Enema

Enema
WHAT IS ENEMA?
It is the introduction of a solution into the rectum
and large intestine( sigmoid colon) to relieve
constipation or evacuate the lower bowel. An enema
administration is a technique used to stimulate stool
evacuation.
TYPES OF ENEMA:
1. Cleansing enema- inteded to remove feces.
a. prevent the escape of feces during surgery
b. prepare the intestines for certain diagnostic tests such
as x-ray or visualization test.( colonoscopy)
c. Remove feces in instances of constipation or impaction

SOLUTIONS TO BE USED:
a.Hypertonic solution – (e.g. saline) 90-120 ml
exert osmotic pressure, which draws fluid from the interstitial space into the
colon.
· The increase volume in the colon stimulates peristalsis hence
defacation.
· Example: fleet enema
· Adverse effect: retention of NA
· Time to effect: 5-10 mins.
b.Hypotonic solution – tap water (500ml- 1L)

· Distends colon, stimulates peristalsis and softens feces.
· Should not be repeated because of the danger of circulatory overload.
· Adverse effect: FE imbalances; water intixication
c.
SOLUTIONS TO BE USED:
Isotonic solutions (e.g. normal saline, 500ml – 1L)
· Exert the same osmotic pressure as the interstitial fluid surrounding the
colon. Therefore , no fluid movement into or out of the colon.
· Considered the safest enema solution (NSS) to use.
· Adverse effect: possible Na retention
d. Soapsuds enemas-500ml – 1L (3-5ml soap to 1L water)

· Stimulates peristalsis by increasing the volume in the colon and irritating
the mucosa, (e.g. pure soap- castile soap)
· Adverse effect: irritates and may damage mucosa.
· Time to effect; 10 – 15 mins.
e. oil ( mineral, olive oil)

· lubricates the feces and the colonic mucosa.
TYPES OF ENEMA:
2. Carminative enema
Ø It is given primarily to expel flatus
Ø The solution instilled into the rectum releases gas, which in turn
distends the rectum and colon thus stimulating peristalsis.
Ø 60 – 80 ml of fluid is instilled for adults
3. Retention enema
Ø Introduces oil or medication into the rectum and sigmoid colon.
Ø Acts to soften the feces and to lubricte the rectum and anal canal,
thus facilitating passage of the feces.
TYPES OF ENEMA:
4. Retention flow Enema
Ø used occasionally to expel flatus.
Ø Alternating flow 100-200 ml of fluid into and out of the rectum
and sigmoid colon stimulates peristalsis. This process is repeated
5 to 6 times until the flatus is expelled and abdominal distention
is relieved.
PURPOSE OF ENEMA
a. To remove feces when an individual is constipated or impacted.
b. To remove feces and cleanse the rectum in preparation for an examination.
c. To remove feces prior to surgical procedure to prevent contamination of the
surgical area.
d. To administer drugs or anesthetic agents.
PRECAUTION
Ø Enemas should not be used as a first line treatment for constipation.
Ø Frequent use of enemas can lead to fluid overload, bowel irritation, and loss of muscle tone of the bowel and
anal sphincter.
Ø Never deliver more than three consecutive enemas to treat a patient.
Ø Patient with diarrhea may not be able to hold an enema.
Ø Must be used with caution in cardiac patients who have arrhythmias or have had a recent MI. ( insertion of the
enema tube and solution can stimulate the vagus nerve which may trigger an arrhythmias such as bradycardia).
Ø Enemas should not be given to patients with undiagnosed abdominal pain because the peristalsis of the bowel
can cause an inflamed appendix to rupture.
Ø Do not force the enema catheter into the rectum against resistance. This can cause trauma to the rectal tissue.
Ø Use only mild soap( unperfumed soap made from olive oil and lye) for soapsuds enemas because other soap
preparations are too harsh and irritate the rectal tissue.
EQUIPMENTS
1. A tray containing the following:
Rectal catheter
Enema can with tubing
Lubricant
Pitcher with hot and cold water
Solution as ordered by physician
Toilet paper,Kidney basin, Gloves
2. apron or gown to protect the uniform
3. bedpan with cover
4. waterproof underpad
5. irrigation stand or IV stand
ASSESSMENT
1. assess status of client. (Determine factors indicating need for enema and influencing the
type of enema used, also establishes baseline for bowel function.)
2. assess medical records for presence of increased intracranial pressure, glaucoma, or
recent rectal or prostate surgery.
3. Inspect abdomen for presence of distention.
4. Determining client”s level of understanding of purpose of enema.
5. Check client’s medical record to clarify reasons for enema.
6. Review physician’s order for enema.

PREPARATION
1. The patient should be encouraged to empty both bladder and bowels before the
procedure.
2. Before administering enema, ensure the patient’s privacy.
3. Have the patient undress completely from the waist down.
4. Position the patient on bed on his/her left side with the top knee bent and pulled
sligthly upward toward the chin.

PROCEDURE: FOR COMERCIAL ENEMA
1. position the patient in left lateral position with the right leg flexed.
2. Alternatively, you may position the client in the knee chest position.
3. After inserting the nozzle into the anus, squeeze the container until all the
solution is instilled.
4. Remove the nozzle and container, have the client continue to lie on left side for the
prescribed length of time.
5. To assist the patient with retaining an enema after instillation, apply gentle
pressure to the rectal opening or squeeze the buttocks together.

AFTERCARE
1. After administering an enema, remain near the patient in case he/she needs
assistance with the bedpan or go to the toilet.
2. Hands wash after performing the procedure.
3. Note the resuts of the enema ( color,consistency,content and amount of feces)
COMPLICATIONS
1. complications of enema adminitration are not common but can include irritation,
swelling, redness, bleeding, or prolapse of the rectal tissue.
2. If any of the symptoms are apparent, or the patient complains of pain or burning
sensation during instillation, stop the procedure and notify the physician.
THANK YOU!

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Enema

a. prevent the escape of feces during surgery

b. prepare the intestines for certain diagnostic tests such

as x-ray or visualization test.( colonoscopy)

c. Remove feces in instances of constipation or impaction

b.Hypotonic solution – tap water (500ml- 1L)

d. Soapsuds enemas-500ml – 1L (3-5ml soap to 1L water)

e. oil ( mineral, olive oil)

Ø Alternating flow 100-200 ml of fluid into and out of the rectum

and sigmoid colon stimulates peristalsis. This process is repeated

5 to 6 times until the flatus is expelled and abdominal distention

type of enema used, also establishes baseline for bowel function.)

2. assess medical records for presence of increased intracranial pressure, glaucoma, or

recent rectal or prostate surgery.

3. Inspect abdomen for presence of distention.

4. Determining client”s level of understanding of purpose of enema.

5. Check client’s medical record to clarify reasons for enema.

6. Review physician’s order for enema.

2. Before administering enema, ensure the patient’s privacy.

3. Have the patient undress completely from the waist down.

sligthly upward toward the chin.

prescribed length of time.

pressure to the rectal opening or squeeze the buttocks together.

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