Enema Administration Health Article

Definition

The term enema is used to refer to the process of instilling fluid through the anal sphincter into the rectum and lower intestine for a therapeutic purpose. An enema administration is performed using a flexible plastic rectal tube with several large holes in the tip. This is connected to the tubing from a solution bag or container. An enema can also be performed using a prepackaged solution that comes in a soft plastic bottle with a pre-lubricated rectal tip attached. Enema solutions are prepared using plain tap water or saline, soapsuds solutions, oil solutions, or various medication solutions.

Purpose

The most common purpose for administering an enema is to stimulate peristalsis (involuntary contraction) and to evacuate stool from the rectum. A tap water or soapsuds enema dilates the bowel, stimulates peristalsis, and lubricates the stool to encourge a bowel movement. These types of enemas are instilled and held for five to 10 minutes, as tolerated. They are used to treat constipation, to cleanse the bowel before a bowel exam, and to cleanse the bowel before bowel surgery. Another type of enema, the oil retention enema, is prepared in a smaller volume and is retained in the bowel for 30–60 minutes. The purpose of the oil retention enema is to soften the hardened stool and allow normal elimination. Enemas are also used to deliver medication directly onto the rectal mucous membranes to be absorbed into the bloodstream. Steroid enema solutions can be administered to alleviate bowel inflammation in patients with ulcerative colitis. Antibiotic enema solutions can be administered to treat localized bacterial infections. Medicated hypertonic enema solutions can be used to pull excessive potassium or ammonia from the bloodstream through the rectal wall. These substances are then eliminated with the stool.

Precautions

Enemas should not be used as a first-line treatment for constipation. Frequent use of enemas can lead to fluid overload, bowel irritation, and loss of muscle tone of the bowel and anal sphincter. Never deliver more than three consecutive enemas to treat a patient. A patient with diarrhea may not be able to hold an enema. Enema administration must be used with caution in cardiac patients who have arrhythmias or have had a recent myocardial infarction. Insertion of the enema tube and solution can stimulate the vagus nerve which may trigger an arrhythmia such as bradycardia. Enemas should not be given to patients with undiagnosed abdominal pain because the peristalsis of the bowel can cause an inflamed appendix to rupture. Enemas should be used cautiously in patients who have had recent surgery on the rectum, bowel, or prostate gland. If the patient has rectal bleeding or prolapse of rectal tissue from the rectal opening, cancel the enema and consult with the physician before proceeding. Do not force the enema catheter into the rectum against resistance. This can cause trauma to the rectal tissue. Use only mild castile soap for soapsuds enemas because other soap preparations are too harsh and irritate the rectal tissue.