What Is an Enema and How Does It Work

An enema delivers liquid through a nozzle and into the anus and rectum. It’s often used to treat constipation, and the ingredients may include salt water, mineral oil, and laxative elements.

Enema Administration

An enema is a technique used to stimulate stool evacuation, usually to relieve constipation. How it’s done depends on the type of enema and whether you can do it at home or at the hospital.

The enema process helps push waste out of the rectum when you cannot do so alone. Enemas are available for purchase at pharmacies for home use, but you should ask a doctor or nurse for specific instructions to avoid injury.

Other types of enemas are administered to clean out the colon and better detect colon cancer and polyps. If you have concerns or worsening symptoms after an enema, ask a doctor right away.

Constipation is a common gastrointestinal condition. It occurs when the colon is unable to remove waste through the rectum. People with this condition have three or fewer bowel movements over a seven-day period. Mild constipation often occurs when you don’t eat enough fiber or drink enough water on a regular basis. Daily exercise also helps to prevent constipation.

An enema administration is most commonly used to clean the lower bowel. However, this is normally the last resort for constipation treatment. If diet and exercise are not enough to keep you regular, your doctor might recommend a laxative before trying an enema. In some cases, laxatives are used the night before an enema administration to encourage waste flow.

Patients, too, are unhappy with the care they receive during those brief interactions with their doctors. Healthcare communications company West Corporation reported that 25% of patients don’t feel that their provider cares about them as an individual and nearly 20% aren’t convinced their doctor is focused on improving their health – even though 93% of doctors strongly agree that patient satisfaction is important.

Enemas may also be used before medical examinations of the colon. Your doctor may order an enema prior to an X-ray of the colon to detect polyps so that they can get a clearer picture. This procedure may also be done prior to a colonoscopy.

There are several common types of enemas.

The purpose of a cleansing enema is to gently flush out the colon. It may be recommended prior to a colonoscopy or other medical examination. Constipation, fatigue, headaches, and backaches may be relieved by a cleansing enema. During a cleansing enema, a water-based solution with a small concentration of stool softener, baking soda, or apple cider vinegar is used to stimulate the movement of the large intestine. A cleansing enema should stimulate the bowels to quickly expel both the solution and any impacted fecal matter.

A retention enema also stimulates the bowels, but the solution that is used is intended to be “held” in the body for 15 minutes or more.

You may be asked to fast or follow special dietary instructions in the days prior to having an enema. Instructions may vary, depending on your doctor and your personal health needs.

If you plan to administer an enema at home, make sure that all of the equipment you are using has been sterilized and that you have a lubricant on hand. Pay careful attention to the way that you prepare the enema solution. You may have to mix it yourself with medicinal components.

To lessen the pressure felt in your colon, empty your bladder before you begin the enema. You may also want to place a towel or cloth down in the area between your bathtub and your toilet, in case fluid leaks out of your bowels when you get up to empty your colon. It’s important to measure and mark your enema tube the first time you use it so that you do not insert the tube more than 4 inches into your rectum.

At a medical office

If you are unfamiliar with enemas, you should consider having a medical professional administer one for you. They can also offer instructions for home kits that are available over the counter at pharmacies. Check with your doctor before use.

Some types of enemas are exclusively administered at medical offices. A barium enema, for example, uses a liquid compound that highlights certain areas of the gastrointestinal tract. This increases the amount of the tract that your doctor can see during an exam. Barium enemas are not used to treat constipation.

At home

Enemas can be administered in the comfort of your own home. This way can be less expensive, but you should ask your doctor for detailed instructions beforehand. Due to the delicate nature of the procedure, a loved one should help.

Enemas utilize a solution of salt water that is placed into a bag on one side of the tube. The other portion is lubed and placed directly into the rectum. In order for the solution to reach the colon properly, hug your knees to your chest while lying on your stomach or on your side. Here are the standard instructions:

1. Fill the enema bag with your desired solution, using warm water. Make sure the clamp is shut. Hold the bag with the hose end down and open the clamp for a moment or so to get rid of any air bubbles, which you do not want to introduce into the colon.
2. Hang the bag alongside the bathtub so that you can access it while lying on your left side.
3. Lubricate the end of the tube to make insertion more comfortable before inserting the tube, no more than 4 inches into your rectum. Bear down and push the anus out as you insert the tube to make it more comfortable. Lie on your left side and pull your knees to your chest.
4. Wait for the fluid to enter your rectum, breathing deeply and watching the bag until it is empty.
5. Remove the nozzle from your rectum slowly.
6. You will probably feel the urge to use the bathroom (“evacuate”) immediately. If you are doing a cleansing enema, carefully stand up and move to the toilet. If you goal is retention, follow the instructions of your desired enema.

Once all of the solution is emptied into the colon, a bowel movement is expected within the hour. If you fail to expel any waste, call your doctor. You may be ordered to perform the procedure at a later time. Successful administrations result in the expulsion of waste from the rectum.

There are plenty of holistic and nontraditional advocates for enemas as a beneficial method for internal cleansing. For Western medicine at large, the verdict is still out on whether regularly administered home enemas have proven benefits. Not much conclusive research has been done into their long-term health benefits. The occasional use of enemas for “colon irrigation” and relief of constipation will most likely not harm you, as long as your equipment is sterile and you follow directions carefully. But keep in mind that administering enemas has risks.

When conducted properly following a doctor’s instructions, enema administrations are generally considered safe. A barium enema can cause waste to take on a white color for a few days afterward. This is the normal effect of barium and should clear up on its own. If you can’t produce waste, talk to your doctor about ways to loosen your stool.

Forcing an enema into the rectum can cause irritation and damage to surrounding tissue. Never force the tube into the rectum. If problems persist, try administration at a later time or call your doctor. Blood that is present in the stool after the enema may mean there is rectal damage or an underlying medical problem. Consult with a physician immediately regarding any rectal bleeding.

Your risks for enema-related complications are greater if you administer the tubes multiple times a day. The best course of action is to use the enema once a day, and around the same time every day, as directed by a doctor. This not only reduces side effects, but will also help to train your body to release waste regularly. If constipation continues for more than a few days, call your physician.

In extremely rare cases, the incorrect administration of an enema can cause an embolism (or blockage) to form. Pulmonary embolisms, which occur in the lungs, can be fatal. In other rare cases, an incorrectly administered barium enema can result in perforation of the rectum.

Older adults should avoid the over-the-counter “Fleet” enema, which contains sodium phosphate. A small study in JAMA Internal Medicine linked it to serious complications such as kidney failure.

Some people find that they have several additional bowel movements in the hours after an enema. For this reason, many plan to stay home for the rest of the day after an enema is administered. But for the most part, you may carry on with your regular routine after the enema process is complete.

What Is an Enema and How Does It Work?

Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.

Updated on June 01, 2022

Jay Yepuri, MD, MS, is a board-certified gastroenterologist and a practicing partner at Digestive Health Associates of Texas (DHAT).

Table of Contents
Table of Contents

An enema is the introduction of a liquid through the anus and into the large intestine. An enema may be given to treat constipation or to administer medication. It also may be used as part of the procedure to empty the contents of the bowel before a test, as with​ a colonoscopy prep.

Some practitioners offer enemas using liquids (like coffee) that are not recommended by healthcare providers. There is no evidence that using an enema for “detoxing,” or for reasons other than removing impacted stool, or cleaning the bowel before a test or procedure, has any health benefits whatsoever.

This article explains how enemas work, their benefits, and what to expect when using one.

Vladimir Sukhachev / Getty Images

How Are Enemas Used?

An enema purchased from a pharmacy has a nozzle on the end of a small bag or bottle. This container is filled with liquid—sometimes salt and water, sometimes mineral oil—that is injected into the body. The nozzle is inserted into the anus and the container is squeezed, sending the liquid out of the nozzle and into the last part of the colon, called the rectum .

The liquid is usually held in the rectum for an amount of time specified in the product instructions. It could be held until the urge to move the bowels comes on. In some cases, it might be suggested that the enema stay inside the body for a few minutes or longer.

When it’s time, the enema and the waste material that is in the rectum are released by sitting on the toilet and moving the bowels like usual.

Tips for Safe Use

• Read and following the directions on the “drug facts” label.
• Use the correct dose and dosing frequency.
• Refrain from using more than one dose of the product in 24 hours.
• Do not give an enema to a child younger than 2.

Liquids Used In Enemas

In some cases, the liquid used in an enema is just saltwater or water mixed with baking soda. Some enemas contain a laxative. The type of liquid may vary, depending on why the enema is used.

Check with your healthcare provider if you are unsure about which enema to use, and be sure they are aware of your enema use. Some common enema liquids include:

• Bisacodyl: Bisacodyl is a laxative that is frequently used in enemas, especially ones used in preparation for a procedure such as a colonoscopy.
• Mineral oil: Mineral oil is both a lubricant and a laxative. This makes it especially useful in enemas that are used to treat constipation, when the anus is sore, or if hemorrhoids are present.
• Saline solution: In cases of constipation, a saltwater enema might be recommended. Health experts advise against making your own enema solution with tap water.

Medications

In the treatment of some conditions, including inflammatory bowel disease (IBD), medication might be given with an enema. Asacol and Rowasa ( mesalamine ) are used to treat ulcerative colitis. They are given in this way.

This treatment usually addresses inflammation that is found in the last section of the colon, where the enema liquid will reach. It’s often recommended that these enemas are used at night to give the medication time to work.

Other Substances

There are practitioners who offer enemas with substances that might surprise you, like coffee, lemon juice, and milk. The idea is to remove toxins from the body and fortify the liver and gallbladder.

People with IBD should be especially wary of these types of enemas. There is the potential to introduce harmful materials into the body with the use of a nonmedical enema. In addition, the colon contains various forms of beneficial bacteria, and the use of an enema may disrupt the bacterial flora and harm the delicate lining of the colon.

What to Expect

In most cases, using an enema is a straightforward process. People typically give enemas to themselves, although some people may need help if they have mobility or cognition issues.

Keep in mind that an enema takes time to work and keeps you in the bathroom for a bit. You’ll want to make sure you’ve set enough time aside for your enema.

Preparation

To perform an enema, first be sure that you have the right enema product and understand the instructions. You’ll also want to ensure that you have space to lie down, typically on the bathroom floor, and some towels.

Administration

The instructions for most anal enema products include the same series of steps. You’ll first apply a lubricant, such as petroleum jelly, to your anus to limit any discomfort and ensure the enema nozzle goes in smoothly. You’ll also take the cap off of the enema nozzle. Other steps include:

• Lying in the best position to reach around to your anus, typically on your side with one knee bent
• Gently inserting the enema nozzle into the anus and rectum, and squeezing all the fluid out
• Taking the enema nozzle back out and then holding the liquid in for the recommended amount of time
• Emptying your bowels in the toilet once the waiting time has passed

Precautions

Most people will not experience any difficulties with the enema procedure but there are a few things to avoid.

You don’t want to insert the enema nozzle too far up into your anus, causing pain. Be sure to use the enema exactly as instructed, because it’s possible for a part to become stuck, causing a foreign body obstruction.

It’s also important to use exactly the amount of fluid that’s called for in the instructions. If you use too little, the enema may not be effective. If you use too much, the enema may take longer to work because the fluid has reached higher into your colon.

Complications with enemas are rare but they can be serious. Among them are the risk of a perforation (puncture) in your intestines, or infection that leads to sepsis, a potentially life-threatening condition. Contact your healthcare provider right away if you have pain, fever, or other symptoms that don’t resolve on their own.

Benefits

Enemas are helpful for relieving discomfort and improving your ability to pass stool (poop). They’re safe for occasional use when treating constipation, IBD, or when you’re preparing for a procedure.

Keep in mind, though, that there’s little data to support the use of enemas when they’re touted as a method to deliver other health benefits.

People who try coffee, alcohol, hydrogen peroxide, or other fluids in an enema—sometimes after reading “recipes” from the Internet—often cause themselves injury and do more harm than good.

Risks

Many people use enemas safely and avoid complications or side effects, but there are a few things to watch out for.

People with certain health conditions should speak to their healthcare providers before using an enema product. They may be at higher risk for dehydration or related electrolyte imbalances, which can disrupt body functions that rely on these key minerals.

This is true of people with IBD, but also those with heart, kidney, and other health conditions. Some patients receiving cancer treatment that requires an enema ahead of surgery also may be at higher risk of complications. In other cases, frequent use of enemas to relieve constipation in people receiving chemotherapy may lead to concerns.

Keep in mind that even if you don’t have a known health condition, your use of enemas may be masking a more serious health issue that’s the cause of your constipation and related symptoms. Among them is colorectal cancer, which often causes constipation and other bowel habit changes.

Other possible risks include:

• Damage to the rectum or intestines due to bloating from the fluid
• Discomfort because of using fluids that are too cold or hot
• Infection if the enema equipment is not kept sterile

It’s worth trying other lifestyle changes, such as diet and exercise, instead of relying too much on enemas to improve your digestive health. Enemas are generally safe products, but there are more health risks from using enemas than there are with other constipation treatment options.

Summary

An enema delivers liquid through a nozzle and into the anus and rectum. It’s often used to treat constipation, and the ingredients may include salt water, mineral oil, and laxative elements.

If you’re using them under the care of a healthcare provider and for a defined purpose, like to prepare for a colonoscopy, then enemas can be helpful. It’s important that you only use enema products recommended by a professional, and avoid other uses without proven benefits.

A Word From Verywell

Enemas are safe, effective, and relatively easy to use if you follow the guidelines. Be sure to use an enema only as directed and follow the instructions for the specific product.

Frequently Asked Questions

How long does it take for an enema to work?

The answer will depend on what type of enema product you use. Some enemas will promote a bowel movement in just 15 minutes or less. Others, such as the bowel prep kits that contain bisacodyl, may take up to an hour before they begin to work. The specific instructions will give you an idea of what to expect.

What enema side effects in kids should I know about?

There are few side effects from the enema procedure itself. Most people report only some cramping and bloating, while others experience nausea, vomiting, dizziness, and other symptoms. These symptoms may be more of a concern in children who need enemas for treatment or prior to colonoscopy.

Is an enema the same thing as a colonic?

No. They’re both used to cleanse the colon, but for different reasons and with a focus on different parts of the colon. A colonic also may present health risks in the absence of evidence-based benefits.

12 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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Additional Reading

• Richter JM, Arshi NK, Oster G. Oral 5-aminosalicylate, mesalamine suppository, and mesalamine enema as initial therapy for ulcerative proctitis in clinical practice with quality of care implications. Can J Gastroenterol Hepatol. 2016;2016:6928710. doi:10.1155/2016/6928710.

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.