An enema, also known as a clyster, is the rectal administration of a fluid by injection into the Large intestine via the anus.Cullingworth, A Manual of Nursing, Medical and Surgical:155 The word enema can also refer to the liquid injected, as well as to a device for administering such an injection.
In standard medicine, the most frequent uses of enemas are to relieve constipation and for bowel cleansing before a medical examination or procedure; also, they are employed as a lower gastrointestinal series (also called a barium enema), to treat traveler's diarrhea, as a vehicle for the administration of food, water or medicine, as a stimulant to the general system, as a local application and, more rarely, as a means of reducing body temperature, as treatment for encopresis, and as a form of rehydration therapy (proctoclysis) in patients for whom intravenous therapy is not applicable.
A large volume enema can be given to cleanse as much of the colon as possible of feces. However, a low enema is generally useful only for stool in the rectum, not in the intestinal tract.
Such enemas' mechanism consists of the volume of the liquid causing a rapid expansion of the intestinal tract in conjunction with, in the case of certain solutions, irritation of the intestinal mucosa which stimulates peristalsis and lubricates the stool to encourage a bowel movement. An enema's efficacy depends on several factors including the volume injected and the temperature and the contents of the infusion. For the enema to be effective, the patient should retain the solution for five to ten minutes, as tolerated. or, as some nursing textbooks recommend, for five to fifteen minutes or as long as possible.
Soapsuds enema is a frequently used synonym for a large volume enema (although soap is not necessary for effectiveness).
A large volume enema may be used in a home setting to relieve occasional constipation, although medical care may be required for recurring or severe cases of constipation.
Normal saline is least irritating to the colon. Like plain water, it simply functions mechanically to expand the colon, but having a neutral concentration gradient, it neither draws from the body, as happens with plain water, nor draws water into the colon, as occurs with phosphates. Thus, a salt water solution can be used when a longer retention period is desired, such as to soften an impaction.
Castile soap is commonly added because its irritation of the colon's lining increases the defecation urgency. However, liquid handsoaps and detergents should not be used.
Glycerol is a specific bowel mucosa irritant serving to induce peristalsis via a Osmotic laxative. It is used in a dilute solution, e.g., 5%.
The 2-4-6 Enema: Consists of 2 ounces of glycerin, 4 ounce of Epsom salt, mixed with 6 ounces of water, injected into the rectum, retained for five minutes. This small injection will produce several copious movements.
Mineral oil functions as a lubricant and stool softener, but may have side effects including rectal skin irritation and oil leakage.
Klyx contains docusate sodium 1 mg/mL and sorbitol solution (70%)(crystallising) 357 mg/mL and is used for faecal impaction or constipation or colon evacuation prior medical procedures, developed by Ferring B.V.
Micralax (not to be confused with MICROLAX®)
MICROLAX® (not to be confused with Micralax) combines the action of sodium citrate, a peptidising agent which can displace bound water present in the faeces, with sodium alkyl sulphoacetate, a wetting agent, and with glycerol, an anal mucosa irritant and hyperosmotic. However, also sold under the name "Micralax", is a preparation containing sorbitol rather than glycerol; which was initially tested in preparation for sigmoidoscopy.
Micolette Micro-enema® contains 45 mg sodium lauryl sulphoacetate, 450 mg per 5 ml sodium citrate BP, and 625 mg glycerol BP and is a small volume stimulant enema suitable where large-volume enemas are contra-indicated.
An international consensus on when and how to use transanal irrigation for people with bowel problems was published in 2013, offering practitioners a clear, comprehensive and straightforward guide to practice for the emerging therapeutic area of transanal irrigation.
The term retrograde irrigation distinguishes this procedure from the Malone antegrade continence enema, where irrigation fluid is introduced into the colon proximal to the anus via a surgically created irrigation port.
While simple techniques might include a controlled Healthy diet and establishing a toilet routine, a daily enema can be taken to empty the colon, thus preventing unwanted and uncontrolled bowel movements that day.Peña A, Guardino K, Tovilla JM, Levitt MA, Rodriguez G, Torres R Bowel management for fecal incontinence in patients with anorectal malformations Pediatr. Surg. 33:1 133–7 1998
Failure to expel all of the barium may cause constipation or possible impaction and a patient who has no bowel movement for more than two days or is unable to pass gas rectally should promptly inform a physician and may require an enema or laxative.
Topical administration of medications into the rectum, such as corticosteroids and mesalazine, is used in the treatment of inflammatory bowel disease. Administration by enema avoids having the medication pass through the entire gastrointestinal tract, therefore simplifying the delivery of the medication to the affected area and limiting the amount that is absorbed into the bloodstream.
Rectal corticosteroid enemas are sometimes used to treat mild or moderate ulcerative colitis. They may also be used along with systemic (oral or injection) corticosteroids or other medicines to treat severe disease or mild to moderate disease that has spread too far to be effectively treated by medicine inserted into the rectum alone.
The enema tube and solution may stimulate the vagus nerve, which may trigger an Heart 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 Appendicitis.
There are arguments both for and against colonic irrigation in people with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids or tumors in the rectum or colon. Its usage is not recommended soon after bowel surgery (unless directed by one's health care provider). Regular treatments should be avoided by people with heart disease or kidney failure. Colonics are inappropriate for people with bowel, rectal or anal disease where the pathology contributes to the risk of bowel perforation.
Recent research has shown that ozone water, which is sometimes used in enemas, can immediately cause microscopic colitis.
A recent case series of 11 patients with five deaths illustrated the danger of phosphate enemas in high-risk patients.
Clyster entered the English language in the late 14th century from Old French or Latin, from Greek κλυστήρ (klyster), "syringe", itself from κλύζειν (klyzein), "to wash out", also spelled glister in the 18th century. It is a generally archaic word used more particularly for enemas administered using a clyster syringe.
In parts of Africa, the calabash gourd is used traditionally to administer enemas. On the Ivory Coast the narrow neck of the gourd filled with water is inserted the patient's rectum and the contents are then injected by means of an attendant's forcible oral inflation, or a patient may self-administer the enema by using suction to create a negative pressure in the gourd, placing a finger at the opening, and then upon anal insertion, removing the finger to allow atmospheric pressure to effect the flow. In South Africa, Bhaca people used an ox horn to administer enemas.Annals of the South African Museum, page 18 Along the upper Congo River an enema apparatus is made by making a hole in one end of the gourd for filling it, and using a resin to attach a hollow cane to the gourd's neck. The cane is inserted into the anus of the patient who is in a posture that allows gravity to effect infusion of the fluid.Friedenwald & Morrison, 'Part I:75-76
As further described below in religious rituals, the Maya in their late classic age (7th through 10th centuries CE) used enemas for, at least, ritual purposes, Mayan sculpture and ceramics from that period depicting scenes in which, injected by syringes made of gourd and clay, ritual hallucinogenic enemas were taken. In the Xibalban court of the God D, whose worship included ritual cult paraphernal, the Maya illustrated the use of a characteristic enema bulb syringe by female attendants administering clysters ritually.Parsons and Carlson:92
For combating illness and discomfort of the digestive tract, the Mayan also employed enemas, as documented during the colonial period, e.g., in the Florentine Codex.
The indigenous peoples of North America employed tobacco smoke enemas to stimulate respiration, injecting the smoke using a rectal tube.
A rubber bag connected with a conical nozzle, at an early period, was in use among the indigenous peoples of South America as an enema syringe,Friedenwald & Morrison, Part II:261 and the rubber enema bag with a connecting tube and ivory tip remained in use by them; in contrast, in Europe a syringe was still the usual means for conducting an enema.Friedenwald & Morrison, Part II:240
In China, c. 200 CE, Zhang Zhongjing was the first to employ enemas. "Secure a large pig's bile and mix with a small quantity of vinegar. Insert a bamboo tube three or four inches long into the rectum and inject the mixture" are his directions, according to Wu Lien-teh.Friedenwald & Morrison, 'Part I:77–80
In India, in the fifth century BCE, Sushruta enumerates the enema syringe among 121 surgical instruments described. Early Indian physicians' enema apparatus consisted of a tube of bamboo, ivory, or horn attached to the scrotum of a deer, goat, or ox.
In Persia, Avicenna (980–1037 A. D.) is credited with the introduction of the "clyster-purse" or collapsible portion of an enema outfit made from ox skin or silk cloth and emptied by squeezing with the hands.
In the first century BCE the Greek physician Asclepiades of Bithynia wrote "Treatment consists merely of three elements: drink, food, and the enema".Scarborough, The Drug Lore of ASCLEPIADES of Bithynia:44 Also, he contended that indigestion is caused by particles of food that are too big and his prescribed treatment was proper amounts of food and wine followed by an enema which would remove the improper food doing the damage.Scarborough, The Drug Lore of ASCLEPIADES of Bithynia:46
In the second century CE the Greek physician Soranus prescribed, among other techniques, enemas as a safe abortion method, and the Greek philosopher Celsus recommended an enema of pearl barley in milk or rose oil with butter as a nutrient for those with dysentery and unable to eat, and also Galen mentions enemas in several contexts.
In medieval times appear the first illustrations of enema equipment in the Western world, a clyster syringe consisting of a tube attached to a pump action bulb made of a pig bladder.
A simple piston syringe clyster was used from the 15th through 19th centuries. This device had its rectal nozzle connected to a syringe with a plunger rather than to a bulb.
In 1694 François Mauriceau in his early-modern treatise, The Diseases of Women with Child, records midwives and man-midwives commonly administered clysters to labouring mothers just before their delivery.
Clysters were administered for symptoms of constipation and, with more questionable effectiveness, stomach aches and other illnesses.
In 1753, Johann Jacob Woyts described an enema bag prepared from a pig's or beef's bladder attached to a tube as an alternative to a syringe.Friedenwald & Morrison, Part II:245
In the 18th century Europeans began emulating the indigenous peoples of North America's use of tobacco smoke enemas to resuscitate drowned people. Tobacco resuscitation kits consisting of a pair of bellows and a tube were provided by the Royal Humane Society of London and placed at various points along the Thames. Furthermore, these enemas came to be employed for headaches, respiratory failure, colds, hernias, abdominal cramps, typhoid fever, and cholera outbreaks.
Clysters were a favourite medical treatment in the bourgeoisie and nobility of the Western world up to the 19th century. As medical knowledge was fairly limited at the time, purgative clysters were used for a wide variety of , the foremost of which were and constipation.
According to the duc de Saint-Simon, clysters were so popular at the court of King Louis XIV of France that the duchess of Burgundy had her servant give her a clyster in front of the King (her modesty being preserved by an adequate posture) before going to the comedy. However, he also mentions the astonishment of the King and Mme de Maintenon that she should take it before them.Saint-Simon, Memoires, vol. 10, ch. 4.
In the 19th century, many new types of enema administration equipment were devised. Devices allowing gravity to infuse the solution, like those mentioned above used by South American indigenous people and like the enema bag described by Johann Jacob Woyts, came into common use. These consist of a nozzle at the end of a hose that connects a reservoir, either a bucket or a rubber bag filled with liquid and held or hung above the recipient.
In the early 20th century the disposable microenema, a squeeze bottle, was invented by Charles Browne Fleet.
Proponents falsely claim that administering enemas to autistic children results in the expulsion of parasitic worms ("rope worms"), which are fragments of damaged intestinal epithelium that are misinterpreted as being human pathogens. Oral and rectal use of the solution has also been promoted as a cure for HIV, malaria, viral hepatitis, influenza, , acne, cancer, Parkinson's, and much more.
Chlorine dioxide is a potent and toxic bleach that is relabeled for "medicinal purposes" to a variety of brand names including, but not limited, to MMS, Miracle Mineral Supplement, and CD protocol. For oral use, the doses recommended on the labeling can cause nausea, vomiting, diarrhea, and potentially life-threatening dehydration.
No clinical trials have been performed to test the health claims made for chlorine dioxide, which originate from former Scientology Jim Humble in his 2006 self-publishing book, The Miracle Mineral Solution of the 21st Century (self published) and from anecdotal reports. Humble coined the name MMS. Sellers sometimes describe MMS as a water purifier to circumvent medical regulations. The International Federation of Red Cross and Red Crescent Societies rejected "in the strongest terms" reports by promoters of MMS that they had used the product to fight malaria.
A coffee enema can cause numerous maladies including infections, sepsis (including campylobacter sepsis), severe electrolyte imbalance, colitis, polymicrobial enteric sepsis, proctocolitis, salmonella, brain abscess, and heart failure,William T. Jarvis, Ph.D., National Council Against Healthcare Fraud, " Cancer Quackery". Accessed 11 July 2012. and deaths related to coffee enemas have been documented.
Gerson therapy includes administering enemas of coffee, as well as of castor oil and sometimes of hydrogen peroxide or of ozone.
Some proponents of alternative medicine have claimed that coffee enemas have an anti-cancer effect by "detoxifying" metabolic products of tumors but there is no medical scientific evidence to support this.
Both women and men may enjoy sexual enema play, heterosexually and homosexually, experiencing sexual arousal from enemas which they find gratifying or sensualAgnew, 1982 and which can be an auxiliary to, or even a substitute for, genital sexual activity.
Klismaphiles may perceive pleasure from a large, water-distended belly, or the feeling of internal pressure. An enema fetish may include sexual attraction to the involved equipment, processes, environments, situations, or scenarios.Brame et al., Different loving – The World of Sexual Dominance and Submission:517 Klismaphiles can gain satisfaction of enemas through fantasies, by actually receiving or giving one, or through the process of eliminating steps to being administered one (e.g., under the pretence of being constipated).
That some women use enemas while masturbating was documented by Alfred Kinsey in Sexual Behavior in the Human Female: "There were still other masturbatory techniques which were regularly or occasionally employed by some 11 percent of the females in the sample... Douches, streams of running water, vibrators, urethral insertions, enemas, other anal insertions, sado-masochistic activity, and still other methods were occasionally employed, but none of them in any appreciable number of cases."
This is different from klismaphilia, in which the enema is enjoyed for itself and as a part of sexual arousal and gratification.
Rectal douching is a common practice among people who take a receptive role in anal sex although rectal douching before anal sex may increase the risk of transferring HIV, hepatitis B, and other diseases.
When enema is prescribed for the administration of drugs or alcohol, a cleansing enema may first be used to clean the colon to help increase the rate of absorption.
With historical roots in the Indian subcontinent, enemas in Ayurveda, called Basti or Vasti, form part of Panchakarma procedure in which Herbalism are introduced rectally.
Political dissenters in post-independence Argentina were given enemas of chili pepper and turpentine.
In the Guantanamo Bay Detention Camp, the Senate Intelligence Committee report on CIA torture documented instances of enemas being used by the Central Intelligence Agency to ensure "total control" over detainees. Enemas, officials said, are uncomfortable and degrading. The CIA forced nutrient enema on detainees who attempted hunger strikes, documenting "With head lower than torso … sloshing up the large intestines … what I infer is that you get a tube up as you can … We used the largest Ewal tube we had" wrote an officer, and "violent enemas" is how a detainee described what he received.
In Shakespeare's play Othello (Act II, Scene I) Iago says: "Yet again your fingers to your lips? would they were clyster-pipes for your sake!"
In Cervantes' Don Quixote, a narrative to Sancho includes "The Knight of the Sun ... bound hand and foot ... was administered a clyster of snow water and sand that almost disracted him"Friedenwald & Morrison, Part I:99
In the 17th century, satirists made physicians a favorite target, resembling Molière's caricature whose prescription for anything was "clyster, bleed, purge," or "purge, bleed, clyster".Magner, A History of Medicine:218
In Molière's play The Imaginary Invalid, Argan, a severe hypochondriac, is addicted to enemas as indicated by such lines as when Bĕralde asks, "Can't you be one moment without a purge?"
In George Orwell's novel Nineteen Eighty-Four, the narrator notes, "Sexual intercourse was to be looked on as a slightly disgusting minor operation, like having an enema."
In Grace Metalious's novel Peyton Place, the town doctor tells of "a young boy with the worst case of dehydration I ever saw. It came from getting too many enemas that he didn't need. Sex, with a capital S-E-X.". As a teenager, the boy enjoys receiving enemas from his mother.
In Flora Rheta Schreiber's book Sybil, Sybil's psychiatrist asks her "What's Mama been doing to you, dear?... I know she gave you the enemas."
TORCH SONG by Anne Roiphe, Farrar Straus & Giroux, RELEASE DATE: Jan. 1, 1976
Water Power is a Pornographic film by Gerard Damiano loosely based on the real-life exploits of Michael H. Kenyon, an American criminal who pleaded guilty to a decade-long series of armed robberies of female victims, some of which involved sexual assaults in which he would give them enemas.
The album Enema of the State by blink-182 is titled with the word in it. It features a nurse on the cover.
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Large volume enemas
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