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This 2qt (about 1.89 liters) open-topped enema bag, or "fountain syringe", equipped with a rectal
nozzle, is to be filled with water or a solution, then suspended near and slightly above the patient
using the hook. Then, the nozzle (shown equipped) is inserted into the anus and the clamp is
released. This bag may also be used for vaginal douches by switching the nozzle.

This rectal bulb syringe may be used to administer smaller enemas.

Enema Device for bowel irrigation

An enema (plural enemata or enemas) is the procedure of introducing liquids into the rectum
and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower
intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a
feeling of extreme urgency and complete evacuation of the lower intestinal tract. ]
Enemas can be carried out as treatment for medical conditions, such as constipation and
encopresis, and as part of some alternative health therapies. They are also used to administer
certain medical or recreational drugs. Enemas are also used for erotic purposes, particularly to
prepare for anal sex, and as part of BDSM activities.

• 1 History
• 2 Medical usage
• 3 Home usage
• 4 Alternative medicine
○ 4.1 Colon cleansing
○ 4.2 Coffee enemas
• 5 Rectal drug administration
• 6 Recreational usage
• 7 Punitive usage
• 8 Precautions
• 9 See also
• 10 Footnotes
• 11 External links
• 12 References

[edit] History
Clyster (also spelled in the 17th Century, `glister') is an old-fashioned word for enema, more
particularly for enemas administered using a clyster syringe — that is, a syringe with a rectal
nozzle and a plunger. 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); some servant or apothecary would then insert the nozzle into the anus and depress the
plunger, resulting in the liquid remedy (generally, water, but also some preparations) being
injected into the colon.
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
A normal clyster syringe (in front) and the nozzle for a syringe designed for self-administration
(in the back). The latter avoided the need for a second party to attend an embarrassing procedure.
Clysters were administered for symptoms of constipation and, with more questionable
effectiveness, stomach aches and other illnesses. In his early-modern treatise, The Diseases of
Women with Child, Francis Mauriceau 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 and 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 More.
Clysters were a favourite medical treatment in the bourgeoisie and nobility of the Western world
up to the 19th century. As medical knowledge was fairly limited in those days, purgative clysters
were used for a wide variety of ailments, the foremost of which were stomach aches and
Molière, in several of his plays, introduces characters of incompetent physicians and
apothecaries fond of prescribing this remedy, also discussed by Argan, the hypochondriac patient
of Le Malade Imaginaire. More generally, clysters were a theme in the burlesque comedies of
that time.
Clysters are famously referred to in the conclusion of John Donne's Elegy XVIII, where the male
persona warns against taking a 'wrong turn' when engaging in sexual activity, lest the unfortunate
male penetrate the 'clyster' orifice.
According to Claude de Rouvroy, duc de Saint-Simon, clysters were so popular at the court of
King Louis XIV of France that the duchess of Burgundy had her servant give her a clyster in
front of the King (her modesty being preserved by an adequate posture) before going to the
Clysters also appear in sado-masochistic literature set during this period, where they are
administered for disciplinary purposes. Girls especially were punished by being made to retain a
large clyster for a specified time. An example is found in P.N. Dedeaux's The Prussian Girls.
Castigation and embarrassment would follow failure to retain the solution.
William Laighton of Portsmouth, New Hampshire, obtained a patent for an enema chair on
August 8, 1846. Upon receiving the patent, Laighton told his assembled colleagues that if the
world were to receive an enema, Gloversville, New York would be the insertion point.[dubious –
[edit] Medical usage
The main medical usages of enemas are:
• As a bowel stimulant, not unlike a laxative – 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 feces along with the enema in
the bedpan or toilet.
• Enemas may also be used to relieve constipation and fecal impaction, 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 suppositories. In-home use
of enemas for constipation and alternative health purposes is somewhat harder to
• 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) or water with a mild hand soap dissolved in it; buffered 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 oil, 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 soap 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 colitis 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 isotonic saline solution is least
irritating to the rectum and colon, having a neutral concentration gradient. This neither
draws electrolytes 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 or
colonoscopy. 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
antiemetics given to reduce nausea (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 administration.
• The topical administration of medications into the rectum, such as corticosteroids and
mesalazine used in the treatment of inflammatory bowel disease. Administration by
enema avoids having the medication pass through the entire gastrointestinal tract,
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 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 States, customary enema usage went well into the 20th
century; it was thought a good idea to cleanse the bowel in case of fever; also, pregnant women
were given enemas prior to labor, supposedly to reduce the risk of feces 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 enema was the principal medical method for resuscitating
victims of drowning during the 18th century.
[edit] 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 bottles, 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 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 in 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 rubber or vinyl 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.
[edit] Alternative medicine
The term "colonic irrigation" is commonly used in gastroenterology to refer to the practice of
introducing water through a colostomy or a surgically constructed conduit as a treatment for
constipation.[1] The Food and Drug Administration has ruled that colonic irrigation equipment is
not approved for sale for the purpose of general well-being[2] and has taken action against many
distributors of this equipment.[3] The use of enemas for reasons other than the relief of
constipation is currently regulated in some parts of the United States while practitioners in other
states may go through a voluntary certification process.
[edit] Colon cleansing
Main article: Colon cleansing
The same term is also used in alternative medicine 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 intestine leads to ill health.[4] 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.[5][6][7]
[edit] Coffee enemas
In the controversial Gerson therapy, coffee enemas are administered.[8] These enemas are
believed to have caused three deaths in the United States.[9]
[edit] Rectal drug administration
An enema might be used to clean the colon of feces first to help increase the rate of absorption in
rectal administration of dissolved drugs, including alcohol.[10]
Enemas have also been used for ritual rectal drug administration such as balché, alcohol,
tobacco, peyote, and other hallucinogenic drugs and entheogens, most notably by the Mayans
and also some other American Indian 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 colon. 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.[12]
[edit] Recreational usage
An aluminium enema nozzle. Specialty enema nozzles are common for non-medical usage,
available on the Internet and in sex shops in a variety of sizes, styles, and materials.

An inflatable enema nozzle shown in a harness, but usually used without. Once inserted, the
nozzle is inflated to a much larger size than can fit back out, allowing the recipient to relax their
muscles while holding the enema, retain a solution they wouldn't normally be able to retain, or to
be forced to take an enema as part of bdsm activities.
The paraphilia directed towards enemas is known as klismaphilia, the enjoyment of enemas.
Enemas may be used as part of BDSM activities, or as a regular sexual activity for an individual
or between partners. In many cities, enemas are available as a service from practitioners in the
sex industry to cater to human sexual desires. Enemas can be pleasurable to either sex, and in
males, enemas can stimulate the prostate gland. Unexpected erections 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 sex or anilingus in order to enhance the sensation of
intercourse, or to remove feces prior to sex, possibly reducing bacterial transmission and risk of
infection, or just to reduce the possibility of fecal material adhering to the genitals or sex toys
used during the subsequent activity.
[edit] 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
Barbarism, for example, Domingo Faustino Sarmiento describes the use of pepper and turpentine
enemas by police forces as a way of discouraging political dissent in post-Independence
[edit] Precautions
Improper administration of an enema may cause electrolyte imbalance (with repeated enemas) or
ruptures to the bowel or rectal tissues resulting in internal bleeding, however these occurrences
are rare in healthy, sober 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. [14]
The enema tube and solution may stimulate the vagus nerve, which triggers an arrhythmia such
as bradycardia. Enemas should not be used if there is an undiagnosed abdominal pain since the
peristalsis of the bowel can cause an inflamed appendix to rupture.
Colonic irrigation should not be used in people with diverticulitis, ulcerative colitis, Crohn's
disease, severe or internal hemorrhoids or tumors in the rectum or colon. It also should not be
used soon after bowel surgery (unless directed by one's health care provider). Regular treatments
should be avoided by people with heart disease or renal failure. Colonics are inappropriate for
people with bowel, rectal or anal pathologies where the pathology contributes to the risk of
bowel perforation.[15]
Recent research has shown that ozone water, which is sometimes used in enemas, can
immediately cause microscopic colitis. [16]
[edit] See also

Wikimedia Commons has media related to: Enemas

• Dry enema
• Michael H. Kenyon, the "Enema Bandit"
• Kancho
[edit] Footnotes
1. ^ Locke GR, Pemberton JH, Phillips SF (2000). "AGA technical review on constipation".
Gastroenterology 119 (6): 1766–78. doi:10.1053/gast.2000.20392. PMID 11113099.
2. ^ "Subpart F--Therapeutic Devices Sec. 876.5220 Colonic irrigation system". Code of Federal
Regulations, Title 21 Food and Drugs, Subchapter H -- Medical Devices, Part 876 --
Gatroenterology-Urology Devices. FDA. 2007-04-01.
3. ^ Department of Health and Human Services (1999-07-21). "Warning letter to Dotolo Research
Corp" (reprint by Casewatch). FDA. Retrieved 2007-12-31.
4. ^ Whorton J (2000). "Civilisation and the colon: constipation as the "disease of diseases"". BMJ
321 (7276): 1586–9. doi:10.1136/bmj.321.7276.1586. PMID 11124189.
5. ^ E.M.D. Ernst (June 1997), "Colonic Irrigation and the Theory of Autointoxication", Journal of
Clinical Gastroenterology: 196–198,
6. ^ Kaiser (1985). "The Case Against Colonic Irrigation". California Morbidity (38).
7. ^ Chen TS, Chen PS (1989). "Intestinal autointoxication: a medical leitmotif". Journal of
Clinical Gastroenterology 11 (4): 434–41. PMID 2668399.
8. ^ "The Gerson Institute - Alternative Cancer Treatment".
9. ^ Hills, Ben. "Fake healers. Why Australia’s $1 billion-a-year alternative medicine industry is
ineffective and out of control.". Medical Mayhem. Retrieved 2008-03-06. "Kefford is particularly
concerned about cancer patients persuaded to undergo the much-hyped US Gerson diet program,
which involves the use of ground coffee enemas which can cause colitis (inflammation of the
bowel), fluid and electrolyte imbalances, and in some cases septicaemia. The US FDA has
warned against this regime, which is known to have caused at least three deaths."
10.^ de Boer AG, Moolenaar F, de Leede LG, Breimer DD (1982). "Rectal drug administration:
clinical pharmacokinetic considerations". Clin Pharmacokinet 7 (4): 285–311. PMID 6126289.
11.^ Diamond, Jared M. (1992). The Third Chimpanzee: The Evolution and Future of the Human
Animal (P.S.). New York, N.Y: Harper Perennial. pp. 432. ISBN 0-06-084550-3. ; pp. 201
12.^ "The Enema Within". Darwin Awards. 2008.
13.html. Retrieved 2008-01-11.
13.^ "Ribbons and Rituals". In Problems in Modern Latin American History. Ed. Chasteen and
Wood. Oxford, UK: Scholarly Resources, 2005. p. 97
14.^ Martelli, ME ([dead link] – Scholar search), Encyclopedia of Nursing and Allied Health,, retrieved 2008-01-11
15.^ "Colon Hydrotherapy". Aetna IntelliHealth. 2005-07-01.
Retrieved 2007-04-23.
16.^ "Ozone Enema: A Model of Microscopic Colitis in Rats". Springer Netherlands. 2004-01-04.

[edit] External links

• An old video showing how to give an enema
[edit] References
• Deeb, Benjamin, Enemas for Everyone: A Case Study of Alexander Moaveni, University
of Nebraska Press, 2000
• M. R. Strict (2003). Intimate Invasion: The Erotic ins & Outs of Enema Play. Greenery
Press (CA). ISBN 1-890159-51-4.
Route of administrations / Dosage forms

Oral Capsule · Pill ·

Tablet · Orally
disintegrating tablet ·
Film · OROS
(osmotic controlled
Enteral/ digestive tract
release capsule)

Elixir · Emulsion ·
LiquidsSyrup · Suspension ·

Inhaler (Metered-dose, Dry

Respiratory tract
powder) · Nebulizer
Circulatory systemSublingual administration

ENT Eye drop · Ear drop · Intranasal

Emulsion (Ointment · Cream · Lotion · Liniment · Gel ·

Transdermal Paste · Film) · Medicated shampoo · Transdermal
implant · Transdermal patch

Subcutaneous (SC) · Intravenous (IV) · Intramuscular

(IM) · Intraosseous · Intraperitoneal (IP) · Intrathecal ·

Pessary (vaginal suppository) · Vaginal ring · Douche ·

Intrauterine device

Rectal Suppository · Enema

This article includes a list of references, related reading or external links, but its sources
remain unclear because it lacks inline citations. Please improve this article by
introducing more precise citations where appropriate. (December 2008)
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