Enemas: Meeting Elimination Needs

Administering an Enema

Types of Enemas

  • Cleansing
    • Large volume: 500-1000 ml of fluid is instilled into the colon
    • Small volume: 50-200 ml of fluid is used, prepackaged disposible enema
  • Oil retention enema: small volume enema that softens hard stool
  • Medicated enemas
  • Return Flow enema: used to remove flatus and stimulate peristalsis, most frequently after surgery


Solutions used

  • tap water: a hypotonic solution that may be drawn into the body cells and cause water toxicity, electrolyte imbalance, and/or circulatory overload.
  • normal saline: isotonic solution that is considered a safe enema solution
  • hypertonic solutions: often prepackaged small-volume enemas that use a hypertonic solution to draw fluid from the body to moisten the stool
  • soap solutions: are very irritating to the colon so are rarely ordered
  • oil: moistens hardened stool
  • carminative solutions: provides relief from gas (such as MGW solution: 30 ml magnesium, 60 ml of glycerin, & 90 ml water)


Nursing Considerations when administering an enema

  • Children and the elderly are more susceptible to fluid and electrolyte imbalances, so should only have small volume enemas. Children and infants should only have normal saline enemas.
  • Enemas are contraindicated in patients with bowel obstruction, inflammation or infection of the abdomen, or if the patient has had recent rectal surgery.
  • Many patients have fears and concerns regarding enemas and their administration - describe the procedure and answer all the patient's questions regarding the procedure.


Administering a return flow enema

  • The recommended position for the patient during enema administration is lying in the left lateral position with their right leg flexed as much as possible.
  • Use a solution at a temperature of 105o to 110oF in adults and 100oF in children. Cool solutions will increase the incidence of cramping.
  • Alternately rise the enema container 12-18 inches above the rectum for an adult and administer approximately 200 ml of fluid, then lower the container 12-18 inches below the patient's rectum until no further flatus is seen.