What's an Enema?

An enema (plural: enemata or enemas) is the procedure of introducing liquids into the rectum and colon via the anus. Enemas can be carried out for medical reasons (as a treatment for constipation), as part of alternative therapies, and also for erotic purposes, particularly as part of BDSM activities. In earlier times, they were often known as clysters. Enemas have even been used to administer beverage alcohol to alcoholics who have developed stomach ulcers.

Medical usage

The main medical usages of enemas are:

* As a bowel stimulant, not unlike a laxative -- the main difference being that laxatives are commonly thought of as orally administered while enemas are administered directly into the rectum, and thereafter, into the colon. When the enema is complete, and after a set "holding time," the patient expels feces along with the enema in the toilet.

* Enemas may be used to relieve constipation and fecal impaction, although in many health-care settings their use has been largely replaced by oral laxatives and laxative suppositories. Bowel stimulating enemas may consist of water, which works primarily as a mechanical laxative, or they may be made up of water with baking soda (sodium bicarbonate) or water with a mild soap dissolved in it; sodium phosphate solution, which draws additional water from the bloodstream into the colon and increases the effectiveness of the enema, but which can often be rather irritating to the colon, causing intense cramping or "gripping"; or mineral oil, which functions as a lubricant and stool softener, but which often has the side effect of sporadic seepage from the patient's anus which can soil the patient's undergarments for up to 24 hours. Other types of solutions are available as well. In the past, castile soap was a common additive to enemas, but it has largely fallen out of use because of the risk of chemical colitis as well as the ready availability of other enema preparations that are perhaps more effective than soap -- but which are certainly more irritating to colonic tissues.

* Cleansing the lower bowel prior to a medical or surgical procedure such as sigmoidoscopy or colonoscopy. Because of speed and supposed convenience, enemas used for this purpose are commonly the sodium phosphate variety. A more pleasant experience can usually be obtained with gently-administered baking soda enemas; cleansing the lower bowel for colonoscopy and other bowel studies can be effectively achieved with water-based enema administration.

* The administration of substances into the bloodstream. This may be done in situations where it is undesirable or impossible to deliver a medication by mouth, such as antiemetics given to reduce nausea (though not all antiemetics are delivered by enema). Additionally, several anti-angiogenic agents can be safely administered via a gentle enema. Medicines for cancer, for arthritis, and for age-related macular degeneration are often given via enema in order to avoid digestion in the normally-functioning digestive tract. Interestingly, some water-based enemas are also used as a relieving agent for IBS (Irritable Bowel Syndrome) even though it seems counter-intuitive to add medicines to an already-irritated bowel system. Finally, an enema may also be used for hydration purposes. See also route of administration.

* The topical administration of medications into the rectum, such as corticosteroids and mesalamine used in the treatment of inflammatory bowel disease. Administration by enema avoids having the medication pass through the entire gastrointestinal tract, therefore simplifying the delivery of the medication to the affected area and limiting the amount that is absorbed into the bloodstream. There is some discussion in medical circles about using steroids versus using other enema additives such as cayenne pepper.

* General anesthetic agents for surgical purposes are sometimes administered by way of an enema. Occasionally, anesthetic agents are used rectally to reduce medically-induced vomiting during and after surgical procedures, in an attempt to avoid aspiration of stomach contents.

* A barium enema is used as a contrast substance in the radiological imaging of the bowel. The enema may contain barium sulfate powder, or a water-soluble contrast agent. Barium enemas are sometimes the only practical way to "view" the colon in a relatively safe manner.

In certain countries such as the United States, customary enema usage went well into the 20th century; it was thought a good idea to cleanse the bowel in case of fever; also, pregnant women were given enemas prior to labor so as to supposedly reduce the risk of feces being passed during contractions. Under some controversial discussion, pre-delivery enemas were also given to women to speed delivery by inducing contractions. This latter usage has since been largely abandoned, because obstetricians now commonly give oxytocin to induce labor and because women generally found the procedure unpleasant. In addition, medically-aided labor reduces the physician's waiting time. However, there is some concern that any medication given to a pregnant woman can adversely affect the fetus.

Home usage

Many home-given enemas are pre-packaged sodium phosphate solutions in single-use bottles sold under a variety of brand names, or in generic formats. These units come with a pre-lubricated nozzle attached to the top of the container. Some enemas are administered using so-called, disposable bags connected to disposable tubing, although in contrast to their product names, such units can commonly be used for many months or years without significant deterioration.

Patients who want easier, more gently-accepted enemas often purchase Jon Dodd Enema Syringes which are commonly referred to as "Doddsys" syringes, and which can also be used as old-fashioned hot water bottles, to relieve aches and pains from gentle, heat administrations to parts of the body.

In medical or hospital environments, reusable enema equipment is now rare because of the expense of administering a water-based solution to the patient, and -- very rarely -- because of the expense and difficulty of disinfecting it. For a single-patient stay of short duration, an inexpensive disposable enema bag can be used for several days or weeks, using a simple rinse out procedure after each enema administration. The difficulty comes in from the longer time period (and expense) required of nursing aides to give a gentle, water-based enema to a patient, as compared to the very few minutes it takes the same nursing aide to give the more irritating, cold, pre-packaged sodium phosphate unit.

For home use, disposable enema bags or bottles are common, but reusable rubber or vinyl bags or enema bulbs may also be used. In former times, enemas were infrequently administered using clyster syringes.

Ritual use

* Ritual enemas were practiced by the Maya and many other North American , Central American and South American Indian tribes; some tribes have continued the practice to the present day. Substances used in the enemas include alcohol, tobacco, peyote, and other hallucinogenic drugs and entheogens. The Maya used a fermented liquid called balché in their enemas.

Colonic irrigation

Colonic irrigation or colon hydrotherapy is a large enema which cleanses the whole colon. It was in vogue for hygienic purposes at the beginning of the 20th century (see John Harvey Kellogg) and remains popular as an alternative health therapy in many parts of the world. Advocates believe that, when carried out by trained personnel using sterile equipment, it can be a safe and valuable tool for eliminating toxins from the body and restoring normal muscular activity in the colon. However, there have been cases of intestinal perforation due to improperly done colonic irrigations. The actual medical benefit of colonic irrigation is controversial.

References

* M. R. Strict, Intimate Invasion: The Erotic Ins & Outs of Enema Play, Greenery Press, 2004. ISBN 1-890159-51-4.
 

Enema and Colonic Health Information Sites

• Health & Yoga - all you need to know about a cleansing enema including difficulties experienced.
• The Colonic Health Network - Wealth of resources on colon health.
• The Colon Health Network - Natural health alternatives and therapy including colon hydrotherapy.
• Curezone.com - Very good bowel cleansing information.
• Lifeknox.com - Excerpts from the book "Love Thine Enemas & Heal Thyself".