Enema

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 a remedy for encopresis, as part of alternative health therapies, and also for erotic purposes, particularly as part of BDSM activities. In earlier times, they were often known as clysters, and were probably used more frequently than at present.

Medical usage

The main medical usages of enemas are:

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, supposedly to 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.

Home usage

Many self-given enemas used at home are the pre-packaged, disposable, sodium phosphate solutions in single-use bottles sold under a variety of brand names, or in generic formats. These units come with a pre-lubricated nozzle attached to the top of the container. Some enemas are administered using so-called disposable bags connected to disposable tubing (despite the 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, so as to relieve aches and pains via gentle heat administrations to parts of the body. Cost for each enema can be as little as the cost of baking soda added to ordinary tap water.

In medical or hospital environments, reusable enema equipment is now rare because of the expense of disinfecting a water-based solution. 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 bottle units 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. If such commercially-available items are not at hand, ordinary water bottles are sometimes used.

In alternative medicine

Enemas in alternative medicine are referred to as colon hydrotherapy or colonic irrigation and involve the use of substances added or mixed with water in order to 'detoxify' the body. Practitioners believe the accumulation of fecal matter in the large intestine leads to ill health, and false urban legends about fecal accumulation circulate the internet. This use is not supported by mainstream medical practitioners and governing bodies, who recommend the use of enemas only in cases of constipation, though its use to treat a variety of ailments has persisted in popular use despite lacking scientific support.

The Food And Drug Administration has ruled that colonic irrigation equipment is not approved for sale (class III) for the purpose of general well-being (it is approved for use by prescription of a doctor, usually in connection to a procedure like a colonoscopy). The FDA has taken action against many distributors of this equipment.

The use of enemas for reasons other than the relief of constipation is currently only regulated in some parts of the United States, though some practitioners go through a voluntary certification process.

The term "colonic irrigation" is also used in gastroenterology to refer to the practice of introducing water through a colostomy or a surgically constructed conduit as a treatment for constipation.

Rectal drug administration

An enema might be used to clean the colon of feces first to help increase the rate of absorption in rectal administration of dissolved drugs or alcohol.

Enemas have also been used for ritual rectal drug administration such as balché, alcohol, tobacco, peyote, and other hallucinogenic drugs and entheogens, most notably by the Mayans and also some other American Indian tribes. Some tribes continue the practice in the present day.

People who wish to become intoxicated faster have also been known to use enemas as a method to instill alcohol into the bloodstream, absorbed through the membranes of the colon. However, great care must be taken as to the amount of alcohol used. Only a small amount is needed as the intestine absorbs the alcohol more quickly than the stomach. Deaths have resulted due to alcohol poisoning via enema.

Recreational usage

The paraphilia directed towards enemas is known as klismaphilia, the enjoyment of enemas. Enemas may be used as part of BDSM activities for either males or females, or as a regular sexual activity for an individual or between partners. In many cities, enemas are available as a service from practitioners in the sex industry to cater to klismaphiliac desires. Enemas can be pleasurable to either sex, and in males, enemas can stimulate the prostate gland. Unexpected erections are common in medical settings, even if the person would otherwise consider it an unpleasant procedure.

An enema may also be used prior to anal sex or anilingus in order to enhance the sensation of intercourse, or to remove feces prior to sex, possibly reducing bacterial transmission and risk of infection, or just to reduce the possibility of fecal material adhering to the genitals or sex toys used during the subsequent activity.

Precautions

Improper administration of an enema may cause electrolyte imbalance (with repeated enemas) or ruptures to the bowel or rectal tissues resulting in internal bleeding, however these occurrences are rare in healthy, sober adults. Internal bleeding or rupture may leave the individual exposed to infections from intestinal bacteria. Blood resulting from tears in the colon may not always be visible, but can be distinguished if the feces are unusually dark or have a red hue. If intestinal rupture is suspected, medical assistance should be obtained immediately.

The enema tube and solution may stimulate the vagus nerve, which triggers an arrhythmia such as bradycardia. Enemas should not be used if there is an undiagnosed abdominal pain since the peristalsis of the bowel can cause an inflamed appendix to rupture.

Colonic irrigation should not be used in people with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids or tumors in the rectum or colon. It also should not be used soon after bowel surgery (unless directed by one's health care provider). Regular treatments should be avoided by people with heart disease or renal failure. Colonics are inappropriate for people with bowel, rectal or anal pathologies where the pathology contributes to the risk of bowel perforation.

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