Enemas for Constipation Relief

Most times, chronic constipation can be rectified with a better diet, water intake, exercise, or laxatives as per your need. Enemas are usually the last resort to alleviate constipation because the side effects are significant and they cannot be used in an unchecked manner.

If you’re looking for some answers for your first-time enema, this article explores all possible options and side effects.

What is an Enema?

An enema is a procedure in which a tube is inserted into your large intestines via your rectum, filling your intestines with some combination of fluid and laxatives, or gas, to help loosen the stool and empty your bowel. Enemas can be given for constipation or fecal impaction - the latter refers to long-standing constipation during which laxatives have been used and are no longer effective, causing a mass of unpassed stool. Enemas are also given to clean out the colon before a colonoscopy, to ensure clear visibility in the scans. They are used to administer medication i.e., rectal installation for disorders like irritable bowel syndrome (IBS) or leaky gut syndrome.

Hospitals can administer enemas or you can self-administer at home, although hospitals are preferable to avoid complications such as bowel perforations due to excess force, volume, or heat of the liquid. If you plan a home-based enema, give yourself the time and space to set it up. Stay close to the bathroom, so you can use it the minute you feel an urge.

Types of Enemas

Enemas are mainly of two types, classified based on their function i.e., retention and cleansing.

Cleansing Enemas

These are injected for a short duration and are water-based, with almost immediate disposal of stool. They can be small-volume/ mini-enemas, less than 500 ml, used only for constipation in the lower colon, or they can be large-volume/full-size enemas that use between 500-100ml liquid. The large-volume enemas have larger side effects, such as autonomic dysreflexia which causes an abnormal nervous system reaction and high blood pressure. They include −

Salt and Water

This is the simplest enema, which can be done at home as long as you follow the instructions on the packet regarding the salt concentration to be used and the time it needs to be retained in the colon. This procedure may also be done in hospitals to clean the anus before a rectal exam. Side effects include mild cramps, dehydration, and gas. If done at home, test the water temperature to avoid burns/scalding, and avoid tap water which is likely to spread pathogens.

Epsom salts i.e., magnesium sulfate used to be an alternative to plain saline. But they were discovered to cause magnesium absorption by the colon muscles, an unsafe development that led to the discontinuation of their use.

Sodium Phosphate

Fleet's Phosphosoda or any other brand of sodium phosphate salt can be used for enemas. These over-the-counter formulas draw water into the intestines, dilating and irritating the bowel, and prompting the evacuation of waste.

This method should only be used once every 24 hours, as too much phosphate in the body can cause fatal imbalances in electrolyte levels.

Bisacodyl

Bisacodyl is a laxative/suppository for short-term use to stimulate bowel muscles. It can cause rectal itching and burning, and nausea.

Soap Suds

This enema is usually administered for fecal impactions identified through X-Rays or scans. Doctors may have to manually remove some part of the impacted stool before an enema can be given. Usually, a mild, castile soap made of vegetable oils like olive oil is mixed into water for this.

Harris Flush/Reverse Flow

In this enema, a large volume of fluids is injected into the colon incrementally and then drawn out with the intestinal flatulence to relieve gas – a process repeated 3-5 times for complete relief.

Retention Enemas

These are retained in the bowel for a minimum of 15 minutes and can be oil or water-based. They include −

Mineral Oil/Oil-Retention

Mineral oils function as laxatives and lubricants, which coat stool to prevent abrasion or cuts for people with sensitive bowels or piles/hemorrhoids. These should be retained for a minimum 5-minute duration. Some oil-retention enemas must be held within for an hour, and they are usually made with a 90:12- oil to water ratio.

Home-made/Alternative Enemas

These enemas are often used as more natural, holistic options, although their efficacy has not been scientifically proven through studies that validate their clinical use. Most of these methods may be unsafe as they introduce external bacteria into the colon and spread harmful infections. These concoctions are not recommended for people with IBS as the intestinal bacterial balance will be disrupted.

Lemon Juice or Apple Cider Vinegar

These can be mixed with lukewarm, filtered water. Lemon juice enema supposedly balances bowel pH, while apple cider vinegar may have anti-microbial properties that disinfect and heal.

Coffee

A solution of brewed coffee and warm water is used to remove bile and as s detox for obesity, although it is never to be self-administered.

Probiotics

Some enemas use the bacterium Limosilactobacillus reuteri found naturally in our digestive tract, to fill the gut with good bacteria and bring down inflammation in pediatric ulcerative colitis. Milk and molasses in equal parts can also be used to jumpstart intestinal function.

Herbal

Herbal preparations like steeping garlic, aloe vera, chamomile, and neem in water may fight off infections, though these could also aggravate existing disorders.

Barium Enemas

In this procedure, a radiologist will fill your distal colon with barium sulfate, a metallic liquid seen in bright contrast on X-Rays. It is allowed to sit in the intestinal wall for a while before the doctor takes the images/scans to discern the shape of your digestive tract.

Conclusion

If you are taking enemas frequently, it’s time to consult a doctor. You may have an illness or you may need to make drastic lifestyle changes. Having too many enemas causes hyponatremia i.e., dangerously low salt levels in the body which can escalate into fatal brain swelling, apart from permanently damaging normal bowel function.