2. Definition
An enema is an introduction of fluid into the
lower bowel through the rectum for the purpose
of cleansing or to introduce medication or
nourishment.
3. Purpose
To stimulate defecation & to treat constipation ex:
simple evacuant enema
To soften hard faecal matter ex: oil enema
To administer medication ex: sedative enema
To protect and soothe the mucus membrane of intestine
& to check diarrhoea ex : emollient enema
To destroy intestinal parasites ex : anthelminitic
enema
To relieve the gaseous distention ex : carminitive
enema
4. Purpose
To administer the fluid and nutrients ex: nutritive enema
To relieve inflammation ex : astringent enema
To induce peristalsis ex : purgative enema
To stimulate a person in shock and collapse ex: stimulant enema
To reduce the temperature ex : cold enema or ice enema
To clean the bowels prior to x-ray studies , visualization of the
bowel , surgery on the bowel or delivery of a baby ex : saline
enema
To make diagnosis ex: barium enema
To establish regular bowel functions during a bowel training
programme
To induce anesthesia ex : anesthetic enema
8. Simple evacuant enema
Purpose :
To stimulate defecation & to treat constipation
To relieve the gaseous distention by stimulating
the peristalsis
To relieve the retention of urine by reflex
stimulation of the bladder
To stimulate uterine contraction & to hasten
the child birth
To cleanse the bowel prior to x-ray studies ,
visualization of the bowels
(ex: sigmoidoscopy) , surgery & retention enemas
9. Simple evacuant enema
Solutions used :
soap & water : soap jelly 50ml to 1 liter of water
Normal saline : sodium chloride 1 teaspoon of half liter of
water
Tap water
Amount of solutions to be used :
Adults : 500 to 1000 ml ( 1 to 2 pint )
Children's : 250 to 500 ml ( 0.5 to 1 pint )
Infants : 250 ml or less
Temp of solution :
Adults : 105 to 110 degree Fahrenheit
Children : 100 degree Fahrenheit
10. Oil enema
These are given to soften faecal matter in case of
severe constipation
Before the 1st bowel movement after operation on the
rectum or perineum. To avoid straining & injury to the
sutures & wounds
It should be retained for half an hour to 1 hour to
soften the faeces
It should then be followed by a soap & water enema to
open the bowels
11. Oil enema
Solutions used :
Olive oil
Gingerly oil or sweet oil
Castor oil & olive oil (1:2)
Amount of solution to be used : 115 to 175
ml
Temperature of the solutions : 100
degree Fahrenheit
12. Purgative Enema
These are given to cause the bowel to
contrast actively & to evacuate its contents
Its acts by their irritating effect on the mucus
lining, stimulate peristalsis& cause the
evacuation of bowel
The stretching of the intestine due to this inflow
of fluid causes the intestine to contract & leads
to the evacuation of bowels
13. Purgative Enema
Solutions used :
Pure glycerin – 15 to 30 ml
Glycerin & water – 1:2
Glycerin & caster oil – 1:1
Magnesium sulphate : 60 to 120 ml with sufficient
amount of water to dissolve it
1-2-3 enema : magnesium sulphate 30 ml, glycerin
60 ml, & water 90 ml
Amount & temp of solution is that of oil enema
14. Anthelmintic enema
This is given to destroy & expel the worms from the
intestines
Before the treatment is given the bowel should be
cleansed by a soap water enema so that the drug may
come in direct contact with the worms & the lining of the
intestine
The treatment is given until the worms are destroyed
Solution :
Infusion of quassia : 15gms of chips to 600 ml of
water
Hypertonic saline solution : sodium chloride 60 ml with
600 ml of water
Amount of the solution : 250 ml
15.
16. Carminitive enema (antispasmodic)
These are given to relieve gaseous distention of the
abdomen by causing peristalsis & expulsion of
flatus &faeces
It is given as simple evacuant enema
Solution :
Turpentine : 8 to 16 ml of turpentine mixed thoroughly
with 600 to 1200 ml of soap solution
Milk and molasses(granular sugar ) : 90 to 230 ml of
molasses well mixed with equal quantity of warm milk
17. Astringent enema
It contracts the tissues & the blood vessels ,
checks bleeding & inflammation , lessens the
amount of mucus discharge & gives a
temporary relief in the inflamed area
It is usually given in colitis & dysentery
They are usually given in the form of rectal or
colonic irrigations
The solution is allowed to run in slowly & return
quickly to avoid distension , pain & irritation of
the inflamed wall
18. Cold enema (ice enema)
This is given to decrease the body temperature
in hyperpyrexia and heat stroke
It is given in the form of colonic irrigation
Complications :
Hypothermia
Abdominal cramps
19. Astringent enema
Solutions :
Tannic acid : 2 gms to 600ml of water
Alum : 30 gms to 600ml of water
Silver nitrate 2% : (silver nitrate is dissolved in
distilled water )
Temperature of the solution : It is given as hot
as the client can stand
21. Stimulant enema
A stimulant enema is given in the treatment of
shock and collapse
It is also sometimes given in case of poisoning ex:
coffee enema is given in case of opium poisoning
Solutions :
Black coffee : 1 table spoon coffee powder to 300 ml of
water
Brandy : 15 ml of brandy added to 120 to 180 ml of
glucose saline
Amount of solution : 180 to 240 ml
Temp of solution : 108 to 110 degree Fahrenheit
22. Sedative enema
It is retention enema containing a sedative drug
given to induce sleep
Drugs used :
Paraldehyde
Chloral hydrate
Potassium bromide
Dose :as ordered by the doctor
23. Emollient enema
This is an introduction of bland solution into the rectum
for the purpose of checking diarrhoea or soothing &
relieving irritation on an inflamed mucus membrane
Solution used :
Starch & opium : opium 1 to 2ml is added to 120 to
180 ml of starch mucilage or rice water
Starch mucilage alone
Amount of solution : 120 to 180 ml
Temp of solution : 100 to 105 degree Fahrenheit (37.8 to
40.5 degree centigrade )
24. Anaesthetic enema
It is a retention enema containing an
anesthetic drug to produce anesthesia in
client
Drugs used :
Avertin 150 to 300 mg per kg of body weight
25. Nutrient enema
It is a retention enema to supply food & fluids to
the body
Selection of the fluids depend upon the ability
of the colon to absorb it
Nutrient enema is particularly useful in
conditions like haemophilia which makes I.V.
infusion difficult or undesirable
26. Nutrient enema
Solutions :
Normal saline
Glucose 2 to 5%
Peptonized milk 120 ml
Amount of solution :
1100 to 1700 ml in 24 hour or 180 to 270 ml at 4 hourly
interval
Temperature of solution :
100 degree Fahrenheit (37.8 degree Fahrenheit )
29. Cleansing enema
Definition
Introduction of solution into the large intestine for
removing feces and cleansing the bowel
Purposes
To relive constipation or fecal impaction
To prevent involuntary escape of fecal matter during
surgical procedure and delivery
To promote visualization of the intestinal tract during
radiographic or instrumental examination
To help establish regular bowel function during a bowel
training program
Preoperative preparation for bowel surgeries
To relieve retention of urine by reflex stimulation of
bladder
30. Solutions used
Hypertonic :sodium phosphate, fleet enema
Hypotonic : tap water
Isotonic : physiological saline (one tsp of table salt in
500 ml of tap water)
Others : 3-5 ml of concentrated soap solutions in
1000 ml water
31. Contraindications
Acute renal failure
Acute myocardial infarction and cardiac problems
Appendicitis
Obstetrical contraindications like antepartum
hemorrhage, leaking membranes
Recent surgical procedures involving lower intestinal
tract
Intestinal obstruction
Inflammation and infection of abdomen
33. General instructions
The appropriate size catheter or rectal tube need to be
used
the rectal tube needs to be smooth and flexible
The rectal tube is lubricated with water soluble lubricant
The temperature of the solutions needs to be adjusted
according to the purpose of enema
The amount of the solution to be administered depends
upon the type of the enema and the age & size of the
person
When enema is administered, the client usually assumes
a left lateral position
The distance to which the tube is inserted depends upon
the age and the size of the client
The height f the can should be adjusted to regulate the
flow of the solution according to the type of the enema
34. General instructions
The length of time that the enema solution is retained will
depend upon the purpose of enema and the ability of the
client to contract the external sphincter to retain the
solution
Make sure the whole apparatus used for the
administration of enemas is in a good working condition
Regulate the flow of fluid according to the type of the
enema, give retention enema very slowly, usually by a
Murphy drip.
If the rectum is impacted, attempt to remove the faecal
matter with gloved finger.
Listen to the complaints of the client and should not
ignore
Prepacked enemas will have their own instructions which
36. Articles
Enema can and tubing method
A tray containing
Disposable gloves
Water soluble lubricant
Bath thermometer
Soap and water
Toilet tissues
Enema can
Tubing and clamp
Appropriate size rectal tube
Adult : 22-30 Fr
Child size : 12-18 Fr
37. Articles
IV stand
K . Basin(2)
Solution as ordered
Mackintosh/waterproof
under pad
Bedpan
Temperature of solution
Adult : 105-110 F (40-43
C)
Child : 100 F(37.1 C)
Amount of solution
Adult :750-1000 ml
Adolescent :500-750 ml
School age :300-500 ml
Toddler :250-300 ml
Infant :150-250 ml
38. Procedure
Assess status of patient
Last bowel movement
Normal bowel pattern
Mobility
Abdominal pain etc.
Determine the level of consciousness and understanding,
provide privacy
Explain procedure purpose to the patient
Assemble articles, wash hands and don gloves
Raise the bed to appropriate height
Assist patient to side lying position (sim’s position)
Place mackintosh under hip and buttocks
Cover the patient exposing only anal area, clearly
visualizing anus
39. Procedure
Place bed pan or commode in easily accessible position
Check temperature of solution on inner wrist
Raise container, release clamp and allow solution to flow
long enough to fill tubing
Clamp the tubing lubricate 6-8 cm of tip of rectal tube with
jelly
Separate the buttocks and locate the anus. Instruct patient
to relax by breathing out slowly through mouth
Insert –tip of rectal tube gently by pointing the tip in the
direction of patients umbilicus
Adult : 7.5-10 cm
Child : 5-7.5 cm
Infant : 2.5-3.7 cm
Hold the tubing in place with one non- dominant hand.
40. Procedure
Open regulatory clamp and allow solution to enter slowly
with the container at the patients hip level.
Raise the enema can slowly to appropriate level above
the anus. Eg: for the infusion rate 1L in 10 mt.
Lower container or clamp tubing for 30seconds.If patient
complaints of cramping or if fluid escapes around rectal
tube.
Clamp tubing after all solution is instilled.
Inform patient, that fluid instillation is over and the tube
will be removed.
Place layers of toilet tissue around tube at anus and
gently withdraw rectal tube.
Explain to patient that feeling of distention is normal and
ask patient to retain solution as long as possible (5-10
mts)while lying quietly in bed.
41. Procedure
Discard the disposable, used items in proper receptacle. If
enema can needs to be reused. Rinse out thoroughly with
soap and warm water.
Assist patient to toilet or help to position on bed pan.
Observe the fecal matter and expelled solution.
Assist as needed to wash anal area with soap and water.
Remove and discard gloves and wash hands.
Assess condition of patient abdomen may indicate serious
problems.
Record type and volume of enema given and characteristics
of return flow.
Report failure to defecate to the physician
Clean and replace the reusable articles. Discard any waste
and disposable items.
43. Articles
A tray containing
Clean gloves
Packet of enema
Toilet tissues
Soap and water
Kidney tray
Mackintosh
Lubricant jelly
Bedpan/commode
44. Procedure
Assess status of patient
Last bowel movement
Normal bowel pattern
Mobility
Abdominal pain etc.
Determine the level of consciousness and understanding,
provide privacy
Explain procedure purpose to the patient
Assemble articles, wash hands and don gloves
Raise the bed to appropriate height
Assist patient to side lying position (sim’s position)
Place mackintosh under hip and buttocks
Cover the patient exposing only anal area, clearly visualizing
anus
Place bed pan or commode in easily accessible position
45. Procedure
Remove plastic cap from rectal tip and lubricate the tip
Gently separate the buttocks and locate the anus.
Instruct the patient to relax by breathing out through
mouth.
Insert tip of the tube gently into rectum
Adult :7.5 cm
Child :5-7.5 cm
Infant : 2.5-3.7 cm
Squeeze the container until all solution has entered
rectum and sigmoid colon while squeezing container roll
it up as fluid is instilled
Place toilet issue around the anus and withdraw the tube
Discard the disposable items in proper receptacle
Assist the patient to toilet or help to position on bedpan
46. Procedure
Observe the fecal matter and expelled solution
Remove gloves and discard, was hands.
Assess condition of patient’s abdomen, cramping or
rigidity which can indicate problems.
Record the enema given and characteristics of
result.
Report any problem if noticed.
49. Giving enema with funnel or catheter
Small enemas to be expelled are given using funnel &
catheter
The oil is kept warm by placing the container in a bowl of
warm water
During the administration , the height of the funnel should be
more than 8 inches from the anus
Help the client to retain the solution either by raising the
foot end or by pressing buttocks
The oil enema is to be retained for 2 to 6 hours to soften
the fecal matter
It may be then followed by a soap & water enema to expel
the fecal contents
The preparation & after care of the client & articles are same
as in soap & water enema
52. Giving enema using glycerin syringe
A glycerin syringe (metal syringe) and a rubber
catheter attached to its nozzle are used
Air to be expelled, prior to the administration of the
fluids
This method is particularly useful for giving enema to
children.
53. Giving enema by the drip
method
Eg: nutrient enema
(Proctoclysis or continuous retention enema )
54. Giving enema by the drip method
Articles required
All the articles used for an evacuant enema EXCEPT the
following
A reservoir (this can be an enema can or a bottle with a
cork)
Tubing attached to the reservoir
Murphy drip and a clamp
A fine catheter
Bed blocks to raise the foot end
55. Giving enema by the drip method
Procedure
Administration of retention enema is done by the drip
method
Purpose : to retain the solution and never to evacuate
Fine catheter is used in place of rectal tube ( to prevent
defecation reflex)
Flow is regulated by Murphy drip or and a clamp (less
than 40 drops per minute )
Foot end is raised to retain the fluid
Usually a retention enema is preceded by a simple
enema to keep the bowel free of faecal matter