Enema

This 2qt (about 2 liters) enema bag, or "fountain syringe", equipped with a rectal nozzle, is to be filled with water or a solution, then suspended near 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.

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

An enema (plural enemata or enemas) is the procedure of introducing liquids into the rectum and colon via the anus. Enemas can be carried out for medical reasons (as a treatment for constipation), as part of alternative therapies, and also for erotic purposes, particularly as part of BDSM activities. In earlier times, they were often known as clysters. Enemas have even been used to administer beverage alcohol to alcoholics who have developed stomach ulcers.

Contents

1 Medical usage
2 Application
3 Effect
4 Advantages
5 Non-medical usage

5.1 Ritual use

6 Colonic irrigation
7 References
8 External links

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 is complete, and after a set "holding time," the patient expels feces along with the enema in the toilet.

Enemas may be used to relieve constipation and fecal impaction, although in many medical settings their use has been largely replaced by oral laxatives and laxative suppositories. Bowel stimulating enemas may consist of water, which works primarily as a mechanical laxative, or they may be made up of water with baking soda (sodium bicarbonate) or water with a mild soap dissolved in it; sodium phosphate solution, which draws additional water from the bloodstream into the colon and increases the effectiveness of the enema, but which can often be rather irritating to the colon, causing intense cramping or "gripping"; 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 solutions are available as well. In the past, castile soap was a common additive to enemas, but it has largely fallen out of use because of the risk of chemical-induced colitis as well as the ready availability of other enema preparations that are perhaps more effective than soap -- but which are certainly more irritating to colonic tissues.

Cleaning the lower bowel prior to a medical or surgical procedure such as sigmoidoscopy or colonoscopy. Because of speed and so-called "convenience", enemas used for this purpose are commonly the sodium phosphate variety. A more pleasant experience can usually be obtained with gently-administered baking soda enemas, and "yes," cleansing the lower bowel FOR colonoscopy and other bowel studies can be effectively achieved with water-based 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 all antiemetics are delivered by enema). Additionally, several anti-angiogenic agents 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 digestion in the normally-functioning digestive tract. Interestingly, some waster-based enemas are also used as a relieving agent for IBS (Irritable Bowel Syndrome) even though it seems counter-intuitive to add medicines to an already-irritated bowel system. 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 mesalamine 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. There is some discussion in medical circles about using steroids versus using other enema additives such as cayenne pepper.

Anesthetic agents (for general anasthesia) 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 not as uncomfortable as some patients anticipate, and are often the only practical way to "view" the colon in a relatively safe manner.

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 so as to supposedly 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 oxytocin to induce labor and because women generally found the procedure unpleasant. In addition, medically-aided labor reduces the physician's waiting time. Unfortunately, there is some concern that any medication given to a pregnant woman can adversely affect the fetus, and caution may be advised.

Application

Conservative estimates suggest that up to one-third of all Americans use enemas at least occasionally. It seems that the Standard American Diet (SAD) induces constipation in many people, or makes bowel movements uncomfortable or inconvenient. Many home-given enemas are pre-packaged sodium phosphate solutions in single-use bottles sold under a variety of brand names, or in generic formats, costing about a $1.25 per dose. These units come with a pre-lubricated nozzle attached to the top of the container but few patients realize that heating the enema by floating the syringe unit in a sink full of hot water for about 20 minutes can make the enema significantly less irritating, and easier to retain. Some enemas are administered using so-called, disposable bags connected to disposable tubing, although in contrast to their product 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," to relieve aches and pains from gentle, heat administrations to parts of the body. Such devices cost anywhere from about $5 to $15 in typical pharmacy or discount department stores, and have an expected lifetime of 10 years or more. Several brands are available but one irritating factor to avoid is the "screw-in" type of nozzle sold with some enema syringes. Such nozzles can often come loose during enema administration, and can be a leak-factor during the enema. Other standard enema syringes, both enema bags and bulbs, can be purchased over the internet, as can more exotic enema syringes, giving some people who need or want enemas -- a feeling of anonymity. Many people who need, want, or enjoy enemas feel embarrassed or inadequate because of their need or desires. The ability to privately purchase enema equipment over the internet has started to revive home enema use, especially among male patients who are occasionally embarrassed to shop in drugstores for such personal use equipment.
In medical or hospital environments, reusable enema equipment is now rare because of the expense of administering a water-based solution to the patient, and -- very rarely -- because of the expense and difficulty of disinfecting it. 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 bags or bottles 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. Regardless of the administration medium, the solution for the enema should be as near as possible to body temperature. Many people seem to prefer enema solutions warmed to about the same temperature as they enjoy with "shower water," in the bath environment.

A French engraving, ca 1780 shows the long-standing interest in the clyster

Effect

At first, the flow of water through the anus and into the rectum causes a slight sensation of pressure in the rectum and can cause a slight urge to release the solution. This pressure comes in waves, but is easily resisted. Then, there is a feeling of slight pressure in the lower abdomen. This feeling starts gradually, but slowly builds until there is a feeling like your abdomen is gradually being inflated.

The feeling of being filled gradually moves up the left of the abdomen, although few new patients can be this discriminating in early enemas. Then, as the enema solution fills the "descending colon," on the left side, it begins to move across the middle in the transverse colon, and then down the right side in the "ascending colon." The pressure causes a cramping sensation which gradually becomes more intense. With the administration of large-volume enemas, the abdomen expands and takes on a pregnant look as the water pushes outward and fills the available space.

Towards the end of the procedure, there can be a feeling of immense inflation and peristalsis (the urge to defecate or "empty" the rectum and colon) coupled with strong pressure in the rectum. Holding the enema allows for greater absorption of the water into the bloodstream and can affect the body chemistry in a favorable manner. It is, and has been, a misnomer, that retaining the enema for any significant period of time allows for better absorption of the liquid into the fecal material. The "detox" reaction is a relatively quick one. As a result, most new enema patients cannot retain an enema for much more than 5 minutes, although, with experience, 15 to 20 minutes retention time is recommended for best results. When the water is released, there is a relatively strong bowel movement that mostly empties the lower intestinal tract over a period of about 15 minutes. Occasionally, the urge to let a bit more enema/feces solution out will reoccur in 15 to 60 minutes. If there is no urge to expel the solution, it simply means the body wanted to absorb the solution more than it wanted to expel it. This is not dangerous, and the patient should simply be given another, separate enema.

Advantages

Unlike laxatives which can take an unpredictable amount time to be effective, an enema relieves the discomfort of constipation within 30 to 60 minutes. When the enema/feces solution has been evacuated from the colon, and when the peristalsis has stopped, the enema is complete with no uncomfortable feeling lingering on. Additionally, water-based enemas are very low cost. The primary expense is the initial purchase of a combination syringe bag, or a fountain syringe which may cost $5 to $10 and which should last for many years. In addition, there can be a very small monthly cost for baking soda, which runs about $0.50 a pound at any food or drug store. Common dosages with baking soda (sodium bicarbonate) are a measured tablespoon of baking soda per quart of enema solution.
Most modern, water-based enemas are made up of two to three quarts (or litres) of tepid "baby-wrist-test-temperature" water (ranging from about 95 Degrees to 105 Degrees - Fahrenheit) with one level tablespoon of baking soda added per quart. Many people find that they can easily accommodate three, four, five, or more quarts of water in each enema. There is no harm in doing so. Generally, it is thought that thoroughly filling the colon with as much water as can be reasonably injected is a good idea.
Although an enema can occasionally be a slightly uncomfortable sensation, many people begin to employ them because they provide such complete and powerful or thorough, yet gentle, relief. In addition, because of the secondary change (an increase) which a properly-formulated baking-soda-solution enema can provide in total body alkalinity, many people come to enjoy the depression-relief and other immune-system enhancing effects that accompany frequent enema usage.

Non-medical usage

The paraphilia directed towards enemas is known as klismaphilia. Klismaphilia is the enjoyment of enema applications because of the pleasurable sensations which they give to many people. ("Klisma" having to do with water injection through the anus and into the rectum, and "philia" having to do with the Greek root word for enjoyment, pleasure, or affiliation.) More than a few males and females learn to enjoy the pleasurable sensations received from a properly-given enema, either gentle or stringent, and seek out enema opportunities more or less frequently.
In some cities, enemas are available as a service from practitioners in the sex industry to cater to klismaphiliac desires, and may be used as part of BDSM activities. In some cities, enemas are available for hire from nurses aides, or other health-care providers at relatively low fees. It's possible to hire either male or female aides for the purpose of giving enemas, depending on your gender orientation. Some such providers require a physician's prescription before they will give an enema, and others will merely give enemas on request to clients who like or need them. It doesn't hurt to contact a provider by phone, or by a Help Wanted ad in the local newspaper to determine the availability of enema services in your community.
A small enema may also be used prior to anal sex or anilingus in order to remove feces, thus reducing bacterial transmission and risk of infection. Or, some people who enjoy anal sex activities use enemas to enhance their sensations during the act. Finally, some people who enjoy anal sex also use a small enema or two to reduce the possibility of fecal material adhering to the sex tool(s) used by themselves or their partners during sexual activity.
People who enjoy the feelings engendered by mild intoxication have also been known to use enemas as a method to instill beverage alcohol into the bloodstream, absorbed through the membranes of the large intestine. Not necessarily alcoholics, these people can enjoy a "buzz" in a direct way, and can enjoy a sleepy encounter after a night of cuddling or other sexual activity. In addition, some health authorities have stated that four or more ounces of red wine a day, taken EITHER by mouth or by rectum, may enhance human health -- because of the effects of resveratrol (a health enhancing compound found PRIMARILY in red wine) in the body. It should be recognized that alcohol injected rectally is absorbed into the human bloodstream much faster, and more completely, than when ingested by mouth. Extreme caution is advised because alcohol injected into the rectum cannot be removed from the body except by natural metabolic processes. Injecting much more than four ounces of wine, mixed into two or more quarts of tepid water, is potentially hazardous to life. One of the very few cases of death occasioned by an enema happened in a Southern state in the last year or so, where one of the participants was accused of using a large injection of fortified alcohol in a sexual partner. Be extremely careful when using anything other than water-based enemas with baking soda or mild soap added to the solution.

Ritual use

Ritual enemas were practiced by the Maya and many other Central American and South American Indian tribes; some tribes have continued the practice to the present day. Substances used in the enemas include alcohol, tobacco, peyote, and other hallucinogenic drugs and entheogens. While the precise nature of the substances used by the Maya are unknown except from pictures of pots containing bubbling liquids, it is presumed these contained alcohol or other drugs.

Colonic irrigation

Colonic irrigation or colon hydrotherapy is a large enema which cleanses the whole colon. It was in vogue for hygienic purposes at the beginning of the 20th century (see John Harvey Kellogg) and remains popular as an alternative health therapy in many parts of the world. Advocates believe that, when carried out by trained personnel using sterile equipment, it can be a safe and valuable tool for eliminating toxins from the body and restoring normal muscular activity in the colon. However, there have been cases of intestinal perforation due to improperly done colonic irrigations. The actual medical benefit of colonic irrigation is controversial.

References

M. R. Strict, Intimate Invasion: The Erotic Ins & Outs of Enema Play, Greenery Press, 2004. ISBN 1890159514.

External links

[How to Give An Enema Safely]

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