Enema Basics

 

         

 

 


Types of Enemas

Sodium Phosphate Enemas

Sodium Phosphate Enemas are used for:

Sodium phosphate enemas are a saline laxative enema.  It works by pulling water from the body into the bowel, which helps to soften the stool and cause a bowel movement.  It can be used for treating constipation or cleansing the bowel before certain medical procedures.  It may also be used for other conditions as determined by your doctor. 

Before using Sodium Phosphate Enemas:

Some medical conditions may interact with sodium phosphate.  Tell your doctor or pharmacist if you have any medical conditions, especially if you are pregnant or planning on getting pregnant, or breast feeding.  Let them know if you are taking any medicines, herbal preparations, or dietary supplements.  Some medicines may interact with sodium phosphate enemas, but no specific interactions are known at this time.

If you have allergies or on a sodium restricted diet or have a history of stomach or bowel problems, you should consult your doctor before taking sodium phosphate enemas.

Sodium phosphate enemas may be contraindicated if you have appendicitis, liver or kidney problems, high blood pressure, low parathyroid function, bone problems (eg, osteomalacia), muscle problems (eg, rhabdomyolysis), pancreas problems, a kidney or bladder infection, kidney stones, electrolyte problems (eg, low blood calcium), a colostomy, nausea, vomiting, stomach pain, or a sudden change in bowel movements lasting longer than 2 weeks

How to use Sodium Phosphates Enema:

Use Sodium Phosphate Enemas as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Remove the protective shield from the enema tip before inserting.  With steady pressure, gently insert the enema tip into the rectum with the tip pointing toward the navel.  Don't force it in.  Squeeze the bulb until all the liquid is gone.  Remove the tip hold the solution for 2 to 5 minutes until there is a strong urge to have a bowel movement.

How to administer a disposable phosphate enema.

Click to watch a demonstration


Coffee Enemas

Coffee 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.

History

While the idea of anal cleansing dates back to the Egyptians, the notion of caffeine as an enema-related substance is relatively new. It was conceived in 1917, and appeared in the Merck Manual until 1972. In 1920, German scientists investigated caffeine's effect on the bile duct and small intestines. Max Gerson proposed coffee enemas had a positive effect of the gastro-intestinal tract; Gerson said that coffee enemas had positive effects on patients with tuberculosis, and later even cancer. He claimed that unlike saline enemas, the caffeine traveled through the smooth muscle of the small intestine, and into the liver. This, he said, cleared even more of the gastro-intestinal tract and removed more toxins and bile than a normal enema. He told his patients often that the "coffee enemas are not given for the function of the intestines but for the stimulation of the liver."

Effects and dangers

Some proponents of alternative medicine have claimed that coffee enemas have an anti-cancer effect by "detoxifying" metabolic products of tumors. There is no medical scientific evidence to support any anti-cancer effect of coffee enemas. Coffee enemas can cause numerous side effects, including infections, sepsis (including campylobacter sepsis), severe electrolyte imbalance, colitis, polymicrobial enteric septicemia, proctocolitis, salmonella brain abscess and heart failure. If the coffee is inserted too quickly or is too hot, it could cause internal burning or rectal perforation. Long term use of coffee enemas can lead to malabsorption of fat, fat-soluble vitamins, and calcium. The use of coffee enemas has led to several deaths as a result of severe electrolyte imbalance, hyponatremia, dehydration, pleural and pericardial effusions. The U.S. Food and Drug Administration (FDA) has ruled that study participants must be warned of the risk of death from coffee enemas in studies that use them.


Barium Enemas

A barium enema is a special X-ray exam used to detect changes or abnormalities in the large intestine (colon). There are two types of barium enema exams:

Single-column barium enema. A single-column barium enema begins by coating the inner surface of the colon with a solution containing the metallic element barium. This allows the doctor to see a silhouette of the shape and condition of your colon.

Air-contrast (double-contrast) barium enema. During an air-contrast barium enema, air is inserted into your colon after the barium coating is in place. The air expands the colon and improves the quality of the X-ray images.

A barium enema exam doesn't require sedation. However, preparing for a barium enema emptying the colon with laxatives or enemas or both can be unpleasant.

Your doctor may recommend a barium enema exam to:

Investigate intestinal signs and symptoms. A barium enema can help your doctor explore possible causes of abdominal pain, rectal bleeding, a change in bowel habits, chronic diarrhea and other intestinal problems.

Identify specific colon problems. A barium enema can help your doctor identify growths (polyps) in your colon, diverticulitis or other colon problems.

In addition, a double-contrast barium enema may also detect cancer. If any growths (polyps) are detected during a barium enema, a follow-up colonoscopy may be needed. However, newer techniques, such as CT colonography, may be used instead of barium enema because newer techniques can produce better images.

Barium enema exams generally aren't done during pregnancy.

Risks

A barium enema exam poses few risks. Rarely, complications of a barium enema exam may include:

Inflammation in tissues surrounding the colon

Obstruction in the gastrointestinal tract

Tear in the colon wall

How you prepare

Before a barium enema exam, you'll need to clean out (empty) your colon. Any residue in your colon may obscure the X-ray images or be mistaken for an abnormality.

To empty your colon, follow your doctor's instructions carefully. You may be asked to:

Follow a special diet the day before the exam. Typically, you won't be able to eat the day before the exam. Drinks may be limited to clear liquids such as plain water, tea and coffee without milk or cream, broth, and clear carbonated beverages. You may not be able to eat or drink anything after midnight the day of the exam.

Take a laxative the night before the exam. The laxative may be in pill or liquid form.

Use an enema kit. In some cases, you may need to use an over-the-counter enema kit either the night before the exam or a few hours before the exam to empty your colon.

Adjust your usual medications. Remind your doctor of your medications at least a week before the exam. You may need to temporarily stop taking certain medications days or hours before the exam.

What you can expect

During a barium enema exam, you'll wear a gown but likely nothing else. Sedation isn't usually necessary.

You'll begin the exam lying on your side on an X-ray machine table. An X-ray will be taken to make sure your colon is clean. Then a lubricated enema tube will be inserted into your rectum. A barium bag will be connected to the tube to deliver the barium solution into your colon.

The barium solution temporarily coats the lining of your colon. This provides a silhouette of the shape and condition of the inner lining of your colon on X-ray images. If you're having an air-contrast (double-contrast) barium enema, air will be inserted through your rectum to expand the colon and improve the quality of images.

The tube that's used to deliver the barium has a small balloon near its tip. When positioned at the entrance of your rectum, the balloon helps keep the barium inside your body. As your colon fills with barium, you may feel the urge to have a bowel movement. Abdominal cramping may occur as well. To relax, take long, deep breaths. Do your best to hold the enema tube in place.

You may be asked to turn and hold various positions on the exam table. This helps ensure that your entire colon is coated with barium and allows the radiologist to view the colon from various angles. You also may be asked to hold your breath at times.

The radiologist may press firmly on your abdomen and pelvis, manipulating your colon for better viewing on a monitor attached to the X-ray machine. A number of x-rays will likely be taken of your colon from various angles.

A barium enema exam typically takes about 30 to 45 minutes.

After the exam

After the exam, most of the barium will be removed from your colon through the enema tube. When the tube is removed, you'll be able to use the toilet to expel additional barium and air. Any abdominal cramping usually ends quickly, and you'll be able to return to your usual diet and activities right away.

You may have white stools for a few days as your body naturally removes any remaining barium from your colon. Because barium may cause constipation, it's important to drink extra fluids in the days following the exam. Your doctor may recommend a laxative if needed.

Check with your doctor if you're unable to have a bowel movement or pass gas more than two days after the exam or if your stool doesn't return to its normal color within a few days after the exam. This may indicate that some amount of barium remains in your colon.

Results

Ask your doctor to review the results of your barium enema with you.

Negative result. A barium enema exam is considered negative if the radiologist detects no abnormalities in the colon. If you had the barium enema to screen for colon cancer and you're at average risk you have no colon cancer risk factors other than age your doctor may recommend waiting five years and then repeating the exam.

Positive result. A barium enema exam is considered positive if the radiologist detects abnormalities in the colon. Depending on the findings, you may need additional testing such as a colonoscopy so that any abnormalities can be examined more thoroughly, biopsied or removed.

If your doctor is concerned about the quality of your X-ray images, he or she may recommend a repeat barium enema or another type of screening test.

An explanation of a barium enema procedure.

Click to watch a demonstration

    
       

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