An
enema (ˈɛnəmə; plural
enemata or
enemas) is the procedure of introducing liquids into the
rectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
and
colonThe colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
via the
anusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful
peristalsisPeristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar...
, a feeling of extreme urgency and complete evacuation of the lower intestinal tract. An enema has the advantage over any laxative in its speed and certainty of action, and some people prefer it for this reason.
Enemas can be carried out as treatment for medical conditions, such as
constipationConstipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
and
encopresisEncopresis is involuntary fecal soiling in adults and children who have usually already been toilet trained. Persons with encopresis often leak stool into their undergarments.-Prevalence:The estimated prevalence of encopresis in four-year-olds is between one and three percent...
, and as part of some alternative health therapies. They are also used to administer certain medical or recreational
drugA drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...
s. Enemas have been used for rehydration therapy (proctoclysis) in patients for whom
intravenous therapyIntravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
is not applicable.
History
Enema comes from
GreekAncient Greek is the stage of the Greek language in the periods spanning the times c. 9th–6th centuries BC, , c. 5th–4th centuries BC , and the c. 3rd century BC – 6th century AD of ancient Greece and the ancient world; being predated in the 2nd millennium BC by Mycenaean Greek...
ἔνεμα (
énema), from ἐνίημι (
eníēmi), "(I) inject".
Clyster, also spelled
glister in the 17th century, comes from Greek κλυστήρ (
klystḗr), from κλύζω (
klýzo), "(I) wash". It is an archaic word for enema, more particularly for enemas administered using a
clyster syringe – that is, a
syringeA syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
with a rectal nozzle and a plunger rather than a bulb. Clyster syringes were used from the 17th century (or before) to the 19th century, when they were largely replaced by enema bulb syringes, bocks, and bags.
The patient was placed in an appropriate position (kneeling, with the buttocks raised, or lying on the side); a servant or
apothecaryApothecary is a historical name for a medical professional who formulates and dispenses materia medica to physicians, surgeons and patients — a role now served by a pharmacist and some caregivers....
would then insert the nozzle into the
anusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
and depress the plunger, resulting in the liquid remedy (generally,
waterWater is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...
, but also some preparations) being injected into the
colonThe colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
.
Because of the embarrassment a woman might feel when showing her buttocks (and possibly her genitals, depending on the position) to a male apothecary, some contraptions were invented that blocked all from the apothecary's view except for the anal area. Another invention was syringes equipped with a special bent nozzle, which enabled self-administration, thereby eliminating the embarrassment.
Clysters were administered for symptoms of
constipationConstipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
and, with more questionable effectiveness, stomach aches and other illnesses. In his early-modern treatise,
The Diseases of Women with Child, François MauriceauFrançois Mauriceau was a French obstetrician from Paris. He received his training in obstetrics at the Hôtel-Dieu.Mauriceau was a leading obstetrician in 17th century Europe...
records that both midwives and man-midwives commonly administered clysters to labouring mothers just prior to their delivery.
In Roper's biography of his father-in-law Sir Thomas More, he tells of Thomas More's eldest daughter falling sick of the sweating sickness. She could not be awakened by doctors. After praying, it came to Thomas More "There straightway it came into his mind that a clyster would be the one way to help her, which when he told the physicians, they at once confessed that if there were any hope of health, it was the very best help indeed, much marveling among themselves that they had not afore remembered it." —
Utopia, Thomas MoreUtopia is a work of fiction by Thomas More published in 1516...
.
Clysters were a favourite medical treatment in the
bourgeoisieIn sociology and political science, bourgeoisie describes a range of groups across history. In the Western world, between the late 18th century and the present day, the bourgeoisie is a social class "characterized by their ownership of capital and their related culture." A member of the...
and
nobilityNobility is a social class which possesses more acknowledged privileges or eminence than members of most other classes in a society, membership therein typically being hereditary. The privileges associated with nobility may constitute substantial advantages over or relative to non-nobles, or may be...
of the
Western worldThe Western world, also known as the West and the Occident , is a term referring to the countries of Western Europe , the countries of the Americas, as well all countries of Northern and Central Europe, Australia and New Zealand...
up to the 19th century. As medical knowledge was fairly limited at the time, purgative clysters were used for a wide variety of ailments, the foremost of which were stomach aches and constipation.
MolièreJean-Baptiste Poquelin, known by his stage name Molière, was a French playwright and actor who is considered to be one of the greatest masters of comedy in Western literature...
, in several of his plays, introduces characters of incompetent
physicianA physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s and
apothecariesApothecary is a historical name for a medical professional who formulates and dispenses materia medica to physicians, surgeons and patients — a role now served by a pharmacist and some caregivers....
fond of prescribing this remedy, also discussed by Argan, the hypochondriac patient of
Le Malade ImaginaireThe Imaginary Invalid is a three-act comédie-ballet by the French playwright Molière. It was first performed in 1673 and was the last work he wrote. In an ironic twist of fate, Molière collapsed during his fourth performance as Argan on 17 February and died soon after...
. More generally, clysters were a theme in the
burlesqueBurlesque is a literary, dramatic or musical work intended to cause laughter by caricaturing the manner or spirit of serious works, or by ludicrous treatment of their subjects...
comedies of that time.
According to
Claude de Rouvroy, duc de Saint-SimonClaude de Rouvroy, duc de Saint-Simon , French courtier, was the second son of Louis de Rouvroy, seigneur du Plessis , who had been a warm supporter of Henry of Guise and the Catholic League....
, clysters were so popular at the court of King
Louis XIVLouis XIV , known as Louis the Great or the Sun King , was a Bourbon monarch who ruled as King of France and Navarre. His reign, from 1643 to his death in 1715, began at the age of four and lasted seventy-two years, three months, and eighteen days...
of
FranceThe French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
that the duchess of
BurgundyThe Duchy of Burgundy , was heir to an ancient and prestigious reputation and a large division of the lands of the Second Kingdom of Burgundy and in its own right was one of the geographically larger ducal territories in the emergence of Early Modern Europe from Medieval Europe.Even in that...
had her servant give her a clyster in front of the King (her
modestyStandards of modesty are aspects of the culture of a country or people, at a given point in time, and is a measure against which an individual in society may be judged....
being preserved by an adequate posture) before going to the
comedyComedy , as a popular meaning, is any humorous discourse or work generally intended to amuse by creating laughter, especially in television, film, and stand-up comedy. This must be carefully distinguished from its academic definition, namely the comic theatre, whose Western origins are found in...
. However, he also mentions the astonishment of the King and Mme de Maintenon that she should take it before them.
Medical usage
The main medical usages of enemas are:
- As a bowel stimulant, not unlike a laxative
Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under...
– the main difference being that laxatives are commonly thought of as orally administered while enemas are administered directly into the rectum, and thereafter, into the colon. When the enema injection into the rectum is complete, and after a set "holding time", the patient expels fecesFeces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
along with the enema in the bedpanA bedpan or bed pan is an object used for the toileting of a bedridden patient in a health care facility, usually made of a metal, glass, or plastic receptacle. A bed pan can be used for both urinary and fecal discharge. Many diseases can confine a patient to bed, necessitating the use of bedpans,...
or toiletA toilet is a sanitation fixture used primarily for the disposal of human excrement, often found in a small room referred to as a toilet/bathroom/lavatory...
.
- Enemas may also be used to relieve constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
and fecal impactionA fecal impaction is a solid, immobile bulk of human feces that can develop in the rectum as a result of chronic constipation.-Symptoms:Symptoms include chronic constipation. There can be fecal incontinence and paradoxical or overflow diarrhea as liquid stool passes around the obstruction. ...
, although in the U.S.A. and some other parts of the world, their use has been replaced in most professional health-care settings by oral laxatives and laxative suppositoriesA suppository is a drug delivery system that is inserted into the rectum , vagina or urethra , where it dissolves.They are used to deliver both systemically-acting and locally-acting medications....
. In-home use of enemas for constipation and alternative health purposes is somewhat harder to measure.
- Bowel stimulating enemas usually consist of water, which works primarily as a mechanical stimulant, or they may be made up of water with baking soda (sodium bicarbonate
Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula Na HCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda . The natural mineral form is...
) or water with a mild hand soap dissolved in it; bufferedA buffer solution is an aqueous solution consisting of a mixture of a weak acid and its conjugate base or a weak base and its conjugate acid. It has the property that the pH of the solution changes very little when a small amount of strong acid or base is added to it. Buffer solutions are used as a...
sodium phosphate solution, which draws additional water from the bloodstream into the colon and increases the effectiveness of the enema – which often can be rather irritating to the colon, causing intense cramping or "griping" – or mineral oilA mineral oil is any of various colorless, odorless, light mixtures of alkanes in the C15 to C40 range from a non-vegetable source, particularly a distillate of petroleum....
, which functions as a lubricant and stool softener, but which often has the side effect of sporadic seepage from the patient's anus which can soil the patient's undergarments for up to 24 hours. Other types of enema solutions are also used, including equal parts of milk and molasses heated together to slightly above normal body temperature. In the past, castile soapCastile soap is a name used in English-speaking countries for olive oil based soap made in a style similar to that originating in the Castile region of Spain.-History:...
was a common additive in an enema, but it has largely fallen out of use because of its irritating action in the rectum and because of the risk of chemical colitisChemical colitis is a type of colitis, an inflammation of the large intestine or colon, caused by the introduction of harsh chemicals to the colon by an enema or other procedure. Chemical colitis can resemble ulcerative colitis, infectious colitis and pseudomembranous colitis endoscopically.Prior...
as well as the ready availability of other enema preparations that are perhaps more effective than soap in stimulating a bowel movement. At the opposite end of the spectrum, an isotonicThe term isotonic may refer to;*Isotonic for the term associated with muscle contraction*An isotone in nuclear physics*Sports drinks are sometimes designed in an isotonic way to assist athletes rehydrate while balancing electrolytes...
salineIn medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...
solution is least irritating to the rectum and colon, having a neutral concentration gradient. This neither draws electrolyteIn chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s from the body – as can happen with plain water – nor draws water into the colon, as will occur with phosphates. Thus, a salt water solution can be used when a longer period of retention is desired, such as to soften an impaction.
- Cleansing the lower bowel prior to a surgical procedure such as sigmoidoscopy
Sigmoidoscopy From Greek Sigma - eidos - scopy, to look inside an s-like object, is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. There are two types of sigmoidoscopy, flexible sigmoidoscopy, which uses a flexible endoscope,...
or colonoscopyColonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
. Because of speed and supposed convenience, enemas used for this purpose are commonly the more costly, sodium phosphate variety – often called a disposable enema. A more pleasant experience preparing for testing procedures can usually be obtained with gently-administered baking soda enemas; cleansing the lower bowel for colonoscopy and other bowel studies can be effectively achieved with water-based, or water with baking soda, enema administration.
- The administration of substances into the bloodstream. This may be done in situations where it is undesirable or impossible to deliver a medication by mouth, such as antiemetic
An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer....
s given to reduce nauseaNausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
(though not many antiemetics are delivered by enema). Additionally, several anti-angiogenic agents, which work better without digestion, can be safely administered via a gentle enema. Medicines for cancer, for arthritis, and for age-related macular degeneration are often given via enema in order to avoid the normally-functioning digestive tract. Interestingly, some water-based enemas are also used as a relieving agent for irritable bowel syndrome, using cayenne pepper to squelch irritation in the colon and rectal area. Finally, an enema may also be used for hydration purposes. See also route of administrationA route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison, or other substance is taken into the body.-Classification:Routes of administration are usually classified by application location...
.
- Emergency blood expansion. Emergency pre-hospital treatment of haemorrhage requires immediate fluid replacement therapy. In mass casualty, remote or rural settings, the lack of sterile fluids, intravenous equipment or the knowledge to use them might limit the treatment options available. In such situations proctoclysis remains an easy and effective way to provide fluid replacement. It does not require sterile fluids, special equipment or complex training, and it is useful when alternative routes are not readily available.
- The topical administration of medications into the rectum, such as corticosteroids and mesalazine
Mesalazine , also known as Mesalamine or 5-aminosalicylic acid , is an anti-inflammatory drug used to treat inflammation of the digestive tract ulcerative colitis and mild-to-moderate Crohn's disease...
used in the treatment of inflammatory bowel diseaseIn medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
. Administration by enema avoids having the medication pass through the entire gastrointestinal tractThe human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
, therefore simplifying the delivery of the medication to the affected area and limiting the amount that is absorbed into the bloodstream.
- General anesthetic agents for surgical purposes are sometimes administered by way of an enema. Occasionally, anesthetic agents are used rectally to reduce medically-induced vomiting during and after surgical procedures, in an attempt to avoid aspiration of stomach contents.
- A barium enema
A lower gastrointestinal series, also called a barium enema, is a medical procedure used to examine and diagnose problems with the human colon . X-ray pictures are taken while barium sulfate fills the colon via the rectum.-Procedure:...
is used as a contrast substance in the radiological imaging of the bowel. The enema may contain barium sulfate powder, or a water-soluble contrast agent. Barium enemas are sometimes the only practical way to "view" the colon in a relatively safe manner. Following barium enema administration, patients often find that flushing the remaining barium with additional water, baking soda, or saline enemas helps restore normal colon activity without complications of constipation from the administration of the barium sulfate.
In certain countries, such as the
United StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
, customary enema usage went well into the 20th century; it was thought a good idea to cleanse the bowel in case of
feverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
; also, pregnant women were given enemas prior to
laborChildbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
, supposedly to reduce the risk of
fecesFeces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
being passed during contractions. Under some controversial discussion, pre-delivery enemas were also given to women to speed delivery by inducing contractions. This latter usage has since been largely abandoned, because obstetricians now commonly give pitocin to induce labor and because women generally found the procedure unpleasant.
Now obsolete, the
tobacco smoke enemaThe tobacco smoke enema, an insufflation of tobacco smoke into the rectum by enema, was a medical treatment employed by European physicians for a range of ailments....
was the principal medical method for resuscitating victims of
drowningDrowning is death from asphyxia due to suffocation caused by water entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia....
during the 18th century.
Home usage
Many self-given enemas used at home are the pre-packaged, disposable, sodium phosphate solutions in single-use bottles sold under a variety of brand names, or in generic formats. These units come with a pre-lubricated nozzle attached to the top of the container. Some enemas are administered using so-called disposable bags connected to disposable tubing (despite the names, such units can commonly be used for many months or years without significant deterioration).
Patients who want easier, more gently-accepted enemas often purchase combination enema syringes which are commonly referred to as "closed top" syringes, and which can also be used as old-fashioned
hot water bottleA hot water bottle is a container filled with hot water and sealed with a stopper, used to provide warmth, typically whilst in bed, but also for the application of heat to a specific part of the body....
s, so as to relieve aches and pains via gentle heat administrations to parts of the body. Cost for each enema can be as little as the cost of baking soda added to ordinary tap water.
In Asian countries, particularly in Japan, commercially available disposable enemas typically contain glycerin (at concentrations varying from 30-50%) or sodium chloride. They are not pre-lubricated and the amount of liquid contained in them may vary, although most contain about 20-40ml of diluted glycerin.
In medical or hospital environments, reusable enema equipment is now rare because of the expense of disinfecting a water-based solution. For a single-patient stay of short duration, an inexpensive disposable enema bag can be used for several days or weeks, using a simple rinse out procedure after each enema administration. The difficulty comes from the longer time period (and expense) required of nursing aides to give a gentle, water-based enema to a patient, as compared to the very few minutes it takes the same nursing aide to give the more irritating, cold, pre-packaged sodium phosphate unit.
For home use, disposable enema bottle units are common, but reusable
rubberNatural rubber, also called India rubber or caoutchouc, is an elastomer that was originally derived from latex, a milky colloid produced by some plants. The plants would be ‘tapped’, that is, an incision made into the bark of the tree and the sticky, milk colored latex sap collected and refined...
or
vinylA vinyl compound is any organic compound that contains a vinyl group ,which are derivatives of ethene, CH2=CH2, with one hydrogen atom replaced with some other group...
bags or enema bulbs may also be used. In former times, enemas were infrequently administered using clyster syringes. If such commercially-available items are not at hand, ordinary water bottles are sometimes used.
Alternative medicine
The term "colonic irrigation" is commonly used in
gastroenterologyGastroenterology is the branch of medicine whereby the digestive system and its disorders are studied. The name is a combination of three Ancient Greek words gaster , enteron , and logos...
to refer to the practice of introducing water through a colostomy or a surgically constructed conduit as a treatment for
constipationConstipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
. The
Food and Drug AdministrationThe Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
has ruled that colonic irrigation equipment is not approved for sale for the purpose of general well-being and has taken action against many distributors of this equipment, including a
Warning LetterThe United States Food and Drug Adminstration defines a Warning Letter as "...a correspondence that notifies regulated industry about violations that FDA has documented during its inspections or investigations...
. The use of enemas for reasons other than the relief of constipation is currently regulated in some parts of the
United StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
while practitioners in other states may go through a voluntary
certificationProfessional certification, trade certification, or professional designation, often called simply certification or qualification, is a designation earned by a person to assure qualification to perform a job or task...
process.
Colon cleansing
The same term is also used in
alternative medicineAlternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
where it may involve the use of substances mixed with water in order to detoxify the body. Practitioners believe the accumulation of fecal matter in the
large intestineThe large intestine is the third-to-last part of the digestive system — — in vertebrate animals. Its function is to absorb water from the remaining indigestible food matter, and then to pass useless waste material from the body...
leads to ill health. This resurrects the old medical concept of
autointoxication which was orthodox doctrine up to the end of the 19th century but which has now been discredited.
Coffee enemas
In the controversial Gerson therapy,
coffee enemaCoffee enemas are the enema-related procedure of inserting coffee into the anus to cleanse the rectum and large intestines. This procedure, although well documented, is considered by most medical authorities to be unproven, rash and potentially dangerous....
s are administered. These enemas are known to have caused three deaths in the United States.
Rectal drug administration
An enema might be used to clean the colon of
fecesFeces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
first to help increase the rate of absorption in rectal administration of dissolved drugs, including alcohol.
Enemas have also been used for ritual rectal drug administration such as
balchéBalché is a mildly intoxicating beverage common among ancient and indigenous cultures in areas of what is now Mexico and upper Central America. Today the drink is still common among the Yucatec Maya, and is made from the bark of a leguminous tree , which is soaked in honey and water, and fermented...
,
alcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
,
tobaccoTobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
,
peyoteLophophora williamsii , better known by its common name Peyote , is a small, spineless cactus with psychoactive alkaloids, particularly mescaline.It is native to southwestern Texas and Mexico...
, and other
hallucinogenic drugThis general group of pharmacological agents can be divided into three broad categories: psychedelics, dissociatives, and deliriants. These classes of psychoactive drugs have in common that they can cause subjective changes in perception, thought, emotion and consciousness...
s and
entheogenAn entheogen , in the strict sense, is a psychoactive substance used in a religious, shamanic, or spiritual context. Historically, entheogens were mostly derived from plant sources and have been used in a variety of traditional religious contexts...
s, most notably by the
MayansThe Maya is a Mesoamerican civilization, noted for the only known fully developed written language of the pre-Columbian Americas, as well as for its art, architecture, and mathematical and astronomical systems. Initially established during the Pre-Classic period The Maya is a Mesoamerican...
and also some other
AmericaThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
n
IndianThe indigenous peoples of the Americas are the pre-Columbian inhabitants of North and South America, their descendants and other ethnic groups who are identified with those peoples. Indigenous peoples are known in Canada as Aboriginal peoples, and in the United States as Native Americans...
tribes. Some tribes continue the practice in the present day.
People who wish to become intoxicated faster have also been known to use enemas as a method to instill alcohol into the bloodstream, absorbed through the membranes of the
colonThe colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
. However, great care must be taken as to the amount of alcohol used. Only a small amount is needed as the intestine absorbs the alcohol more quickly than the stomach. Deaths have resulted due to alcohol poisoning via enema.
Recreational usage
The
paraphiliaParaphilia is a biomedical term used to describe sexual arousal to objects, situations, or individuals that are not part of normative stimulation and that may cause distress or serious problems for the paraphiliac or persons associated with him or her...
directed towards enemas is known as
klismaphiliaThe term Klismaphilia refers to the receiving of sexual arousal from introducing liquids into the rectum and colon via the anus. This paraphilia often involves the use of enemas. The term klismaphilia was coined in 1973 by Dr...
, the enjoyment of enemas.
Enemas may be used as part of
BDSMBDSM is an erotic preference and a form of sexual expression involving the consensual use of restraint, intense sensory stimulation, and fantasy power role-play. The compound acronym BDSM is derived from the terms bondage and discipline , dominance and submission , and sadism and masochism...
activities, or as a regular sexual activity for an individual or between partners. Enemas can be pleasurable to either sex, and in males, enemas can stimulate the
prostateThe prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
gland. Unexpected
erectionPenile erection is a physiological phenomenon where the penis becomes enlarged and firm. Penile erection is the result of a complex interaction of psychological, neural, vascular and endocrine factors, and is usually, though not exclusively, associated with sexual arousal...
s are common in medical settings, even if the person would otherwise consider it an unpleasant procedure.
An enema may also be used prior to
anal sexAnal sex is the sex act in which the penis is inserted into the anus of a sexual partner. The term can also include other sexual acts involving the anus, including pegging, anilingus , fingering, and object insertion.Common misconception describes anal sex as practiced almost exclusively by gay men...
or anilingus in order to enhance the sensation of intercourse, or to remove
fecesFeces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
prior to sex, possibly reducing bacterial transmission and risk of infection, or just to reduce the possibility of fecal material or detritus from sexual activity adhering to the genitals or sex toys used during the subsequent activity. Enemas used for anal sex should not be used consistently and enema bottle contents should be removed and replaced with simple luke-warm water. Continual usage of enema solution may be harmful for the anal cavity.
Punitive usage
Antagonistic factions in unstable nations have often forcibly applied enemas as a means of punishment. In the vastly influential Latin American text
Facundo, or Civilization and BarbarismFacundo: Civilization and Barbarism is a book written in 1845 by Domingo Faustino Sarmiento, a writer and journalist who became the seventh president of Argentina...
, for example,
Domingo Faustino SarmientoDomingo Faustino Sarmiento was an Argentine activist, intellectual, writer, statesman and the seventh President of Argentina. His writing spanned a wide range of genres and topics, from journalism to autobiography, to political philosophy and history...
describes the use of
pepperChili pepper is the fruit of plants from the genus Capsicum, members of the nightshade family, Solanaceae. The term in British English and in Australia, New Zealand, India, Malaysia and other Asian countries is just chilli without pepper.Chili peppers originated in the Americas...
and
turpentineTurpentine is a fluid obtained by the distillation of resin obtained from trees, mainly pine trees. It is composed of terpenes, mainly the monoterpenes alpha-pinene and beta-pinene...
enemas by police forces as a way of discouraging political dissent in post-independence Argentina.
Precautions
Improper administration of an enema may cause electrolyte imbalance (with repeated enemas) or ruptures to the bowel or
rectalThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
tissues resulting in internal
bleedingBleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
. However, these occurrences are rare in healthy,
soberSobriety is the condition of not having any measurable levels, or effects from, alcohol or other drugs that alter ones mood or behaviors. According to WHO "Lexicon of alcohol and drug terms..." sobriety is continued abstinence from alcohol and psychoactive drug use...
adults. Internal bleeding or rupture may leave the individual exposed to infections from intestinal bacteria. Blood resulting from tears in the colon may not always be visible, but can be distinguished if the feces are unusually dark or have a red hue. If intestinal rupture is suspected, medical assistance should be obtained immediately.
The enema tube and solution may stimulate the
vagus nerveThe vagus nerve , also called pneumogastric nerve or cranial nerve X, is the tenth of twelve paired cranial nerves...
, which may trigger an arrhythmia such as
bradycardiaBradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...
. Enemas should not be used if there is an undiagnosed
abdominal painAbdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
since the
peristalsisPeristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar...
of the bowel can cause an inflamed
appendixThe appendix is a blind-ended tube connected to the cecum , from which it develops embryologically. The cecum is a pouchlike structure of the colon...
to rupture.
Colonic irrigation should not be used in people with
diverticulitisDiverticulitis is a common digestive disease particularly found in the large intestine. Diverticulitis develops from diverticulosis, which involves the formation of pouches on the outside of the colon...
,
ulcerative colitisUlcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset...
,
Crohn's diseaseCrohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...
, severe or internal hemorrhoids or tumors in the
rectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
or
colonThe colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
. It also should not be used soon after bowel
surgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
(unless directed by one's
health care providerA health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
). Regular treatments should be avoided by people with
heart diseaseHeart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
or
renal failureRenal failure or kidney failure describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood...
. Colonics are inappropriate for people with bowel, rectal or anal
pathologiesA disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
where the pathology contributes to the risk of bowel perforation.
Recent research has shown that ozone water, which is sometimes used in enemas, can immediately cause
microscopic colitisMicroscopic colitis refers to two medical conditions which cause diarrhea: collagenous colitis and lymphocytic colitis. Both conditions are characterised by the following triad of clinicopathological features:# Chronic watery diarrhoea;# Normal colonoscopy;...
.