EnemaIs the process of instilling a solution/fluid

through the anal sphincter into the rectum and large intestine for a therapeutic purpose.

-The action is to distend the intestine and to irritate the intestinal mucosa, thereby increasing peristalsis and excretion of feces and flatus

Types of EnemaCleansingCarminativeRetentionReturn-Flow enema

Cleansing Enema To prevent the escape of feces during surgery To prepare the intestine for certain diagnostic tests such

as x- ray or visualization tests To remove feces in instances of constipation and

impaction Cleansing Enema may also be: High-given to cleanse as much of the colon Low-is used to clean the rectum and sigmoid colon only

The force of flow of the solution is controlled by the ff:

The height of the solution containerSize of the tubingViscosity of the fluidResistance of the rectum

Commonly Used Enema Solutions Solution

Constituents Action Time to

Take Effect

Adverse Effect

Hypertonic 90-120 ml. of sol.(e.g., sodium phosphate)

Draws water into the colon

5-10 min Retention of sodium

Hypotonic 500-1,000 ml. of tap water

Distends colon, stimulates peristalsis, and soften feces

15-20 min Fluid and electrolyte imbalance, water intoxication

Isotonic 500-1,000 ml of normal saline(9mlNaCl to 1,000 ml water)

Distends colon, stimulates peristalsis, and soften feces

15-20 min Possible sodium retention

Soapsuds 500-1,000ml(3-5ml soap to 1,000ml water)

Irritates mucosa, distends colon

10-15 min Irritates and may damage mucosa

Oil(mineral, olive, cotton seed)

90-120ml Lubricates the feces and the colonic mucosa

½-3 hrs

Carminative Enema: -Is given primarily to expel flatus -The solution instilled in to the rectum release

gas, which in turn distends the rectum and the colon, thus stimulating peristalsis

-For adult, 60-80 ml of fluid is instilled Retention Enema -Introduces oil or medication into the rectum

and sigmoid colon -The liquid is retained for a relatively long

period(e.g.1-3hrs) -It soften the feces and lubricate the rectum

and anal canal, thus facilitating passage of the feces

Antibiotic Enemas- Are used to treat infection locally

Anthelmintic Enemas- are used to kill helminthes such as worms and intestinal parasite

Nutritive enemas- Are used to administer fluids

and nutrients to the rectum

Return-Flow Enema: - Is used to occasionally to expel flatus - Alternating flow of 100ml to 200ml of fluid

into and out of the rectum and sigmoid colon stimulates peristalsis

-This process is repeated 5 or 6 times until the flatus is expelled and Abdominal distension is relieved

Precautions: -Can lead to fluid overload, bowel irritation, and loss of

muscle tone of the bowel and anal sphincter. - Never deliver more than three consecutive enemas

to treat a patient. - A patient with diarrhea may not be able to hold an

enema. - Must be used with caution in cardiac patients who

have arrhythmias or have had a recent myocardial infarction.

- Should not be given to patients with undiagnosed abdominal pain because the peristalsis of the bowel can cause an inflamed appendix to rupture

- Should be used cautiously in patients who have had recent surgery on the rectum, bowel, or prostate gland.

-If the patient has rectal bleeding or prolapse of rectal tissue from the rectal opening, cancel the enema and consult with the physician before proceeding

-Do not force the enema catheter into the rectum against resistance

-Use only mild castile soap for soapsuds enemas because other soap preparations are too harsh and irritate the rectal tissue.

Complications: -Include irritation, swelling, redness,

bleeding, or prolapse of the rectal tissue -Pain or burning during enema instillation Equipment: -Incontinence sheet -Bedpan or commode -Disposable gloves -Gauze -Lubricating jelly -Enema -Jug/container

Procedure in Administering an Enema:

1. Assessment a. When the client last had a bowel movement

and the amount, color,and consistency of the feces

b. Presence of abdominal distention c. Whether the client has sphincter control d. Whether the client can use a toilet or

commode or must remain in bed and use a bedpan 2. Planning: a. Determine whether a physician’s order is

required b. Determine the size of the rectal tube to use

specified by the doctor c. Determine the presence of kidney or cardiac

disease

3. Implementation:

Preparation: a. Lubricate about 5cm(2 in) of the rectal

tube b. Run some solution through the connecting

tubing and the rectal tube to expel any air in the tubing

c. Close the clamp

Performance: a. Explain the procedure b. Wash hands, apply clean gloves and

observe appropriate infection control procedure

c. Provide for client privacy d. Place client to a left lateral position, with

right leg acutely flexed as possible and the linen-saver pad under the buttocks

e. Lift the upper buttocks and insert the rectal tube smoothly and slowly into the rectum, directing it toward the umbilicus

f. If there is resistance at the internal sphincter, ask the client to take a deep breath, then let a small amount of solution run through the tube

g. Never force tube or solution entry

H. Slowly administer the enema solution

- Raise the solution container, and open the clamp to allow fluid flow

- If client complains of fullness or pain, use the clamp to stop the flow for 30 seconds, and then restart the flow at slower rate

- After all the solution has been instilled or when client can’t hold anymore and feels the desire to defecate , close the clamp, and remove the rectal tube from the anus

- Place the rectal tube in disposable towel as you withdraw it

I. Encourage the client to retain the enema

- Ask the client to remain lying down

- Let the client retain the solution for the appropriate amount of time. 5-10 min. for a cleansing enema; 1 to 3 hours for retention enema

J. Assist the client to defecate

K. Document type of solution; length of time solution was retained; amount, color, and consistency of the returns

Aftercare: - Remain near the patient - After instillation of solution to client with

retaining enema apply gentle pressure to the rectal opening using a 4×4 gauze

- Tuck a 4×4 gauze pad between the buttocks to collect seepage.

- Cover the patient after the procedure and instruct him or her to lie still for five to 10 minutes or longer if a medicated solution or retention enema is administered.

- Wash items that might be reused, such as non-disposable enema bags and tubing

in warm soapy water. Rinse and allow them to air dry

- Place disposable items, gauze pads, and gloves in a trash bag, then seal and discard it

- Assist the patient to the bathroom or with the bedpan after he or she has held the

enema solution for the correct amount of time - Hands should be washed after performing the

procedure. Note the results of the enema