Are Enemas Safe?

Enemas are sometimes used for constipation when other measures like laxatives or dietary measures aren't working. They are also used to clear out the colon before a colonoscopy or other test.

While they can be safe and effective, enemas do have risks when performed at home, or if they're used too frequently. Sometimes, they can cause serious complications such as bowel perforation or sepsis, a life-threatening condition due to infection.

This article will explain when enemas are used, as well as the risks and possible complications of using them. It will also offer alternative ways to reduce constipation.

Safe Use of Enemas

Enemas work by getting fluid into your large intestine so it can soften up your stool and help it pass. The fluid is administered into the rectum and large intestine through the anus. Enemas are used for a variety of reasons:

• Before tests: One or more enemas might be used before having a test such as a colonoscopy, to clear the large intestine of all stool.
• During x-rays of the colon: To get the large intestine to show up better on an x-ray, healthcare providers use barium enemas. Barium is a metallic substance that coats the lining of your colon. This makes it easier to detect abnormalities, such as colon cancer.
• To deliver medication: Certain medications can be delivered directly to the rectum or the sigmoid colon (the lowest part of the large intestine) as a treatment for conditions such as inflammatory bowel disease (IBD).
• To relieve constipation: Enemas can effectively relieve occasional constipation when nothing else works.
  

Enema Kits

If your healthcare provider recommends an at-home enema, you can buy an over-the-counter enema kit. Most of them contain water and salt, mineral oil, or a mild laxative.

Purchase the kind your healthcare provider recommends. Don't add anything to it and make sure you follow the directions carefully. Don't try to put together a "DIY" enema using your own supplies or liquids.

Unsafe Use of Enemas

Using an enema at home always comes with certain risks. Risks of a single enema include:

• Damage to or perforation (puncturing) of rectum or intestines due to stretching
• Disruption of the natural microflora in your gut
• Pain caused by using liquid that is too hot or cold
• Introducing too much liquid, which may stay in the body and come out without warning
• Infection introduced by equipment that's not sterile. This is especially a problem for people with autoimmune diseases or an otherwise compromised immune system.

Repeated Use

The repeated use of enemas can, over time, cause serious problems, such as:

• Weakening the muscles of the intestine so you're dependent on enemas to have a bowel movement
• A condition called hyponatremia, or water intoxication, which is an imbalance of electrolytes that occurs when the body does not have enough sodium. In severe cases, it can cause confusion, seizures, and coma.

One type of enema sometimes used in alternative medicine is called a high colonic or colon hydrotherapy. These are invasive and can be harmful if you use them to clear out stool on a regular basis.

Contraindications

If you have hemorrhoids, enemas may cause extra pain. If you have a rectal prolapse (in which the end of the lower intestine protrudes from the rectum), you should avoid using an enema.

In 2014, the U.S. Food and Drug Administration (FDA) issued a warning against the repeated use of enemas containing sodium phosphate. These are found in some store brands, including the Fleet Enema. The sodium phosphate enema is especially dangerous for people over 55 and should never be used in children under two years old. It can lead to hyperphosphatemia—an electrolyte disorder that involves high phosphate levels and low calcium levels in the blood. This can lead to pain, rash, muscle cramps, intermittent spasms, kidney and liver damage, and (rarely) death.

Fad Enemas

A lot of people tout at-home enemas, often with "special" ingredients, for cleansing your bowel, improving digestive health, or other supposed benefits. These types of enemas are not recommended by the medical community.

Fad enemas may contain coffee, herbs, minerals such as Epsom salts, soap suds, acidic solutions, and more. In addition to the regular risks of enemas, these fad enemas can cause:

• Disruption of gut bacteria
• Electrolyte disturbances
• Severe dehydration that can be fatal
• Rectal burns, inflammation, and infection that can be fatal
• Internal bleeding that leads to blood transfusion and possibly removal of your colon

Safe Treatments for Constipation

Again, an enema should be a last resort for treating constipation. In most cases, constipation can be relieved with lifestyle changes, such as:

• Adding fiber to your diet
• Exercising
• Drinking more water

Over-the-counter laxatives may be an option for you, but they also come with risks. Talk to your healthcare provider about them, especially if you have regular constipation.

Summary

Enemas work by releasing liquid into the colon and large intestine via a tube inserted into the anus. Enemas are used before tests, such as a colonoscopy, which requires a clear view of the colon. They are also used to relieve constipation sometimes when other measures have not been successful. Enemas can be dangerous when performed at home or repeatedly. They must be used under the supervision of a healthcare provider to avoid complications.

A Word From Verywell

If treatments such as dietary measures or laxatives have not relieved your constipation, you might want to consider using an enema. Always talk to your healthcare provider before attempting to give yourself an enema at home. They can help you choose the right one and give you advice on how to use it properly and safely. Keep in mind that in some cases constipation can be a sign of a serious condition, such as neurological problems or colon cancer. If you have repeated bouts of constipation that are hard to relieve, especially if they are followed by diarrhea, talk to your healthcare provider.