What is an enema?
The enema - also called enema - is a procedure by which liquid solutions, usually medicated, are introduced into the rectum and colon, using a small tube introduced into the anus. There are different types, each with a specific purpose.
Types of Enema
Laxative enemas
Enemas with lukewarm water (500-1000 cc), in which purgative substances (eg glycerine) have been dissolved, are recommended for their evacuating action in the presence of constipation (enema evacuating).
Instead of glycerine, two or four tablespoons of olive oil, or other substances - preferably natural - with a purgative action can be added (in the past soap was used, about 20 grams per 500 cc of water, but today for her irritant action it is preferred to replace it with natural or saline substances).
Evacuating enemas are also performed in preparation for surgery or a diagnostic examination of the last section of the intestine, often in association with laxatives. For example, in the preparation for colonoscopy one or two enemas can be practiced with Sorbiclis ® or Macrolax ®.
Therapeutic Enemas
Enemas based on medicinal solutions (therapeutic enema) are used to introduce drugs with systemic or local action (for example corticosteroids or mesalazine in the treatment of ulcerative proctitis); their use is precious whenever, for any reason, it is not possible to use the oral route (for example in the presence of vomiting or when the drug is absorbed or metabolized in an undesirable manner by the digestive system).
Diagnostic enemas
Enemas based on barium sulfate (traditional barium enema and double contrast) are used for radiographic examination of the colon (barium is opaque to X-rays and allows to observe the walls of the large intestine).
hydrocolontherapy
The practice of enema is proposed even in the absence of a real organic need to promote the state of general well-being, thanks to the elimination of toxins accumulated in the body.
In this regard, aqueous solutions are used in which purifying substances are dissolved and the operation is repeated several times after some time; however, despite being fascinating, the practice of hydrocolontherapy lacks a real scientific basis, consequently it does not find the unanimous consent of the experts.
Advice and Way of Use
The practice of enemas has a certain diffusion also in the domestic environment and it is therefore very important to respect some precautions, which make the operation as useful and less harmful as possible.
First of all, the solution used must be possibly sterile, to avoid the risk of introducing pathogenic germs into the colon. Its volume, if an evacuating or cleaning effect is sought, is 500-1000 ml and must not exceed 1500 ml; otherwise, especially if enemas are performed with a certain frequency (which should not be higher than the two treatments a day), there is a risk of water intoxication (which is absorbed by the colon increasing the plasma volume and diluting the salts, with danger of hyponatremia, there is also electrolyte recall in the intestinal lumen due to osmotic action).
The already prepared solutions that can be purchased in pharmacies have more or less the same osmolarity as the plasma and this limits the danger of irritation and the excessive dilution of the internal medium (they are often pre-dosed).
In children, obviously, the quantities must be adapted in relation to body size (an approximate indication is 30 ml for each year of age).
The water temperature should be similar to the body temperature and in any case not to exceed 37.5 ° C to avoid irritating the intestinal mucosa and causing shock, even when the solution is too cold.
The devices for practicing the enema should be, as anticipated, possibly sterile, such as the "disposable" type, which can be purchased in pharmacies. Furthermore, it is important to respect the instructions for use, which provide a generous lubrication before anal insertion.
A suitable device also ensures the right infusion pressure, important to avoid excessive absorption of the solution and to save trauma to the intestinal mucosa (thanks to the joint use of lubricant and soft rubber materials). If these occur, even in a non-evident way (for example if you notice unusually dark stools or streaks of blood), it is important to request a prompt medical intervention.
Contraindications
It should be remembered that enemas should never be used, especially in a home environment, in the presence of inflammation (Crohn's disease and ulcerative colitis), intestinal bleeding, appendicitis, peritonitis, severe hemorrhoids or rectum-colon tumors; caution even in the presence of heart disease or kidney failure.
