An enema involves passing fluid through the anus into the intestines. In most cases, this is water. However, this can also be mixed with various additives such as table salt or glycerine. The indications for an enema can be diagnostic or therapeutic.
What is the enema?
An enema involves passing fluid through the anus into the intestines. In most cases, this fluid is water. Known devices for performing an enema are irrigators, clysopumps or pear syringes. Different devices with different capacity can be used for an enema. Known devices for performing an enema are irrigators, clysopumps or pear syringes. The liquid content ranges from 50 to 800ml. The most common form of application is the enema. Here, the enema volume is a maximum of 200ml. There are special enema pumps for self-use. With these, liquid can be aspirated by means of an integrated ball pump and injected into the anus. Irrigators are used for passive enemas. For this, a tube connected to a fluid container is inserted into the anus. The fluid container is suspended in an elevated position so that the water can flow through the anus into the bowel. There are numerous medical indications for an enema. However, enemas and clysters are also used to prepare for anal intercourse or can be part of sexual practices in the realm of clinician eroticism or BDSM.
Function, effect, and goals
Most often, the enema is used as a laxative measure. This is done, for example, in cases of stubborn constipation, intestinal obstruction, bowel cleansing before fasting cures, before surgery or before childbirth. The laxative enema is usually performed by means of an enema, which results in a rapid evacuation of stool. The effect of the enema can be enhanced by various techniques. Lowering the temperature of the enema fluid to about 32°C has a stimulating effect on the bowel, as does inserting a longer intestinal tube. In children or infants, simply inserting a clinical thermometer into the anus often has a laxative effect. Various agents can also be added to the irrigation fluid, which in most cases is water, which also leads to an improved effect. For example, olive oil or milk have a stool-softening effect, and table salt or sorbitol enhance the osmotic effect. In certain cases, it is necessary to deliver medications that are usually administered orally to the body by means of an enema. This may be the case if the patient is acutely unable to take the medication orally. Anal administration is also suitable for children. The administration of drugs by enema also shows several advantages. First, the first-pass effect is reduced. Every orally administered drug first passes through the liver before it then ends up in the blood and later at the target organ. The first-pass effect here describes the conversion of the drug substance in the liver. If the drug is administered anally, part of the active ingredient passes through the intestinal mucosa of the rectum directly into the bloodstream and thus reaches the target organ more quickly and in its original form. Nasty-tasting active ingredients or drugs that are acid-sensitive and would be destroyed by stomach acid can also be administered by enema. In the case of a so-called hepatic encephalopathy, i.e. brain damage caused by cirrhosis of the liver, a lactulose enema is often administered. The cause of the brain damage is ammonia in the blood, which the damaged liver can no longer break down. The lactulose contained in the irrigation fluid is supposed to bind this ammonia so that it can then be excreted more easily. A Resonium enema, on the other hand, is performed in cases of acute or chronic renal insufficiency. Damaged kidneys mean that not enough potassium can be excreted. Resonium is a medication used to exchange potassium ions for sodium ions. It is applied by means of a single-use enema. For optimal effect, it must remain in the patient’s anus for between four and ten hours. If this is not possible, the application must be repeated. Enemas can also be given to reduce fever. This used to be a common procedure, but it seems to have gone out of fashion.For the fever-reducing enema, 30°C lukewarm water is added with a pinch of salt and flushed into the intestine. The amount of liquid should be up to 100ml for infants, 250ml for toddlers, and between 500 and 600ml for older children and adults. With this technique, a fever reduction of about one degree can be achieved. However, an enema can be used not only for therapeutic purposes, but also for diagnostic purposes. For this purpose, a contrast medium is added to the irrigation fluid. This then enters the patient’s colon via the anus and is distributed there. This is followed by further irrigation to empty the bowel and remove excess contrast medium. Air insufflation, i.e., the blowing in of air, is used to dilate the intestine. In the subsequent X-ray examination, the colon can now be visualized on the X-ray image. Enemas are also given to diagnose fecal incontinence. This involves measuring the amount of fluid that can be poured in until it comes out through the anal muscle. In another experiment, 500ml of fluid is poured into the rectum and the time the patient can consciously hold the substance before defecation occurs is measured.
Risks, side effects, and hazards
If bowel obstruction or acute abdominal disease is present, an enema should not be performed or should be performed only under the detailed instructions of a physician. Caution should also be exercised in cases of congenital anus malformations, hemorrhoids, pregnancy, and chronic inflammatory bowel disease such as Crohn’s disease or ulcerative colitis. If the temperature of the irrigation fluid is too high or too low, scalding or cramps in the bowel may occur. If the irrigation devices are used improperly, there is a risk of injury to the intestinal wall or anus. Care should be taken to ensure that the irrigation fluid is safe. An excessively high alcohol or acid content irritates the intestinal mucosa. Chamomile tea, which used to be frequently used for enemas for inflammatory bowel diseases, is also not recommended as an irrigation fluid. Asthmatics or allergy sufferers are at risk of anaphylactic shock. In the worst case, this can be fatal. Overly frequent enemas can also lead to damage to the intestinal flora.
Typical and common intestinal diseases
- Crohn’s disease (chronic inflammatory bowel disease)
- Inflammation of the intestine (enteritis)
- Intestinal polyps
- Intestinal colic
- Diverticula in the intestine (diverticulosis)
