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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.

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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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 gastrointestinal diseases, 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. Increased stool volume stimulates mechanoreceptors, enhances 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 treatment 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.

Contrast enema | Memorial Sloan Kettering Cancer Center

This information will help you prepare for your contrast enema at Memorial Sloan Kettering (MSK).

A contrast enema is an x-ray examination of the colon. It is done with a contrast medium such as barium or iodine solution, also called iohexol (Omnipaque ^® ), air, or a combination of the two. The contrast agent makes it easier to examine the colon during x-ray examination.

Most people need to have a colon cleanse (prepare the bowel) before a contrast enema. Please check with your healthcare provider prior to your procedure to determine what preparation you need.

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Before your procedure

If you are hospitalized before your contrast enema, your ward nurse will give you everything you need to prepare your bowels. If you are coming to the hospital from home for the contrast enema, check with your doctor about preparations. Most people need to purchase everything listed below a few days before the procedure.

• Polyethylene glycol (MiraLAX®). You will need 1 vial (238 g).
• Gatorade® (light in color, not red or purple). You will need 2 bottles (32 oz. (950 ml) each).
• Bisacodyl (Dulcolax®), 5 mg tablets. You will need 4 tablets.

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The day before your procedure

Follow the No Treatment Diet

Follow the No Treatment Diet the day before your procedure. Drink plenty of other fluids besides water, coffee, and tea. You need to get calories from these liquids so that you don’t get weak.

Bowel Preparation Instructions

At 3:00 pm , take 2 bisacodyl (Dulcolax) tablets.

At 17:00:

• Divide MiraLAX into two halves. Pour half MiraLAX into each bottle of Gatorade (32 oz. (950 ml) each).
• Shake until completely mixed.
• Drink a glass (8 ounces (240 ml)) every 30 minutes until you have finished both bottles.

At 7:00 pm , take the remaining 2 bisacodyl (Dulcolax) tablets.

Instructions for eating and drinking before the procedure

• Do not eat after midnight the night before your procedure. This also applies to lozenges and chewing gum.
• Between midnight and two hours before your scheduled arrival time at the hospital, you can drink no more than 12 ounces (350 ml) of water (see picture).
• Refrain from eating and drinking two hours before your scheduled arrival time at the hospital. This also applies to water.

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Day of procedure

Things to remember

• Take only the medicines your doctor has told you to take on the morning of your procedure. Wash them down with a few small sips of water.

What to bring

• List of medications you are taking.
• Medications for breathing problems (such as an inhaler), if needed.
• Medicines for chest pain, if you use them.
• If you have a stoma, bring an extra bag and supplies with you.

Where to Park

The MSK Garage is located on East 66 ^th Street between York Avenue and First Avenue. For parking pricing, call 212-639-2338.

To enter the garage turn onto East 66 ^th Street off York Avenue. The garage is located about a quarter of a block from York Avenue, on the right (north) side of the street. A pedestrian tunnel leads from the garage to the hospital.

There are other garages located on East 69 ^th Street between First Avenue and Second Avenue, East 67 ^th Street between York Avenue and First Avenue, and on East 65 ^th Street between First Avenue and Second Avenue .

Where to go

You need to come to the MSK main building. Enter through the entrance at 425 East 67 ^th Street, between First Avenue and York Avenue, and take elevator A to the 2nd floor ^.

What to expect on the day of your procedure

When you arrive at the hospital, doctors, nurses, and other medical staff will ask you several times to spell and spell your name and date of birth. This is necessary for your safety. People with the same or similar names can have the procedure on the same day.

After you change into a hospital gown, the technologist and radiologist will talk about the procedure and answer your questions. You will be helped to lie flat on your back on the X-ray table.

You will have an x-ray of your abdomen to make sure there is no stool (feces) in your colon. The radiologist will insert a small tube into the rectum so that the contrast agent can flow into the large intestine. At this point, you may feel spasms. The radiologist will monitor the passage of the contrast agent through the colon on a monitor screen while the machine takes x-rays.

During the procedure, the top of the table may be tilted up or down and you may be assisted in different positions. This will help the contrast agent cover the entire surface of the colon.

The technologist will remove the tube from your rectum and take you to the bathroom where you can release the contrast material and air. After that, one or more x-rays will be taken. After the radiologist has reviewed all x-rays, you can leave.

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After your procedure

You can return to your normal diet and lifestyle unless your doctor or nurse tells you otherwise.

If you have been given a barium enema, your stools will be white for the next few days until all of the barium has been eliminated. Barium can cause constipation, so it’s important to drink plenty of fluids to help move it out of the intestines.