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Enema – types, uses, procedure and guidelines
This article explains various types of enema like evacuant enema, retained enema, purgative enema, astringent enema, cold enema etc. Each type of enema is explained in detail. It also describes the uses, procedure and guidelines of enema with solutions or materials used in each type of enema.
Enema is used to clean or introduction of medicines or nutrients. Enema is the introduction of the fluid into colon through rectum for cleaning, feeding or administering medication.
Uses of enema
Enema is used for variety of purposes. It is used in case of constipation, to administer medications, as pre investigative procedure, as pre operative procedure etc. Various are described below.
Enema softens fecal materials in the rectum and makes easy removal of waste product from the rectum
It can be used to treat constipation as it stimulates defecation. Some types of enema increases peristalsis to have easy defecation. Peristalsis is the movement of intestine which propels the food matter towards rectum. During the passage of food material to rectum the digestion and absorption of food materials takes place, the remaining part is formed as stool matter and stored sigmoid colon upto defecation
Enema is used to introduce medications
The fluid which contains medications is introduced into bowel through rectum. Anti-helminthic enema destroys worms in the colon. Worms are parasites which live in intestines for their survival and take away the food material of host human being.
Enema is performed before some investigative procedures
Enema clears the intestines to have a clear visualization of bowel and rectum in colonoscopy. Colonoscopy is an endoscopic visualization of rectum and large intestine. It is also used to have clear view for abdominal x-rays as it cleans the bowel and shade of gas and intestinal contents are eliminated.
Enema is performed before conduction of normal delivery
Enema clears the rectal contents and has a role in prevention of perennial tears during labor or child birth.
Enema is used as a routine pre-operative procedure
Enema clears the colon and prevents the soiling of operation theatre after anesthesia or during the surgery as there will be relaxation of muscles of patient including sphincters.
Enema is used as a diagnostic procedure
Barium enema is used as a diagnostic tool. Barium is a radio-active substance so it is used for X-rays. X-rays after barium enema will give the picture of rectum and colon.
Enema is used to relive the gaseous distension of abdomen
Enema is used to reduce the temperature
Enema is also used to administer fluids
Types of enema
Enema is classified into evacuant enema and retained enema.
Evacuant enema is classified into
Simple evacuant enema
Medicated evacuant enema
Retained enema is classified into
Simple evacuant enema
Simple evacuant enema is used to remove fecal materials and gaseous distension. It is also used to clean the bowel and rectum before investigations, surgeries and child birth. Soap water or normal saline are used usually for simple evacuant enema. The amount of the solution used is variable depending on the age of the patient / client and temperature of the solution. For adults 500 – 1000 ml solution is used, for children 250 – 500 ml and for infants <250 ml is used generally.
Medicated evacuant enema
Medicated evacuant enema is used to administer medications through the rectum. Ther are different types of medicated evacuant enema. They are
Oil enema is used to soften the fecal matter. Oil enema is used in following conditions
- Severe constipation
- After surgeries to rectum and perineum to prevent injury to sutures
After oil enema simple evacuant enema is performed to remove the softened the stool matter. The solutions used for oil enema are olive oil, castor oil and sweet oil.
Astringent enema is used to reduce the inflammation, bleeding and mucous discharge in colon. Astringent enema is used in following conditions
The solutions commonly used in astringent enema are 2% silver nitrate solution, tannic acid and alum.
Purgative enema is used to improve the peristalsis to empty the bowel.
The solutions used commonly in purgative enema are glycerin and castor oil, oxgall, glycerin and water.
Anti-helminthic enema is used to kill the intestinal parasitic worms. Soap water enema is performed before anti-helminthic enema is performed. The solutions used in this enema are hypertonic saline solutions.
Carminative enema is called anti-spasmodic enema. It is used to remove the gaseous accumulation in abdomen. It acts by increasing the peristaltic movement of intestines. Solutions commonly used in this enema are milk and molasses, asafetida in soap water and terpentine.
Cold enema is used to reduce the body temperature during high fever and heat stroke.
Hypothermia and abdominal cramps are common complication of cold enema.
Stimulant enema is used in shock, collapse and in some poisoning cases. The solutions used are black coffee / brandy. Black coffee is prepared in 300ml water with tea spoon of coffee powder
Sedative enema is used to induce sleep or sedation. Paraldehyde, potassium bromide, chloral hydrate are the main drugs used with the solution of sedative enema.
Anesthetic enema produces anesthesia in the patient. The drug avertin is used for anesthetic enema. The dose of avertin is 150 to 300 mg per kg.
Procedure of enema
The articles used for enema are a enema catheter or rectal tube, enema can and the kidney tray. Wash hand thoroughly before starring procedure. Fill the enema can with recommended fluid. Hang the enema can on a stand. Regulate the flow of the solution and introduce rectal tube through the anus. The rectal tube should be lubricated before the insertion of tube into rectum. It allows smooth insertion of tube and prevents damage of mucus membrane. Advice the patient to take breath by mouth as it relaxes the muscles of abdomen. Procedure should be stopped if there is any discomfort reported by the patient. Remove the catheter after administering recommended amount of the fluid.
Guidelines for giving enema
Select appropriate size of catheter
Select smooth rectal tube
Lubricate the catheter before insertion
Select appropriate temperature of solution
Provide left lateral position during procedure as it facilitates instillation of the fluid
The length of catheter should be inserted is depends upon the age of the client
The time of enema should be retained in the rectum is depends on the purpose and type of enema
The amount of fluid flow is also depends on the type of enema
Avoid entry of air into the rectum
The height of the can should be adjusted to regulate the flow of enema solution
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