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An internal cleansing
From time to time, you might need (or want) an enema. It's one way of relieving constipation, and some people like to flush out their systems. Enemas are also used to prepare for certain types of surgeries. An enema is a solution delivered via the rectum to cleanse the lower portion of the large intestine. You use a long, narrow tube equipped with a small nozzle on one end, and on the other end, an enema bag or a disposable kit filled with fluid. Enemas clear the colon with tap water, saline or herbal solutions, vegetable oils, or soapy solutions, which lubricate the bowels and soften stool. Be sure to administer an enema properly, and don't overuse the product. As with any laxative, use the minimum amount needed for the shortest amount of time to alleviate constipation. In general, enemas and laxatives should not be used for more than one week. Proper dietary fiber intake, adequate fluids, and regular exercise can help maintain a regular bowel regimen and decrease the need for enemas and laxatives.
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Overuse Is Not Useful
Enemas are meant for the occasional bout of constipation or in preparation for surgery -- not for chronic constipation. If you are chronically constipated you need to consult a physician. Overuse of enemas can lead to a variety of problems, including the following:
- Electrolyte imbalance
- Laxative dependence
- Rectal gangrene
- Anaphylatic shock
- Acute colitis or infections of the large intestine
Coping with Constipation
- Constipation is often caused by low-fiber diets. Increase your vegetables, fruits, and whole grains and drink at least eight glasses of water a day.
- Increase your daily exercise -- sedentary activity can slow the bowels.
- Defecate when you feel the urge to pass a bowel movement. This can be particularly difficult when you are traveling, but it's an important part of keeping yourself regular.
- Don't become dependent upon laxatives -- regular use can impair your bowel-movement timing.
- Ask yourself if you are really constipated; the average person passes a bowel movement anywhere from three times a day to three times a week.
Don't Forget About Dehydration
Discontinue enema use if you show symptoms of dehydration, which include the following:
- Muscle cramps
- Irregular heartbeat
- Fatigue
- Disorientation
- Confusion
- Extreme thirst
- Dry mouth
- Skin texture changes
- Cold feeling in your arms and legs
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Hyperosmotics
Hyperosmotic enemas contain glycerin, a substance that attracts water into the stool to make passing it less difficult. These types of laxatives work quickly; usually within 15 to 60 minutes.
Lubricants
Lubricant enemas typically contain liquid petrolatum or mineral oil. They work to soften the stool by coating it and preventing it from losing more moisture while in the colon.
Saline
Saline enemas contain ions or particles that cannot be absorbed by the colon. This causes water to enter the colon to balance out all the extra particles and achieve fluid balance, thus softening the stool. Saline enemas work relatively quickly; results are seen in two to 15 minutes. Common saline laxatives include monobasic sodium phosphate and dibasic sodium phosphate. Long-term use of saline enemas is not recommended, since they can alter fluid and electrolyte balance in the body.
Emollients
Docusate enemas work like a detergent. They soften stool by increasing the amount of fat and water it retains while in the colon.
| Hyperosmotics | Ingredient | Description |
|---|
| Glycerin | ? | Glycerin usually takes effect within 30 minutes. Considered safe and effective for adults and children over age 2. | | Lubricants | Ingredient | Description |
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| Mineral Oil | ? | Do not use mineral oil if you are using docusate sodium, docusate calcium, or docusate potassium. Consult a physician before use on children under age 2. | | Saline | Ingredient | Description |
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| Sodium Phosphate | ? | Consult a physician before using on children under age 2. | | Emollient | Ingredient | Description |
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| Docusate Sodium | ? | Works like a detergent laxative. The effects might be delayed. Consult a physician before using on children under age 6. |
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Proper Use of Enemas- Lie on your left side. (If you remain in a sitting position, the enema only clears the rectum.)
- Bend your knees or draw your knees to your chest.
- Be careful not to over-insert the enema. You may want to use a water-based lubricant on the anal sphincter to minimize friction.
- Let the solution flow slowly -- you might feel discomfort if the flow is too fast.
- Read directions to all specific products carefully, as they may vary.
- It may take up to one hour for the enema to work.
- Consult a physician if you experience rectal bleeding or do not have a bowel movement after using an enema. This may be a sign of a serious condition. If you are pregnant, consult a physician before using any enemas or laxatives.
Recommended Dosage
| Hyperosmotic | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Glycerin (liquid) | Not recommended | | Refer to package or consult a physician. | | Refer to package or consult a physician. | | Emollient | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
|---|
| Docusate Sodium | 200 mg, 283 mg | Refer to package or consult a physician | Refer to package or consult a physician | | Refer to package or consult a physician | | Lubricant | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Mineral Oil | 118 ml | Refer to package or consult a physician | Refer to package or consult a physician | | Refer to package or consult a physician | | Saline | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Sodium Phosphate-Biphosphate | 7 gram sodium phosphate
19 gram sodium biphosphate in 118 ml | Refer to package or consult a physician | Refer to package or consult a physician | | Refer to package or consult a physician | | Stimulant | | Drug | Adults & Children Over Age 12 | Max. Daily | Children Ages 6 to 12 | Max. Daily | Children Under Age 6 | Max. Daily |
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| Bisacodyl | 10 mg | Refer to package or consult a physician | Refer to package or consult a physician | | Refer to package or consult a physician |
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Warnings
Emollient
Consult a physician before using or do not use if you have:
- Rectal bleeding
- Perforated or enlarged colon
Or if you:
- Are pregnant; consult your physician first.
- Plan to use for chronic constipation; consult your physician.
- Develop new symptoms or your symptoms worsen.
- Develop symptoms of dehydration, including the following:
- Thirst
- Dry mouth
- Sunken eyes
- Loss of skin tone
- Rapid, unsteady pulse
- Cold extremities
- Fatigue
- Unconsciousness
Or if you are taking:
- Mineral oil: emollients may increase mineral oil absorption and toxicity
Hyperosmotic
Consult a physician before using or do not use if you have:
- Rectal bleeding
- Perforated or enlarged colon
Or if you:
- Are pregnant; consult your physician first.
- Plan to use for chronic constipation; consult your physician
- Develop new symptoms or your symptoms worsen.
- Develop symptoms of dehydration, including the following:
- Thirst
- Dry mouth
- Sunken eyes
- Loss of skin tone
- Rapid, unsteady pulse
- Cold extremities
- Fatigue
- Unconsciousness
Lubricant
Consult a physician before using or do not use if you have:
- Rectal bleeding
- Perforated or enlarged colon
Or if you:
- Are pregnant; consult your physician first.
- Plan to use for chronic constipation; consult your physician.
- Develop new symptoms or your symptoms worsen.
- Develop symptoms of dehydration, including the following:
- Thirst
- Dry mouth
- Sunken eyes
- Loss of skin tone
- Rapid, unsteady pulse
- Cold extremities
- Fatigue
- Unconsciousness
Or if you are taking:
- Docusate sodium: may increase mineral oil absorption and toxicity
- Fat soluble vitamins: may reduce absorption of vitamins A, D, E, and K
Saline
Consult a physician before using or do not use if you have:
- Rectal bleeding
- Perforated or enlarged colon
- Heart disease or heart failure
Or if you:
- Are pregnant; consult your physician first.
- Plan to use for chronic constipation, consult your physician.
- Develop new symptoms or your symptoms worsen.
<- Develop symptoms of dehydration, including the following:
- Thirst
- Dry mouth
- Sunken eyes
- Loss of skin tone
- Rapid, unsteady pulse
- Cold extremities
- Fatigue
- Unconsciousness
Stimulant
Consult a physician before using or do not use if you have:
- Rectal bleeding
- Perforated or enlarged colon
Or if you:
- Are pregnant; consult your physician first.
- Plan to use for chronic constipation; consult your physician.
- Develop new symptoms or your symptoms worsen.
- Develop symptoms of dehydration, including the following:
- Thirst
- Dry mouth
- Sunken eyes
- Loss of skin tone
- Rapid, unsteady pulse
- Cold extremities
- Fatigue
- Unconsciousness
Common Side Effects
Infrequent to Rare Side Effects
Emollients
Hyperosmotics
Lubricant
- Anal itching from seepage or leaking
- Reduced absorption of fat-soluble vitamins A, D, E, and K
- Diarrhea
Saline
- Diarrhea
- Fluid and electrolyte imbalances
Peristaltic stimulant
Effects of Overdose
Emollients
- Electrolyte imbalances
- Severe diarrhea
Hyperosmotics
- Electrolyte imbalances
- Severe diarrhea
Lubricant
Saline
- Electrolyte imbalances
- Severe diarrhea
Peristaltic stimulant
What to Do in Case of Overdose
- It is unlikely that an overdose of this medication will cause life-threatening symptoms. If you are still concerned, please seek the advice of your health professional.
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Sources & Further Reading
Books
- 1. Covington, TR et al. Handbook of Non-Prescription Drugs, Eleventh Ed. American Pharmaceutical Assoc. Washington, DC 1996.
- 2. Kastrup EK et al. Drug Facts and Comparisons. Facts and Comparisons.
- 3. Inlander, CB and Slamans, S.The Over-the-Counter Doctor. Cader Books. New York, NY 1997.
Find more books on health and wellness at  barnesandnoble.com.
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