Enema

General objective

• At the end of the session,B.Sc Nursing 1 st year students will

be able to explain about “enema”.
Specific objectives

• At the end of the session, B.Sc Nursing 1 st year students will

be able to:
1. introduce enema .
2. list the purpose of enema
3. explain the types of enema.
4. explain the principles of giving enema.
5. explain the procedure of enema.
 Enema

Introduction

• Enema is the process of instillating fluid through the anal

sphincter into the rectum and lower intestine for both
therapeutic and diagnostic purpose.

• The instillation of fluid into the colon through rectal tube for
a therapeutic purpose .
Introduction cont’d....

• The volume of the fluid installed in the rectum:

- softens stools and breaks up the fecal mass

- increases peristalsis and stretches the rectal wall.

- initiates the defecation reflex.

Purpose of giving enema

• To relieve constipation, flatulence or distension.

• To prevent involuntary escape of fecal matter during surgical

procedure and delivery.

• To promote visualization of the intestinal tract during a

radiographic or instrumental examination like protoscopy.
Purposes cont’d ...

• To stimulate peristalsis.

• To provide fluid , nutrients and medication like sedatives.

• To induce labor.

• To soothe or treat irritated mucosa of the colon.

Purpose cont’d...

• To diagnose diseased conditions of the colon such as

ulcer,tumor or new growth.
Types of enema

A. Retention enema
B. Non-retention enema
C. Return flow enema
Types cont’d...

A. Retention enema

• Retention enema are to be retained for a shorter or longer

period.
• These enema are given slowly with small rectal catheter
and funnel.
• Short retaining enemas allow fluid to retain for 10-30 minute
for absorption whereas long retaining enema is retained for 30-
40 minutes for absorption.
Types cont’d ....

Types of retention enema :

1.Oil retention enema

• Mustard oil and cotton seed oil are used.
• It lubricates the rectum and colon.
• The feces absorb the oil and become softer and easier to pass.
Types cont’d...

2. Antispasmodic carminative enema

• Molasses 6-8 oz or turpentine oil 400ml
• It is used to relieve distension

3.Antihelmintic enema
• Sodium chloride 8 gm per 500 ml of water.
• This is given to kill worms.It is followed by cleansing enema.
Molasses
Types cont’d....

4.Astrigent enema
• Solution tannic acid 2 GM and water 500ml ,silver nitrate 2%
is used.
• Its purpose is to relieve spasms of inflamed intestine.

5.Nutrient enema
• Normal saline 200ml with glucose 2 to 5%
• Its purpose is to supply nourishment to the body.
Types cont’d...

6.Barium(diagnostic) enema
• Its purpose is to introduce barium for x-ray to find the outline of
the intestine.

7.Medicated enema
• These enema provide medicines that are absorbed through rectal
mucosa.
• For eg; enema containing neomycin to decrease bowel bacterial
count.
Barium enema
Types cont’d...

8. Sedative enema

• Opium bromide with normal saline about 200 ml.

• Purpose:
- for sedative action.
- to relieve pain.
Types cont’d...

B. Non- retention enema/cleansing enema

• Non-retention enema are given for the purpose of evacuating
faeces and gas from the bowel for surgical or any other
diagnostic purposes.

• It promotes the complete evacuation of feces from the colon

by stimulating peristalsis through the infusion of a large
volume of solution or through local irritation of the colon’s
mucosa
 Types cont’d...
Solution used:
1.Normal saline
• It is an isotonic solution and exerts the same osmotic pressure
as the intestinal fluids in the bowel.

• So,it is considered as the safest solution for giving enema.

• The volume of the saline stimulates peristalsis.

Types cont’d...

2.Tap water

• Tap water is hypotonic solution and exerts a lower osmotic

pressure than the surrounding interstitial fluids causing water
to move from the colon to the interstitial space.
Types cont’d...

• Before the water moves from the colon,it stimulates

peristalsis and defecation.

• These enemas should not be repeated because it may lead to

circulatory overload.
Types cont’d...
3.Soapsuds solution

• Soapsuds may be added to tap water or saline enema to create

bowel irritation to stimulate peristalsis.
• It is prepared by adding 1 teaspoon full soap jelly to 1 ltr. of
warm water .
• Only pure soap (Castile soap) should be used in order to
minimize mucosa irritation.
Types cont’d...

C. Return flow enema (Harris flush)

• Return flow enema is given to expel flatus.

• For an adult,100-200ml of solution is installed into the rectum and

sigmoid colon.

• Then the solution container is lowered so that the solution flows

back into the container by gravitational force.
Types cont’d....

• The process is repeated 5 to 6 times and the alternating flow

of solution stimulates peristalsis and aids in expelling the
flatus.

• If the returned solution becomes thick with feces ,it is

replaced by fresh solution.
Principles of giving enema

• The appropriate size of rectal catheter or rectal tube of

cleansing enema is 22 fr. for adults, 12 fr. for infant and 14-
18 fr. for children.

• Be sure that the equipment is in a good working condition.

• Check doctor’s order , maintain patient’s privacy.

Principles cont’d....

• The rectal tube need to be smooth and flexible.

• Use lubricant to facilitate insertion and to decrease irritation

of the rectal mucosa.

• Prevent air from entering the rectum by expelling the air and
clamping the tube before inserting it into the rectum.
Principles cont’d ....

• Do not let the fluid run completely out of the container.

• Tell the patient to take a deep breath while the rectal tube is
inserted and to hold the fluid inside the rectum until the
procedure is finished.

• The patient is usually placed in left lateral position during

administration of enema.
Principles cont’d....

• The distance to which tube is inserted depends upon the age

and the size of the patient .For an adult it is normally 7.5-
10cm (3-4 inches) , for children it is 2.5-3.5 cm (1- 1.5
inches).

• Maintain the temperature of fluid about 98-100 °F.

Procedure for giving enema

1. Equipment required
- A tray containing :
• Enema can
• Rubber tubing with the connection
• Rectal catheter and clamp
• Solution required for enema
• Lubricating jelly
Equipment cont’d...

• Kidney tray
• Enema stand or other stand to hang enema can
• Screen
• Disposable gloves
• Rubber sheet/ Mackintosh
• Bed pan (for helpless patient)
Procedure

• Check doctor’s order.

• Identify the patient and explain the procedure to the patient.
• Give advice to empty the bladder.
• Perform hand hygiene.
• Bring equipments to the patients bedside.
• Maintain privacy.
Procedure cont’d...

• Prepare the solution.

• Position the patient to the left lateral with right knee flexed(Sims
position).

• Put on gloves.

• Place a rubber sheet under the patient’s buttocks and cover the
patient with a blanket or linen according to weather.
Procedure cont’d....

• Expel the air from the tubing of the enema and clamp it.

• Lubricate the tip of rectal tube with lubricants to about 6-8

cm and connect it to the enema can.

• Separate the buttocks with the left hand, exposing the anus.
• Insert the rectal catheter slowly by pointing the top towards
the direction of the patients umbilicus.
Procedure cont’d...

• If resistance is encountered,ask the client to take a deep

breath,and then run a small amount of solution through the
tube , withdraw the tube slightly and continue inserting.

• Open regulating clamp and allow solution to enter slowly with

container at patient’s hip level.

• Withdraw it before emptying the can and disconnecting the

rectal tube
Procedure cont’d...

• Instruct the patient to hold the solution as long as possible

(5-15 minutes for cleansing enema and at least 30 minutes for
a retention enema) and explain that the feeling of distention
is normal.

• Discard the wastes in appropriate trash receptacle or rinse out

the enema container throughly with warm soap and water if
you be reused.
Procedure cont’d...

• Assist the patient to bathroom or help the patient to position

on bedpan.
• Remind the patient not to flush commode before the nurse
inspects the results of enema.
• Assist the patient as needed to wash the anal area.

• Observe the character of feces and amount and fecal content

Procedure cont’d...

• Remove and discard gloves and perform hand hygiene.

• Remove and discard gloves and perform hand hygiene.
• Record time and type of enema given to the patient and it’s
result.
• Place all equipment in proper place .
• Report failure to defecate to the physician.
Assignment

• Read about enema.

References

1. Basavanthapa,BT.(2003).”Fundamental of Nursing”.New Delhi: Jaypee Brothers.

2. Pathak,S& Devkota,R.(2010).”A Textbook of Fundamental of Nursing”.(1st ed.).
Vidyarthi Prakashan.
3. Subedi,D.(2015).”Textbook of Fundamental of Nursing”.(2nd ed.).Makalu
Publication House.
4. Weishaupt,J.(2021, November 24).Enema:Types, Procedure,Side Effects and
More.retrived from;
https://www.webmd.com
5. Watson,K.(2023,March 9).Enema Administration: Purpose, Procedure and
Risks.retrived from;
https://www.healthline.com