What is an Enema?

Written by: Simon Spichak, M.Sc

Updated: April 12th, 2023

Enemas are a common healthcare procedure that involves injecting fluids into the rectum. They may be used to stimulate defecation, cleanse the colon before surgery, and deliver drugs for gut conditions. However in recent years, online influencers have popularized questionable colon cleanses like Implant-O-Rama system or at-home coffee enema ^[¹^],[²^].

Learning what enemas can and can’t do will help with making informed health decisions. Speak with a primary care physician to learn more about the benefits and risks of enemas and administering them.

Different Types of Enemas

Different types of enema solutions provide relief for specific gastrointestinal issues. Most enema solutions are available over-the-counter. They are usually self-administered while lying on the side, though some types of enemas are only used in a healthcare setting.

Enemas for constipation

Constipation is a common condition causing difficulty passing stools. Many solutions are tested and designed to treat constipation. They soften the stool, lubricate the gut, and stimulate muscle contractions in the colon, leading to defecation. Holding in the solution inside the rectum for one to five minutes is usually enough to stimulate defecation.

Enema solutions for constipation include:

Sodium phosphate or saline^[³^]. A salt and water solution that softens the stool.
Glycerin^[⁴^]. This helps stimulate muscle contractions in the colon.
Bisodacyl^[⁵^]. A common laxative that stimulates defecation.
Mineral solution^[⁶^]. This type of enema lubricates the gut, making it easier for bowel movements to pass through the colon.
Sorbitol pulls water into the large intestines causing distention, thereby stimulating the normal forward movement of the bowels.

Enemas for fecal impaction

Severe, prolonged constipation could lead to lumps of dry, hard stool getting stuck in the rectum. This painful condition is called fecal impaction^[⁷^]. Mineral oil enemas help soften the stool and make it easier for the lumps to exit the rectum. In addition to the enema, an abdominal massage and daily intake of polyethylene glycol helps the impactions pass.

Enemas for medical procedures

For some procedures, a doctor uses a camera on the end of an endoscope to survey the gut. Colonoscopies and sigmoidoscopies look for cancer, polyps, or signs of other disease. Before the procedure, a saline enema will be administered to cleanse the colon^[⁸^] so that it looks clean and clear for diagnostic and treatment purpose.

An enema solution containing the element barium also helps doctors spot abnormalities. This helps make X-ray images of the gut much clearer, making it easier to spot disease.

Enemas for delivering medication

Mesalamine is a common medication used to treat ulcerative colitis. This condition leads to sores and inflammation in the colon and rectum. Mesalamine administered through an enema helps treat inflammation in the colon. This medication stays inside the rectum for a few hours^[¹⁰^]. Some antiemetics and several anti-angiogenic agents which works better without digestion are also administered via gentle enema. Administration by enema avoids having the medication pass through the entire gastrointestinal tract, therefore simplifying the delivery of the medication to the affected area and limiting the amount that is absorbed into the bloodstream.

Debunking Common Enema Myths

Many alternative health products and procedures sound a lot like enemas. They’re promoted online by influencers and celebrities. They are expensive and often do more harm than good.

Terms like “colonic”, “hydrotherapy”, and “detox” sound medical and legitimate. This may lead people to believe these procedures are evidence-based like other enemas. But these solutions may cause more harm than good.

Myth #1: Coffee enemas boost the immune system and fight off disease

Ah, coffee. The tasty drink that powers people through their morning. Coffee is associated with a bevy of positive health outcomes, but there is no evidence that it does anything good in enema form.

One review looked at medical case reports of people who used coffee enemas to treat inflammation in ulcerative colitis. Ultimately, they found no evidence that these procedures are effective¹¹^]. Other experts warn that this type of cleanse can also cause damage to the colon^[¹^]. In fact, it comes with the risk of normal enema complications, and the potential for rectal burns if the coffee is too warm. It is also possible to take in too much caffeine, if you are using larger amounts of coffee than you would normally drink.

Remember, coffee belongs in a cup, not the colon.

Myth #2: Cleanses and colonics boost the body’s immune system to treat disease

There is no evidence that any cleanses, colonics, or irrigation confer any benefits^[¹^],[²^]. Boosting the body’s immune system isn’t a proven claim, and even if enemas could do this, it would be a bad idea!

Boosting the immune system increases inflammation. This leads to the autoimmune conditions like ulcerative colitis in the first place^[¹^],[²^],[¹²^]. In addition, there isn’t any evidence these cleanses treat cancer, depression, anxiety, or any other conditions^[²^].

Myth #3: Cleanses help the body “detox” or get rid of “toxins”

Purveyors of colonic therapy or hydrotherapy claim they’ll clear dried out plaques of feces releasing toxins into the body. But unless you’ve developed fecal impaction, there is no evidence that this is what is happening.

The clinics seldom define “toxins” or explain exactly what chemicals they’re getting rid of. And besides, the human body has specific organs built-in that get rid of toxic molecules — the liver, kidneys, lungs and other organs^[¹³^].

How Safe Are Enemas?

When enemas are administered correctly this procedure is nothing to worry about. It may just cause temporary discomfort like cramping or bloating^[¹⁴^].

However, if it isn’t done right, there are risks^[¹⁴^]. Improper technique could cause a person to tear a hole in the lining of their gut, called a bowel perforation^[¹⁴^]. When too large of a dose is used, it leads to dehydration or electrolyte imbalance^[¹⁴^]. In some cases, it can lead to infection^[¹⁴^]. Enemas also negatively affect the good bacteria in the gut (probiotics), which can damage the microbiota balance and cause digestive symptoms.

Please see a doctor if you experience^[14]:

Nausea, drowsiness, or vomiting
Increased thirst or a decrease in urination
Swelling in the lower extremities

Are Enemas Safe?

Enemas are a common procedure that involves administering fluid into the rectum. Most commonly, enemas are used to treat constipation by hydrating the stool and stimulating defecation. They are also used for certain medical procedures used to diagnose gut pathology or remove polyps.

While there are many at-home enema concoctions that claim to cleanse or “detox” the gut, boost the immune system, or treat disease, there is no evidence that any of these products work as intended. They may even damage the colon. Please speak with a primary care physician for more details on enemas to ensure this procedure is right for your needs. One should ask a nurse or a doctor for specific instructions before using enema to avoid injury.

References