most potent, Dr. Curtin notes that any enema can be effective when administered correctly. He typically avoids oil-based enemas due to their messy nature.

Proper Administration of an Enema

Administering an enema correctly is crucial for its effectiveness and safety. Dr. Bharat Pothuri, a gastroenterologist at Memorial Hermann in Houston, provides the following guidelines for proper enema use:

1. Hydrate by drinking 16 ounces (two glasses) of water before the procedure to prevent dehydration.
2. Position yourself on your stomach with knees pulled to your chest. If this is uncomfortable, lie on your left side with both knees bent and arms resting comfortably.
3. Lubricate the enema tube and gently insert it into your rectum.
4. Squeeze the enema container to allow the contents to enter your rectum.
5. Maintain your position until you feel the urge to move your bowels.
6. Try to retain the enema for at least five minutes to maximize its benefits.

Dr. Curtin emphasizes the importance of holding the enema until the urge to defecate becomes strong. This ensures optimal effectiveness of the treatment.

Potential Risks and Side Effects of Enema Use

While enemas can be beneficial for treating severe constipation, they are not without risks. What are the potential side effects of using enemas. Some of the risks associated with enema use include:

• Anorectal pain disorders from frequent use
• Damage to intestinal tissue
• Bowel perforation
• Infection, including sepsis, if non-sterile
• Electrolyte imbalances from long-term use

Research, including a case report published in 2020 in SAGE Open, has shown that incorrectly administered enemas can cause bowel perforation. In severe cases, complications such as perforation, hyperphosphatemia, and sepsis following enema use may result in death in up to 4 percent of cases.

Long-term use of enemas can lead to electrolyte imbalances, potentially causing symptoms like fatigue, headache, muscle cramping, nausea, and vomiting, according to the Cleveland Clinic.

Who Should Avoid Enemas?

Certain individuals should refrain from using enemas due to increased risks. These include:

• People with colorectal cancer
• Those with an enlarged, distended colon prone to perforation
• Individuals with active inflammatory bowel disease

It is crucial to consult a healthcare provider before using an enema, especially if you have any underlying health conditions or concerns about its safety.

Safer Alternatives for Constipation Relief

Given the potential risks associated with enemas, they are typically recommended as a last resort for constipation treatment. Which safer alternatives exist for constipation relief. Before considering an enema, try the following options:

High-Fiber Diet

Increasing dietary fiber is often the first recommendation for managing constipation. How does a high-fiber diet help alleviate constipation. Fiber adds bulk to stool, accelerating its passage through the digestive system. Dr. Curtin advises constipated patients to aim for 20 to 30 grams of daily fiber.

To increase fiber intake:

• Add more fruits and vegetables to your diet
• Incorporate whole grains into meals
• Gradually increase fiber intake to avoid bloating and gas
• Consider over-the-counter fiber supplements like Metamucil (consult your doctor first)

Proper Hydration

Adequate water intake is essential for maintaining regular bowel movements. How does hydration contribute to constipation relief. Proper hydration helps soften stool and promotes easier passage through the intestines. Aim to drink at least 8 glasses of water per day, adjusting based on your activity level and climate.

Regular Exercise

Physical activity can significantly improve bowel regularity. How does exercise help alleviate constipation. Regular movement stimulates intestinal contractions, promoting more frequent bowel movements. Aim for at least 30 minutes of moderate exercise most days of the week, such as brisk walking, swimming, or cycling.

Over-the-Counter Medications for Constipation

When lifestyle changes alone are insufficient, various over-the-counter medications can provide relief from constipation. These include:

Osmotic Laxatives

How do osmotic laxatives work to relieve constipation. These medications, such as Miralax (polyethylene glycol), draw water into the intestines, softening stool and promoting easier passage. They are generally well-tolerated and can be used for longer periods under medical supervision.

Stimulant Laxatives

Stimulant laxatives, like bisacodyl (Dulcolax) or senna, work by increasing intestinal contractions. How do stimulant laxatives provide constipation relief. By enhancing bowel motility, these medications help move stool through the intestines more quickly. However, they should be used sparingly and not for extended periods without medical advice.

Stool Softeners

Stool softeners, such as docusate sodium (Colace), work by increasing the water content of stool. How do stool softeners aid in constipation relief. By softening the stool, these medications make it easier to pass, reducing straining during bowel movements. They are generally safe for short-term use but may take several days to show effect.

When to Consider Enemas as a Treatment Option

When should enemas be considered as a treatment option for constipation. Enemas are typically reserved for cases of severe constipation that have not responded to other treatments. Some situations where an enema might be recommended include:

• Preparation for certain medical procedures or surgeries
• Severe constipation causing significant discomfort or impaction
• When rapid bowel evacuation is necessary for medical reasons

It’s crucial to exhaust other safer options before resorting to enemas. Always consult with a healthcare professional before using an enema, especially if you have any underlying health conditions or concerns.

The Role of Probiotics in Managing Constipation

Probiotics have gained attention for their potential role in digestive health, including constipation management. How do probiotics contribute to constipation relief. Probiotics are beneficial bacteria that can help maintain a healthy gut microbiome, potentially improving bowel regularity.

Some studies suggest that certain probiotic strains may be effective in alleviating constipation symptoms. These include:

• Bifidobacterium lactis
• Lactobacillus casei Shirota
• Bifidobacterium longum

While research is ongoing, incorporating probiotic-rich foods or supplements into your diet may provide some benefit for constipation relief. Always consult with a healthcare provider before starting any new supplement regimen.

Lifestyle Modifications for Long-Term Constipation Management

In addition to dietary changes and proper hydration, several lifestyle modifications can help manage constipation in the long term. These include:

Establishing a Regular Bathroom Routine

How does a consistent bathroom schedule help alleviate constipation. Setting aside time each day for bowel movements, preferably after meals when the gastrocolic reflex is strongest, can help train your body and promote regularity.

Improving Toilet Posture

Proper positioning on the toilet can facilitate easier bowel movements. How does toilet posture affect constipation. Using a footstool to elevate your feet while on the toilet can help align the rectum for smoother passage of stool.

Stress Management

Chronic stress can negatively impact digestive function and contribute to constipation. How does stress reduction help with constipation relief. Incorporating stress-reduction techniques such as meditation, deep breathing exercises, or yoga can help improve overall digestive health and regularity.

Avoiding Prolonged Sitting

Extended periods of sitting can slow down digestion and contribute to constipation. How does regular movement throughout the day help alleviate constipation. Taking frequent breaks to stand, stretch, or walk can help stimulate bowel function and promote regularity.

By implementing these lifestyle modifications alongside dietary changes and appropriate medical interventions when necessary, many individuals can effectively manage constipation without resorting to more invasive measures like enemas.

Should You Use An Enema for Constipation Relief?

Having been used for thousands of years, enemas are one of the oldest methods of getting the bowels moving again if you’re suffering from constipation. Historically, the use of enemas makes sense, developing before the invention of oral and intravenous medication, notes the Canadian Society of Intestinal research.

In recent years, some celebrities have touted enemas as a way to “flush out” the digestive system and detoxify the body. However, this advice is a load of nonsense, and the regular use of enemas can actually be dangerous.

Today, better and safer treatment options, including laxatives, suppositories, and a high-fiber diet, mean enemas are typically recommended as a last resort for constipation because of possible side effects.

The Back Story: How Does an Enema Treat Constipation?

Treating constipation with an enema involves introducing fluid into the intestines via the rectum. This helps soften and break up the stool, says Bryan Curtin, MD, a gastroenterologist and director of the Center for Neurogastroenterology and GI Motility at the Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy in Baltimore.

There are several types of enemas, including tap water, sodium phosphate (such as Fleet enemas), saline, glycerin, soap suds, and mineral oils.

“While phosphorus-based enemas are traditionally considered the most potent, I find that any enema can be effective if done correctly,” Dr. Curtin says. “The oil-based enemas are fairly messy and I typically avoid those.”

How to Administer an Enema

To administer an enema, follow the instructions on the box or leaflet closely.

Bharat Pothuri, MD, a gastroenterologist at Memorial Hermann in Houston, offers the following tips for using an enema safely and effectively:

• Drink 16 ounces of water (two glasses) prior to the enema, as an enema can cause you to become dehydrated.
• Lie on your stomach with your knees pulled to your chest. If you are unable to, lie on your left side with both knees bent and your arms resting comfortably.
• Lubricate the enema tube and gently insert it into your rectum, squeezing the enema so that the contents can enter your rectum.
• Wait in that position until you feel the need to move your bowels. Try to hold the enema in for at least five minutes to achieve maximum benefit.

“It’s important to make sure you hold onto the enema until the urge to defecate is strong,” Curtin says.

Possible Side Effects of Enemas

While enemas can be a useful tool for treating severe constipation, they do come with some risks and are not meant for frequent use.

“Like any other medication, enemas can be abused,” Curtin says. “Too much enema use can lead to anorectal pain disorders. Generally, you should avoid using enemas regularly unless instructed to by your doctor.”

Enemas that are administered incorrectly can damage the tissue in the large intestine and cause bowel perforation, research such as a case report published in 2020 in SAGE Open, has shown. If an enema is not sterile, it can put you at risk of an infection, including sepsis, Dr. Pothuri notes.

One study notes that perforation, hyperphosphatemia (a condition characterized by too much phosphate in the blood), and sepsis following enema use may cause death in up to 4 percent of cases.

Long-term use of enemas can lead to electrolyte imbalances, which can cause uncomfortable symptoms like fatigue, headache, muscle cramping, nausea and vomiting, per the Cleveland Clinic.

People with colorectal cancer, an enlarged distended colon which may be more prone to perforation, and people who have active inflammatory bowel disease should avoid using enemas, Pothuri says.

If you have any questions about the safety of enemas, talk to your doctor. It’s best to consult your healthcare provider before using an enema and to exhaust all other ways of treating constipation first.

Safer Options for Constipation Relief

Because of the possible side effects of enemas, it’s usually only advised as a last-resort option to treat constipation.

Before considering an enema, make sure you’ve tried the following options:

High-Fiber Diet “Generally, your doctor will first start by recommending dietary changes,” Curtin says. Adding fiber to your diet increases the bulk of your stool, speeding up its passage through the digestive system. Curtin says patients who are constipated should aim for 20 to 30 grams of daily fiber. A good starting point is to add more fruits and vegetables into your diet, as well as whole grains. A sharp increase in fiber can cause bloating and gas, per the Mayo Clinic, so aim to gradually increase the amount over a few weeks. Over-the-counter supplemental fiber, such as Metamucil, is also available. Talk to your doctor to learn if this is a good option for you.

Stay hydrated. Drinking enough water is important for overall health, including digestion. “The main purpose of the colon is to reabsorb water from the stool, and if you are dehydrated more water will be taken in, leading to harder to pass stools,” Curtin says. The National Academies of Sciences, Engineering, and Medicine suggests that women get a total of about 2.7 liters (11 cups) of fluid per day and that men get about 3.7 liters (16 cups) per day. Note that not all of this fluid has to be water; it can also include nutrient-rich foods and beverages like fruit, vegetables, juice, and tea. Also, it’s important to spread out the fluids over the day. Alcohol and caffeinated drinks can cause dehydration, so you’ll want to avoid those if you’re constipated.

Laxatives Laxatives, or stool softeners, such as docusate or milk of magnesia, are available over the counter. Talk to your doctor or pharmacist if you have any questions about these medications. Overusing laxatives can lead to worsening symptoms, per the Cleveland Clinic, so you should not use the treatment for more than two weeks without talking to your healthcare provider.

Other lifestyle changes like exercise can help get things moving in your digestive tract. It’s also smart to keep a food journal so you can see which foods trigger your constipation. Certain medications and supplements may also cause constipation, so if that is a concern, talk to your doctor, who may adjust your dose or switch your prescription.

Some prescription drugs are also available to treat chronic constipation. Your healthcare provider will work with you to decide on which one is best for you. If there’s a structural problem in your colon that’s causing your constipation, your doctor might recommend surgery.

Call your doctor to talk through options if constipation is a new issue for you or you’ve been constipated for more than a few weeks.

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Enemas are used to relieve constipation and cleanse the colon. Water- or saline-based enemas tend to carry the least risk. However, enemas can have side effects, such as disturbing your gut bacteria and affecting your body’s electrolyte balance.

Enemas are rectal injections of fluid intended to cleanse or stimulate the emptying of your bowel.

They have been used for hundreds of years to treat chronic constipation and prepare people for certain medical tests and surgeries (1).

Enemas can be administered by a medical professional or self-administered at home.

This article reviews different types of enemas, as well as their potential benefits and health concerns.

Constipation is a condition in which the natural movement of your stool slows down, making them hard, dry, and difficult to excrete. For many people, this can be a chronic problem that requires an intervention like an enema — or a laxative inserted rectally.

Enemas may also be prescribed to flush out your colon before certain diagnostic tests or surgeries. Your bowel needs to be empty before these procedures to reduce infection risk and prevent stool from getting in the way.

According to some enema advocates, when waste builds up in your colon over time, it leads to ailments like depression, fatigue, headaches, allergies, and irritability, and using enemas can provide relief.

While it’s true that many people with chronic constipation experience depression and other psychological symptoms, evidence is lacking to suggest that waste buildup directly leads to the other aforementioned effects (2, 3).

There are two main types of enemas — cleansing and retention.

Cleansing enemas

Cleansing enemas are water-based and meant to be held in the rectum for a short time to flush your colon. Once injected, they’re retained for a few minutes until your body rids itself of the fluid, along with loose matter and impacted stool in your bowel.

Some of the most common cleansing enemas include (3, 4):

• Water or saline. The least irritating of all options, water or saline — salt water that mimics your body’s sodium concentration — are used primarily for their ability to expand the colon and mechanically promote defecation.
• Epsom salt. This is similar to a water or saline enema, but magnesium-rich Epsom salt is said to be more effective at relaxing bowel muscles and relieving constipation.
• Sodium phosphate. This is a common over-the-counter enema that works by irritating your rectum, causing it to expand and release waste.
• Lemon juice. Lemon juice mixed with warm, filtered water is said to balance the pH of your body while cleansing your colon.
• Apple cider vinegar. Advocates say that mixing apple cider vinegar with warm, filtered water can quickly clear the bowel and may have other antiviral healing effects on your digestive system.
• Soap suds. Adding castile soap, or another mild soap with minimal additives, to water mildly irritates the bowel, which encourages the rapid excretion of stool.

Retention enemas

Retention enemas are designed to be held in your bowel for an extended period — usually a minimum of 15 minutes — before being released. Retention enemas may be water- or oil-based, which softens the stool and makes it easier for your body to expel.

Some of the most common retention enemas include (5, 6, 7):

• Coffee. Coffee enemas are a mixture of brewed, caffeinated coffee and water thought to promote bile removal from the colon. They were popularized by Max Gerson, a physician who used them to help treat people with cancer.
• Mineral oil. This type of enema works primarily by lubricating waste inside of your colon, sealing it with water, and promoting its removal.
• Probiotic. Mixing probiotics with water may cleanse your bowel while helping colonize your good gut bacteria. Lactobacillus reuteri enemas have been shown to reduce inflammation in children with ulcerative colitis.
• Herbal. Some people use herbs like garlic, catnip tea, or red raspberry leaf mixed with water to make herbal enemas with purported nutritional, infection-fighting, and anti-inflammatory benefits.

Summary

Enemas are rectal injections of fluid that are intended to cleanse your bowel or treat chronic constipation. The two main types — cleansing and retention enemas — come in a variety of solutions and can be injected at home.

Enemas can treat constipation and clear out your bowel. However, many people choose to use enemas for other purported health benefits (8, 9).

Some advocates claim that enemas can support weight loss, remove toxins and heavy metals from your body, and improve your skin, immunity, blood pressure, and energy levels.

Still, evidence is limited to suggest that enemas are effective for these purposes or that they benefit everyone who uses them. Most evidence in support of their effectiveness is anecdotal, despite their widespread use in modern medicine (10).

Enemas appear to be most effective when used to relieve chronic constipation in a medical setting, though they come with many risks, especially when self-administered at home (11, 12).

Summary

Enemas can be effective in cleansing the bowel and treating chronic constipation, but most evidence in their favor is anecdotal rather than science based.

Though enemas can clean out your bowel, you should consider their risks and take certain precautions before using one.

May interrupt your body’s natural balances

Enemas may disturb your gut bacteria and throw off your body’s electrolyte balance.

Research shows that enemas used in preparation for medical procedures significantly disrupt gut bacteria, though the effect appears to be temporary. However, enemas that are split and administered in two doses seem to have fewer effects on the microbiome (13, 14).

Electrolyte disturbances have been observed with various types of enemas, such as large-volume soap suds enemas and those containing minerals.

For instance, there have been reports of Epsom salt enemas causing death from magnesium overdose. In another case, an older man died from severe electrolyte disruption caused by taking two sodium phosphate enemas (3, 15, 16).

Other reports note that the overuse of enemas to flush out the colon may lead to severe dehydration, which can be fatal (17).

Enema solutions can harm your bowel

Lemon juice, apple cider vinegar, and coffee enemas are highly acidic, and scientific evidence to suggest their effectiveness or safety is lacking.

What’s more, the evidence shows that their acidity and makeup can harm your bowel and lead to rectal burns, inflammation, infections, and even death (1).

Similarly, there are reports of children being given acidic hydrogen peroxide enemas, which resulted in an inflamed colon, bloody diarrhea, vomiting, and long-term complications (18).

Furthermore, in some people, herbal enemas have caused internal bleeding that required a blood transfusion and removal of the colon (1).

Dirty or improperly used tools can cause infection and damage

If you self-administer an enema at home, it’s critical to make sure that the tools you use are sterile, meaning they’re free of harmful germs. The use of dirty tools increases your risk of contracting a potentially dangerous infection.

Improper tool use may also cause physical damage to your rectum, anus, or colon. Studies indicate that perforation of the bowel is not a rare complication of frequent enema use that could put your internal organs at risk of infection (3, 12, 19).

Sterile enema injection kits, which usually include a bucket, tubing, solution, and sometimes a bulb, can be found online or at many local drug stores. They come with directions for cleaning and safe use.

Summary

Though enemas can be safe and effective, they come with many risks, especially when administered at home. Improperly used enemas can cause potentially life-threatening physical and chemical damage to your rectum or colon.

If you’re mainly considering an enema to stimulate and clean out your digestive system, there may be other, less invasive options.

Some potential alternatives to enemas, which can promote waste excretion and bowel regularity, include (20, 21, 22, 23):

• drinking caffeinated coffee, which is known to stimulate defecation
• staying well hydrated with water
• getting regular exercise like walking, running, biking, or aerobics
• trying an over-the-counter oral laxative like magnesium
• increasing your fiber intake by eating whole plant foods like fruits, vegetables, whole grains, nuts, and seeds.

If you have severe constipation or other medical issues, speak to your medical provider to determine whether an enema would be a safe and appropriate treatment.

Summary

Less risky alternatives to enemas that can help stimulate bowel movements include staying hydrated, getting regular exercise, and following a healthy, high-fiber diet.

Enemas are used to relieve constipation and cleanse the colon. Water- or oil-based solutions are injected into the bowel through your rectum to expel impacted waste.

Mild enemas like water or saline carry the least risk, but you should consult your healthcare provider before using one at home. Furthermore, ensuring the proper use of sterile injection tools is very important for safety.

Many people swear by enemas to promote regularity and prevent constipation, but evidence of their effectiveness is limited.

Other, less risky alternatives may be a better option in most cases.

what to choose for the treatment of chronic constipation

Laxatives and enemas: what to choose for the treatment of chronic constipation

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• Laxatives and enemas: what to choose for the treatment of chronic constipation

Chronic constipation is most often observed in the elderly: more than 36% of patients over 60 years of age suffer from defecation disorders, while before the age of 60 the problem is 3 times less common. Also at risk are people with limited mobility, bedridden patients, patients after operations on the abdominal organs.

Constipation significantly impairs the quality of life, disrupts the digestive process, and can lead to dangerous coloproctological diseases. Therefore, patients with chronic constipation must be prescribed treatment: diet therapy, exercise therapy, drug therapy (laxatives), enema, if indicated.

Laxatives for constipation – types and features of use

Medication for constipation is challenging because most people self-medicate and take over-the-counter laxatives for a long time. Unsystematic therapy exacerbates existing disorders, therefore, by the time of examination by a doctor, a person usually has many days of constipation, and the defecation process is accompanied by strong straining, the need for manual assistance for emptying.

General principles for the use of laxatives:

● the choice of the drug is carried out taking into account the cause of constipation: irrational nutrition, physical inactivity, intestinal atony after surgery, chronic diseases of the gastrointestinal tract, etc.;

● with long-term constipation and the presence of concomitant diseases, a combination of laxatives with a different mechanism of action is recommended;

● The dosage and frequency of use of laxatives are periodically changed in order to achieve a good therapeutic result without harm to health and adverse reactions;

● with difficult and painful bowel movements, oral laxatives are combined with local remedies in the form of rectal suppositories;

● for neurological and psycho-emotional causes of constipation, drugs are prescribed that affect the peripheral and central nervous system.

In medical practice, different types of laxatives are used. They differ in mechanism and strength of action, adverse reactions, indications. Next, we will talk in detail about each group of drugs, mentioning their advantages, disadvantages and nuances of use.

Please note that the information is provided for informational purposes only! For the selection of laxatives, we recommend that you consult an ID-Clinic therapist, which is available online, at a clinic appointment, at home for patients with limited mobility.

Stool bulking agents

Medicines contain bran, cellulose, flax seeds and other components that increase the amount of feces and normalize its consistency. The increased volume of feces stimulates mechanoreceptors, increases intestinal motility and promotes the process of defecation.

The drugs act gently and physiologically, so they are prescribed for long-term use, including in elderly and debilitated patients. The exception is patients in the postoperative period and those with adhesive disease, in whom such laxatives can provoke an increase in pain.

The advantages of drugs from this group:

● have good drug compatibility, which is important for people who constantly take drugs to correct chronic diseases;

● safe medicines with a minimum number of adverse reactions and complications;

● do not “turn off” the motor function of the intestine and are not addictive;

● can be used for a long time without the risk of complications;

● bind cholesterol and increase its excretion with feces, thereby helping to correct dyslipidemia and atherosclerosis.

Osmotic laxatives

Another commonly used group of laxatives. They increase the osmotic pressure in the intestinal lumen and retain water, thereby softening the stool. Like the previous group of drugs, osmotic preparations increase the volume of feces, contribute to its promotion and painless removal during defecation. Medicines can be used long-term to normalize the functioning of digestion and regular stools in patients with chronic constipation.

Benefits of osmotic laxatives include:

● do not irritate the intestinal mucosa;

● are not addictive;

● are not absorbed into the blood, do not wash out salts and vitamins from the intestines;

● have an additional prebiotic effect – stimulate the growth of beneficial intestinal microflora;

● show an auxiliary therapeutic effect in cardiovascular diseases, renal and hepatic insufficiency, diabetes mellitus.

Drugs that cause chemical irritation of intestinal receptors

Drugs from this group have a dual effect. First, they increase intestinal motility, helping to move the stool and causing the urge to defecate. Secondly, drugs stimulate the secretion of fluid and electrolytes into the intestinal lumen, which allows you to increase the volume of feces and make them more liquid. Medicines have a quick laxative effect, so patients often purchase them for self-medication.

However, this category of drugs has a number of significant disadvantages:

● provoke secretory type of diarrhea, causing disturbances in water and electrolyte balance in the body;

● quickly addictive, require a constant increase in doses, which is fraught with dangerous side reactions;

● with prolonged uncontrolled use cause degenerative changes in the nervous structures of the intestine;

● can provoke a specific drug complication – laxative disease.

Given the potential risks and complications, stimulant laxatives are usually given in short courses of up to 2 weeks. They help to cope with long-term constipation, after which patients are transferred to milder and gentler drug options for continuous use.

Softeners

This category includes various types of oils that are taken orally, administered in the form of rectal suppositories. They soften the feces, coat the mucous membrane of the rectum and facilitate the process of defecation.

Such drugs do not have a pronounced laxative effect, so they are used to a limited extent. Most often, oil products are used in the postoperative period and in bedridden patients to reduce straining during bowel movements.

Enemas for constipation – when and why they are prescribed

For many people, enema becomes the main self-help remedy for constipation, but in fact, this procedure is not a treatment and does not help solve the problem of the gastrointestinal tract. Abuse of artificial bowel cleansing is fraught with a violation of the microflora, progressive atony of the colon and aggravation of constipation. Therefore, enemas are prescribed only as a one-time procedure to remove the accumulation of stool and improve the patient’s condition.

The main indication for enema is the lack of effect from drug treatment of constipation. However, do not prescribe an enema yourself. This is a medical procedure that should be carried out on the recommendation of a doctor no more than 1 time per week. For cleansing, ordinary water or water-oil solutions are used, which cover the walls of the intestine, facilitate the removal of dry, lumpy feces.

In addition to conventional enemas, microclysters are also used. They contain a combination of laxatives that are injected in small amounts into the rectum. On sale there are options for single use – a portioned tube with a special tip for rectal use. Microenemas show a strong and fast effect, but like regular enemas, they are not suitable for frequent use.

If the prescribed therapy regimen does not help, and there is a frequent need for enemas to empty the intestines, you should visit the doctor again. A change in pharmacotherapy, the use of stronger laxatives or drug combinations may be required.

With the progression of constipation, the absence of the effect of conservative tactics and complicated forms of colostasis, surgical intervention is indicated. In this case, the ID-Clinic doctor gives a referral for hospitalization, so that the hospital surgeon selects the tactics of the operation and performs the necessary treatment.

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Constipation enema – how to do, contraindications, types

Enema with constipation of the intestine
Enema with constipation – how to do, contraindications, types | Phytomucil Norm
Enema for adult constipation is an effective treatment that can be done at home. The article is about how to properly put an enema for constipation of the intestine and their types (for example, cleansing). Fitomucil Norm
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Constipation is often accompanied by painful sensations and is fraught with intoxication. It is necessary to fight constipation, so doctors often offer an integrated approach to treatment: dieting, increasing physical activity, taking laxatives or other medications. With prolonged constipation, it is important to empty the intestines as soon as possible. An enema will help to do this.

An enema is a medical procedure that involves injecting water or liquid solutions into the rectum through the anus. It can be performed both by the patient himself, and by a medical worker or relative – no special knowledge is required during the procedure. However, it should be understood that such manipulation has certain indications and contraindications, the technique of execution and the features of the conduct.

Enema for constipation

Enema is one of the most affordable methods used both in the hospital and at home. It allows you to get a quick effect and empty the intestines within 5-15 minutes after the introduction of the solution. Understanding how to make an enema for constipation allows you to instantly alleviate the symptoms of stool retention: cleanse the large intestine, stimulate intestinal motility, remove gases.

This approach has disadvantages, especially if we are not talking about once occurring, but about chronic constipation. An enema is not a treatment for constipation and the digestive system disorders that cause it. Many people who have tried all the ways to get rid of constipation note the following disadvantages of an enema:

• discomfort – when washing the intestines, discomfort is inevitable;

• the impossibility of using an enema repeatedly – it is strongly not recommended to use an enema regularly, as this can lead to complications;

• the presence of contraindications in the form of hemorrhoids, anal fissure and other anorectal diseases – frequent companions of constipation;

• the risk of developing addiction – enema can cause the development of lazy bowel syndrome and provoke dependence on manipulations.

According to the gastroenterologist, KMN Shulpekova O. Yu., “in some cases, the formation of dependence on enemas is a big problem” (Shulpekova Yu. O., 2006, p. 90). This happens due to not agreed with the doctor or too frequent use.

The constant use of an enema does not solve the underlying problem. The person fights against the symptom, but does not direct their attention to the source of the problem – the disease of the gastrointestinal tract, the specifics of the diet or the level of physical activity. Therefore, you should not be zealous with enemas, it can only help in special cases when you need to urgently empty your intestines.

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A pear enema is indicated for acute constipation – in cases where stool retention is rare and not chronic. In addition, the procedure is carried out with caution if the patient has a so-called fecal blockage.

A fecal blockage is a condition in which an accumulation of feces forms in a certain area of ​​​​the rectum. The lump is gradually compacted, while gaps remain between it and the walls of the intestine, through which liquid feces pass and are brought out. The person thinks they are developing diarrhea and may start taking antidiarrheal medication, which exacerbates the problem.

With partial obstruction of the rectum, symptoms of intoxication quickly increase. Treatment of fecal obstruction is carried out without laxatives. However, the enema is also used with caution: the procedure will help in cases where the enema tip freely penetrates above the stone and there is no risk of injuring the walls of the rectum.

In addition to constipation, there are other indications for bowel cleansing with enemas:

• intoxication, poisoning;

• planned operations;

• forthcoming birth;

• upcoming proctological examination;

• preparation for X-ray examination of the digestive, urinary system, pelvic organs;

• preparation for endoscopic interventions;

• preparation for the formulation of a medicinal enema.

Sometimes an enema is prescribed in the postoperative period, when your own stool is not observed after a certain time after surgery. Usually on the second or third day.

But for whatever indication an enema is planned, it is important to remember that this procedure must be carried out only with a doctor’s prescription. After all, there are a number of serious contraindications that you may not recognize in yourself.

Enema contraindications

Enemas for constipation are categorically contraindicated in cases of suspected complete intestinal obstruction. Doctor Subbotin A. M. emphasizes that “due to its low efficiency, the use of enemas is currently used mainly only in patients with signs of partial intestinal obstruction” (Subbotin A. M., 2010, p. 1754).

But it is important to distinguish between partial and complete obstruction: in the first case, loose stools pass. Partial blockage ends with a resolution in the form of liquid feces with a putrid odor.

Complete intestinal obstruction is characterized by acute pain, pallor of the skin, sweating, tachycardia, often accompanied by nausea and vomiting. A characteristic feature is asymmetric bloating. In some cases, long-term constipation can only be distinguished from intestinal obstruction using ultrasound or x-rays. Therefore, if you suspect such a condition, it is better to consult a doctor.

There are other contraindications to enema:

• bleeding from any part of the gastrointestinal tract, bleeding from the rectum;

• inflammation of the large intestine;

• rehabilitation period after interventions in the rectal area, perianal area, for example, after removal of hemorrhoids;

• hemorrhoids, anal fissure, proctitis, proctosigmoiditis;

• intestinal tumors.

Enema stimulates intestinal peristalsis and uterine tone, so if possible it is better to refuse the procedure during menstruation, so as not to increase bleeding. During pregnancy, an enema is done only under the supervision of a doctor and in case of urgent need.

How to make an enema

How to make an enema for an adult with constipation? If you have been prescribed an enema by a doctor, it is important to know how to do it correctly. First of all, you should prepare. You will need an Esmarch mug or a rubber pear with a tip, an oilcloth or an absorbent sterile diaper, liquid paraffin or baby cream, an antiseptic (for example, a solution based on chlorhexidine).

It is better to carry out the procedure in the bathroom, if it is suitable for this. It is important that the surface on which the person lies is flat and firm. It is necessary to cover the surface with oilcloth and prepare a solution for enema. About which solution is best suited in a particular case, we will describe later in the article.

The tip of a syringe or Esmarch’s mug should be wiped with an antiseptic, applied to the tip with petroleum jelly or baby cream, in extreme cases – vegetable oil. A person should take a comfortable position – lie on either side or stand in a knee-elbow position, relax.

The enema is injected into the anus to a depth of 5-10 centimeters. The urge to go to the toilet can begin immediately after the start of the introduction of the solution, and it is important to restrain them for a certain time. The temperature of the solution can be from 10-21 to 39 ° C, depending on the indications.

Please note that the steps involved in giving an enema may vary depending on the type of enema.

The steps for self-administering an enema are as follows:

• collect Esmarch’s mug according to the instructions;

• fill it with a solution;

• bleed some fluid to bleed air;

• treat the tip with vaseline oil or baby cream;

• lie on your left side, pull your knees to your chest;

• push the buttocks apart, insert the tip into the anus to a depth of no more than 10 cm;

• pour in the solution;

• remove the tip, turn on your back and wait 15 minutes.

After the procedure, there will be a strong urge to defecate, it is important to restrain them only in the first few minutes, and then ensure the opportunity to spend as much time in the toilet as needed. Defecation can occur several times, so there is no need to rush.

Types of enemas for constipation

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The correct enema for constipation should be carried out taking into account the general state of health, the situation, the causes of stool retention. The characteristics of the solution used may vary depending on the type of enema.

The following solutions are used for cleansing and therapeutic measures:

• Oily: used for regular, prolonged constipation, often at bedtime. Unlike many other solutions, in this case, the laxative effect occurs after a few hours.
• Soapy: This solution is prepared with water and baby soap with glycerin. Used for a simple cleansing enema.
• Hypertonic: provides for the dissolution of salt in water, promotes the removal of excess fluid.
• Acidic: involves the use of acids (eg lemon juice or vinegar), used as a cleanser.
• Ognev’s enema solution: contains hydrogen peroxide, glycerin, soap shavings in the ratio 1:1:1. This solution is used for severe, prolonged constipation.
• Starch: this solution is used for hot enemas with temperatures up to 40-42 degrees. Also used for colitis. The composition of this solution includes starch and medicinal substances.
• Drip: The solution is a combination of drugs prescribed by a doctor. Can be used for dehydration, usually up to 4 treatments per day.
• Nutrient: May contain glucose, amino acids, etc. Also used for dehydration.

By volume, enemas are classified as follows:

Oil

It is recommended for spastic constipation, dehydration of feces. For example, in cases where constipation was the result of a poor drinking regimen. The solution is olive, castor, vaseline or other oil in its pure form.

The oil is heated in hot water to 38 ° C, drawn into a Janet syringe or syringe, injected into the anus. The urge to empty may not come immediately, but only after a few hours, so it is often more appropriate to use laxatives with a delayed, predictable effect.

Hypertonic enema

Hypertonic enema involves the use of water with sodium chloride or potassium permanganate dissolved in it. Such an enema is used, as a rule, to remove excess fluid during edema. Usually enough 0.2-0.5 liters of clean cold water. Warm water can be absorbed into the intestines, then the desired effect will not be. Salt solution increases osmotic pressure, stimulates the liquefaction of feces, the effect occurs after 20-30 minutes.

Cleansing enema

Cleansing enema for constipation involves thermal irritation with water of a certain temperature. Pure warm water is used, which mechanically stimulates the intestinal walls, has a temperature effect, and changes the consistency of feces. The effect comes immediately after the procedure.

Cleansing Enema thins stools, stimulates bowel movement and can be used in the treatment of chronic constipation, and to promote detoxification and elimination of stool in preparation for childbirth or surgery. Sometimes a cleansing enema is placed before the medicinal one. So medications based on medicinal enema are better absorbed.

In addition to pure water, it is possible to use water with the addition of 2 tbsp. l. glycerin or vegetable oil. As a preparation, you need to lay an oilcloth on the couch, lower one edge into a container on the floor.

Esmarch’s mug is filled with a solution with a temperature of 25−35 degrees, open the tap to remove air. Next, you need to close the tap and hang the mug above the couch. The person lies on his side, bending his knees.

Cleansing enema algorithm:

• Treat the tip with Vaseline.
• Insert 10 cm tube.
• Open the tap, inject liquid.
• Detect 10 minutes.

If the pressure of the solution is not enough, pull the tip out a little and increase the water pressure, and if soreness is felt, reduce the pressure.

Siphon enema

Siphon enema involves cleansing the intestines with the help of a repeated washing procedure according to the principle of two communicating vessels – intestines and funnel. It differs from the cleaning one not only in the multiplicity of conduction, but also in technology. Before the procedure, you need to put an oilcloth, the edge of which is lowered into the container.

The person is laid on his side, after which the vaseline-treated tip of the rubber tube is inserted into the rectum by 10 cm. Then the funnel at the other end of the tube is filled with liquid, it is held at the level of the buttocks, then it is raised 0.5 m above the body level. When the waning water reaches the boundary of the constriction of the funnel, the funnel is lowered below the level of the body.

Intestinal contents will begin to flow out of it. This raising with the addition of liquid and lowering the funnel is repeated several times until the water coming out of it becomes clear. It should be remembered that only a specialist should carry out a siphon enema.

Medicinal

Typically, such enemas are indicated for inflammatory diseases of the rectum or sigmoid colon. In some cases, medicines are used as a solution, including decoctions of medicinal herbs. Sometimes general medicines are administered. systemic action. Only a specialist can prescribe a drug. It is important to do such enemas strictly in accordance with medical recommendations.

It should be understood that enema is not a treatment for constipation. In addition, in the case of alimentary constipation, it does not have any effect on the causes. Chronic constipation occurs in 15–25% of the adult population of developed countries, and in most cases it is associated with the diet and low physical activity of a modern person.

That is why the first recommendation of a gastroenterologist for constipation in a patient is almost always a menu correction – replenishing the diet with foods rich in dietary fiber. Sometimes additional fiber supplementation is required.

For this reason, the most effective laxatives are bulk ones, in particular preparations based on psyllium hulls. One of these laxatives is the British drug Fitomucil Norm, which contains soluble fibers in the form of psyllium seed husks and plum fruit pulp, as well as insoluble fibers.

Due to the latter, the product stimulates peristalsis, and soluble fiber increases the water content in the feces, contributes to their softening and comfortable excretion. Plum pectin additionally promotes the growth of beneficial microflora. “Fitomucil Norm” acts without pain, swelling and sudden urges, is not addictive, unlike drugs with hay in the composition.

It is important to consult your doctor about taking an enema for constipation. There may be certain limitations, and only a specialist will tell you how to deal with the problem.
The article is for informational purposes only. The authors are not responsible for the quality of services provided by third parties and for possible complications.

References

• Parfenov AI Strategy and tactics of treatment of chronic constipation // Medical Council. – 2011. – No. 9−10. — S. 12−17.

• Subbotin AM Ideal preparation for colonoscopy — reality or goal on the horizon? Stages of improving its quality // Regular issues of “RMZH”.