Enema

Indications

• Cleaning lower bowel
• Emptying the bowel
• Diagnostic
• Therapeutic—introduction of drugs.

Equipment

Enema can with rubber tubing

• Rectal catheter with clamping device
• Bedpan. Solution (Depends on the purpose) Soap and Water Enema 30 ml of soft soap in 600 ml of water at 100–105° F
• To treat constipation
• Relieve distention
• Stimulate uterine contraction
• Clean the bowel. Oil Enema To soften the fecal matter postoperatively (in rectal and perineal operations). Olive oil or castor oil and olive oil 1:2; 150 ml at 100° F. Purgative Enema To cause the bowel to contract actively and evacuate. 15– 30 ml of pure glycerin or glycerin and water 1:2 or glycerin and castor oil 1:1 or magnesium sulphate 60–120 ml with sufficient water.

Method (Soap and Water Enema)

1. Prepare the solution and hang the enema can at a height of about 45 cm from the anus.
2. Attach the rectal catheter to the tube from the enema can, check the patency and make air free and adjust the screw clamp.
3. Lubricate the tip of the rectal catheter.
4. Keep the patient in left lateral position towards the edge of the table with the right knee slightly flexed.
5. Separate the patient’s buttocks for proper visualization of anus; introduce the tip for about 8-10 cm gently while the patient exhales a deep breath.
6. Release the clamp.
7. Instruct the patient to take deep breath to keep abdominal muscles relaxed.
8. If the patient wants to defecate, decrease the height of enema can.
9. Clamp the tubing after introducing sufficient quantity and remove the tube gently.
10. Place the bedpan under buttocks. Keep the head end raised. Encourage the patient to retain the fluid for 10– 15 minutes.

Precautions

Appropriate size catheter is to be used. For adults No. 22 French. Children No. 15–18 French.

• Temperature should be adjusted. For evacuation enema 105–110° F (children - 100° F). For retention enema – body temperature. Higher temperature may injure the tissues. Lower temperature may produce severe cramping.
• Distance to which rectal tube to be inserted depends on the age and the size of the patient. For adults 8–10 cm. For children 2.5–3.5 cm.
• Height of the ‘enema can’ depends on the purpose of the enema: — Evacuation enema – 45 cm from anus. — Retention enema – 20 cm from anus.
• Retention time depends on the purpose and the nature of the solution.
• Cleansing enema retained for up to 10 minutes.
• Oil enema for 2-3 hours.
• Prevent air from entering into the rectum.
• Be cautious while giving enema to patients with ischemic heart disease. To assist a baby to pass the tube, the buttocks can be pressed together, thus providing pressure over the anal area.