enema

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With an enema, liquid, for example water or contrast medium, is passed through the anus into the intestine. Reasons for an enema are either diagnostic purposes, therapeutic or cleaning measures, such as when fasting. Read everything about the enema, when it is necessary and the risks it entails.

What is an enema?

An enema is a collective term for the introduction of fluid through the anus into the intestine. This is done using a thin plastic tube. The liquid is usually water at body temperature, X-ray contrast media or solutions mixed with certain medications, which are then absorbed through the intestinal mucosa.

How much fluid is introduced depends individually on the age and general condition of the patient, as well as the reason for use.There are systems that are only used once, such as the enema or enema (200 to 300 milliliters) or the microclist (5 milliliters). These consist of a squeeze bag with a syringe going out from it. Other systems can be reused (after sterilization), for example in the form of balloon syringes or tubes that are attached to vessels. If the enema is to work further up in the digestive tract, it is possible with some systems to attach an intestinal tube as an extension.

In addition to the enema and the intestinal enema, a distinction is also made between the intestinal irrigation, in which the intestine is rinsed with the help of large amounts of liquid until the liquid emerges clearly again.

When do you do an enema?

An enema can be performed for various purposes. On the one hand, the enema itself is often used as therapy for a disease or offers relief from ailments. On the other hand, contrast media for imaging procedures can be introduced into the intestine via an enema. In addition, some intestinal examinations, such as a colonoscopy, require a colon cleanse.

Enema during diagnostic measures

So that the doctor can see the bowel sufficiently during a colonoscopy, it must be cleaned beforehand. When examining higher sections of the intestine, the patient cleanses the intestines using laxative fluids that are drunk. However, if only a partial colonoscopy is necessary, i.e. only the part of the intestine near the exit is mirrored, an enema or an intestinal irrigation, which is carried out directly before the examination, is often sufficient.

Contrast media can also be fed into the intestine via the enema, which is necessary for some imaging examinations of the digestive tract, such as magnetic resonance imaging.

Enema as a therapeutic measure

The enema is used as therapy or supportive measure in the following situations:

• before delivery (controversial)
• laxative enema for persistent constipation (constipation)
• fresh intussusception (invagination of part of the intestine into the next section of the intestine)
• Sluggishness of the bowel after an operation
• Elevated potassium levels (hyperkalemia)
• Medication for ulcerative colitis

If a patient is acutely unable to ingest medication by mouth, the enema is also used to deliver medication to the body through the intestinal lining. If the ammonia level in the blood is too high, usually caused by cirrhosis of the liver, the doctor uses a so-called lactulose enema, for example. The lactulose then binds the ammonia and it can be excreted more easily. Patients with chronic kidney failure, on the other hand, are sometimes given a resonium enema because the impaired kidney function causes a lot of potassium to accumulate in the blood. The resonium in the rinsing liquid then supports the potassium excretion in exchange for sodium ions.

Enema for personal hygiene

Even when fasting, the enema is part of the program for many. However, this practice is rather controversial among medical professionals: the enema may remove water and minerals from the body, which can massively disrupt the body's own household. In addition, the risk of injury if an enema is performed by laypeople is greater than if an enema is carried out by an experienced nurse.

Outside of the health sector, anal rinsing is also carried out as part of various sexual practices, for example as preparation for anal intercourse or as part of clinical eroticism.

When is it not allowed to do an enema?

Since an intestinal lavage always has an irritant effect on the intestinal activity and intestinal mucosa, there are situations in which an enema should not be performed:

• Vomiting or abdominal pain if the cause is unknown
• acute abdominal diseases, such as inflammation of the peritoneum or intestinal obstruction
• Early pregnancy or imminent miscarriage
• after operations on the colon
• Bleeding in the digestive tract
• mechanical intestinal obstruction

What do you do with an enema?

An enema can be performed by a doctor, a nurse or the patient himself. Please note: If you do an enema on yourself, the tube must never be forcefully inserted into the anus! Otherwise, you risk damaging the intestines.

storage

The enema is carried out, for example, in the patient's bed or in the bathtub or on an exercise mat that is placed on the floor. The position of the patient is mostly dependent on his general state of health, but due to the possible circulatory stress, the patient should rather lie down. People who do the enema on themselves often use the so-called knee-elbow position: They crouch on the floor and support themselves on their knees and with one elbow so that the other hand is free to move the intestinal tube in introduce the anus.

Enema with sachets: enema or enema

If the nurse has positioned the patient appropriately, she puts some lubricant on the tip of the enema, which is now inserted into the rectum. This will make it easier for her to insert the enema.

It asks the patient to relax and loosen the sphincter muscle. Then she carefully inserts the end into the rectum while twisting. The liquid is now slowly pressed from the bag into the tube and thus directed into the intestine. The patient should then tense the sphincter muscle. The caregiver will now remove the hose. After a previously agreed waiting time (usually around 10 minutes), the patient is allowed to empty his bowel in the normal way on the toilet.

Enema

Before the intestinal enema, the nurse warms tap water to body temperature. Since the intestinal enema is mostly used for emptying and cleaning the intestine, or to clear stubborn blockages, the liquid must now be brought higher up in the digestive tract than is the case with an enema with an enema. To do this, the nurse uses an intestinal tube of the appropriate length. She then puts a lubricant on this again and introduces it into the patient's bowel about 10 to 20 centimeters deep with gentle turning movements. When the tip of the intestinal tube comes to rest in the desired position, the nurse connects a tube to the intestinal tube through which the liquid slowly flows in. It is important that the patient breathes with his mouth open so that he does not press against it with his abdominal muscles. Once all of the fluid has run into the intestine, the patient is asked to squeeze the sphincter and the nurse carefully removes the intestinal tube.

Colon irrigation

A body-warm irrigation fluid is also used for the intestinal irrigation; in adults, the irrigation is usually carried out with 5,000 milliliters. According to the intestinal enema, the nurse prepares an intestinal tube coated with lubricant, which this time is connected to an inlet and an outlet hose, and asks the patient to relax the sphincter muscle. Then she guides the tube into the patient's intestine by rotating movements and lets the first 100 to 200 milliliters of liquid run into the intestine via the connected hose. She repeats this process until clear liquid runs out of the draining tube. Then she clamps off the tube and carefully pulls the intestinal tube out of the patient's anus, who is supposed to compress the sphincter muscle.

What are the risks of an enema?

Enemas can lead to various health problems, which is why they should only be performed by trained personnel:

• Puncture of the intestines
• Rupture of the bowel from excessive stretching
• Circulatory disorders of the intestinal wall, possibly with death of the intestinal section
• Scalds from rinsing solution that is too hot
• Disturbance of the electrolyte balance
• infection
• Stress on the circulatory system, especially in poorly circulated patients

What do I have to consider after an enema?

After the enema you should try to suppress the bowel movement for the agreed period of time. Report to the nursing staff if you need help using the toilet or if you have been to the toilet. Sometimes it is important not to flush the toilet after an enema so that the caregiver can assess the amount, color, and consistency of the stool.

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