It is important to use the exact enema ordered by the physician. Some are often ordered by a physician as part of a method to thoroughly cleanse the system before a medical diagnostic procedure, such as a barium enema, colonoscopy, or proctosigmoidoscopy.
Most enemas for this use contain ingredients known as saline laxatives (containing dibasic and monobasic sodium phosphate) or docusate.
Other enemas contain mineral oil. These help in eliminating hard stool and fecal impactions.
Whichever enema is used, there are certain steps in using the enema that must be followed exactly. Two positions are appropriate for giving the enema. One is the side position, in which the patient lies on the left side with the right knee slightly bent so that it is comfortably resting on the bed. In the knee-chest position, the patient kneels on the bed, with the head and upper chest lowered so that the head is resting on the bed.
The following tips can be helpful when using enemas:
1. Remove the protective tip from the bottle. In most cases, the enema nozzle beneath this tip is lubricated with petrolatum.
2. Next, insert the nozzle into the rectum with gentle pressure while the tip is pointing toward the navel. Should insertion cause pain, the procedure should be halted. Also, if insertion is difficult, the enema should not be given.
3. When the nozzle is comfortably and fully inserted, the patient should begin to empty the enema container. Better results are obtained if most of the solution is given. To best accomplish this, the bottle can be squeezed from the bottom to the top, being rolled up like a toothpaste tube. This minimizes the medication in the lower part of the container. The bottle is designed to contain more than the effective dose, so that some fluid will be left in the bottle with normal use.
Onset of Action
A major error in use of enemas is to attempt to evacuate the bowels immediately, once the enema has been given. With products containing monobasic and dibasic sodium phosphate, some time must elapse before the product is effective. During this time, the enema is drawing fluid into the lower bowel to liquefy the stool and ease elimination. Attempting to defecate too rapidly only evacuates the enema solution. Therefore, the manufacturers recommend that the patient wait at least 2-5 minutes until lower abdominal cramping is definitely present, although it may take as long as 15 minutes to acheive such action.
The sodium phosphate enemas are available in adult and pediatric sizes. Neither one should be given to children under 2 years old.
They should not be used in patients with kidney disease.
Do not attempt to create a homemade enema. Tap water, hydrogen peroxide and soapsuds enemas have been found to cause rectal bleeding, severe injury and death. Even though pharmacies often sell enema bulbs, they should not be used unless suggested by a physician.
Never use an enema if abdominal pain is present.