The Procedural Work For an Enema

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Inpatient guide

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- Enema

An enema is the introduction of liquid or gas into the rectum to empty the intestines, either for diagnostic purposes or to administer medication. It is often used when dealing with troublesome constipation, helping to remove toxins and waste from the rectum. It is beneficial for managing severe constipation and for certain cancer treatments through specific food solutions, including the use of coffee enemas (National Cancer Institute).
Enemas are often considered a type of laxative, and there are many different types. They typically stimulate the rectal muscles, leading to the expulsion of waste.
An enema consists of a tube and a flexible rubber bulb, which may contain medication that is gently inserted into the rectum. When the rubber bulb is squeezed, the liquid and medication are pushed into the rectum, where they begin to work.
Enemas used for absorbing solutions are typically administered with antibiotics or seizure medications when oral administration is not possible, as the rectum can absorb liquids and nutrients more effectively than suppositories. They are also useful in cases of dehydration caused by vomiting, or when intravenous fluids cannot be administered.
While enemas can be used to treat certain medical conditions, regular use can be risky and may lead to serious health problems. Therefore, they should only be used for medical purposes.
There are several types of enemas, and they vary based on their content. Some enemas may contain a solution of oil or a laxative, while others may contain gas.

- Types of Enemas

1. Cleansing Enema:
   Used to help empty the colon and rectum using water or saline.
2. Retention Enema:
   Used to help treat inflammatory bowel disease or to deliver medication directly to the colon using a solution of drugs like hydrocortisone. It is designed to remain in the colon for an extended period.
3. Oil Enema:
   Used to relieve constipation by using a solution of mineral oil or olive oil.
4. Carminative Enemas:
   Used to relieve gas and bloating in the colon using a solution of warm water and mild soap.
5. Barium Enema:
   Used to help diagnose colon and rectum conditions, such as tumors or polyps, using a barium sulfate solution. This solution coats the colon lining and allows for X-ray imaging.

- Indications for Using an Enema

• Colonoscopy: A colonoscopy is performed to visualize the inside of the colon for medical examination purposes. The intestines must be empty before performing a colonoscopy.
• Preparation for Surgery: Enemas are used to empty the intestines before undergoing colon or bowel surgery.
• Treatment of Constipation: Enemas can help treat severe constipation.
• Cancer Screening: A barium enema helps detect colon and intestinal cancer. In such cases, two enemas are used: one to empty the intestines and another containing barium to clearly outline the intestines during X-ray imaging.
• Hepatic Coma (Liver Coma): An enema may be used in the management of hepatic coma.

- Tools Used During Enema Administration

• Enema device
• Enema solution as per doctor's instructions, at an appropriate temperature (43°C for adults)
• Latex gloves – Personal protective equipment
• Medical gel to facilitate catheter insertion
• Solution holder – Blanket
• Protective plastic sheet
• Dressing and gauze

How to Use an Enema and Nursing Care During Enema Administration:

The enema is in the form of a bag or container connected to a tube or nozzle. The bag contains a liquid or gas that is pumped into the rectum by applying pressure to the bag. The enema can be safely used by following these instructions:

• Ensure the doctor’s order for the enema and prepare the necessary equipment.
• Explain the procedure and its purpose to the patient.
• Assess the anal area for any tears, wounds, or ulcers.
• Wash hands and wear personal protective equipment.
• Gather the tools on the patient’s table in an easily accessible location.
• Ensure the patient is in a comfortable position, such as lying on their left side with their knees bent.
• Close the curtains and door to maintain the patient’s privacy.
• Choose a suitable location that provides enough space to lie down, with the bathroom being the most appropriate place for the enema.
• Remove the lower clothing of the patient.
• Spread a towel in a suitable place for the patient to lie down, ensuring they lie on their left side.
• Bend the knees toward the chest.
• Adjust the bed to an appropriate height and stand on the patient’s left side. Expose the anal area and cover the patient with a blanket, placing a protective plastic sheet underneath them.
• Monitor vital signs, particularly blood pressure, before starting the enema. Do not proceed with the enema if the blood pressure is lower than 60/90.
• Remove the cap from the enema nozzle.
• Apply medical gel to the tip of the tube to ease insertion.
• Administer the enema solution slowly, using a lubricated tube.

 

• Insert the enema nozzle into the rectum slowly and gently to a depth of 7–10 cm.
• Squeeze the liquid from the enema bag slowly until the bag is emptied completely.
• Remove the enema nozzle from the rectum gently.
• Wait for the enema to take effect, i.e., when the patient feels the urge to defecate.
• Ask the patient to hold the solution for the recommended duration, usually from 30 minutes to an hour.
• Encourage the patient to lie on their left side during the retention period to help ensure the solution reaches the target area.
• Monitor the patient for any negative reactions or side effects from the medication.
• Advise the patient to drink plenty of fluids to help soften the stool and promote bowel movement in the case of an oil enema.
• Monitor the GCS (Glasgow Coma Scale) to assess the patient’s level of consciousness.
• If the patient needs to defecate, direct them to the toilet to empty their bowels or place a bedpan under the patient.
• Record the amount and type of solution used, as well as the quantity and color of the stool. Assess the anal area for any bleeding or inflammation.

- Benefits of Enemas

            Enemas are used to prepare a patient for certain medical procedures or to treat specific medical conditions. However, there is no scientific evidence to suggest that enemas generally benefit health.

Some types of medication can be administered through an enema. These medications can help treat health problems affecting the colon, such as inflammatory bowel disease. Additionally, the network of blood vessels in the rectum can help quickly deliver medications into the body.

- Risks of Enemas

Regular use of enemas to detoxify the body can be harmful. Introducing substances like oils through the rectum may introduce harmful bacteria into the body. Potential risks associated with enemas include:

- Contraindications for Medicinal Enemas

• Kidney diseases.
• Heart congestion.
• Gastric or intestinal obstruction.
• Enlarged colon, ileus, or intestinal inflammation.
• Dehydration.
• Pregnant or breastfeeding women should consult a doctor before using medicinal enemas.

- References

Internal Department Operational Guide 2017