Are Enemas Safe? What About Repeated Use?

Enemas are a common treatment for constipation, and while they can be safe and effective, they do have risks when performed at home, or if they're used too frequently. When over-used for constipation, they can even make your health problems worse. They can lead to life-threatening complications, as well.

Enemas work by getting fluid into your intestines so it can soften up your stool and help it pass. However, this is a last resort for constipation. Before you opt for an enema, and especially repeated enemas, you need to understand the risks and how often they can be safely used.

An enema, broadly speaking, is the introduction of a fluid 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.
• Colon x-rays: To get the large intestine to show up better on an x-ray, doctors use barium enemas, which contain a metallic substance that coats the lining of your colon. This allows them to better detect abnormalities, such as colon cancer.
• To deliver medication: Inflammatory 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).
• Constipation: While enemas can effectively relieve constipation, you should only use them on the direct advice of a doctor, and you shouldn't use them frequently.

Enemas are also called high colonics or colon hydrotherapy. They're invasive and can lead to harmful effects if you use them to clear out stool on a regular basis.

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

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

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

In 2014, the U.S. Food and Drug Administration (FDA) issued a warning against the repeated use of enemas containing sodium phosphate, such as the brand Fleet Enema and multiple store brands with the same ingredients.

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

This includes enemas containing coffee, herbs, minerals such as Epsom salt, soap suds, acidic solutions, and basically anything your doctor hasn't told you to use. 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

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 doctor about them, especially if you have regular constipation.

Constipation can be caused by a serious conditions, such as neurological problems or colon cancer. If you have constipation that it's hard to relieve, talk to your doctor.

If your doctor recommends an at-home enema, you can buy an enema kit over-the-counter. Most of them contain water and salt, mineral oil, or a mild laxative. Get the kind your doctor recommends, don't add anything to it, and make sure you follow the directions carefully.

Don't try to put together an enema kit from things you have around the house.

Constipation isn't pleasant and you probably want quick relief. If safe and recommended treatments don't offer that, seek medical help instead of trying home remedies that may do more harm than good.