Gut Check: Should You Use an Enema for Constipation Relief?

People have used enemas to “flush out” stool since before constipation medications existed. An enema is a procedure that injects a liquid solution into the rectum through a small tube or nozzle. The fluid can help soften stool and stimulate a bowel movement quickly.

An enema delivers fluid into the intestines via the rectum. This can treat constipation by softening and breaking up the stool, says Bryan Curtin, MD, a gastroenterologist and the director of the center for neurogastroenterology and GI motility at the Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy in Baltimore.

“While phosphorus-based enemas are traditionally considered the most potent, I find that any enema can be effective if done correctly,” Dr. Curtin says. “The oil-based enemas are fairly messy and I typically avoid those.”

Fleet enemas can cause some electrolyte abnormalities, so they have fallen out of favor. Most doctors simply recommend tap water enemas now.

Enemas can be used for purposes other than relieving severe constipation. Doctors may recommend using enemas to:

• Clear the colon or rectum before a surgery, imaging procedure, or colonoscopy
• Deliver medicine directly into the lower bowel for conditions such as ulcerative colitis
• Treat fecal impaction, a hard mass of stool stuck in the rectum

To administer an enema, follow the instructions on the box or leaflet closely.

Bharat Pothuri, MD, a gastroenterologist at Memorial Hermann in Houston, offers the following tips for using an enema safely and effectively:

1. Drink 16 ounces of water (two glasses) before the enema, because an enema can cause you to become dehydrated.
2. Lie on your stomach with your knees pulled to your chest. If you are unable to, lie on your left side with both knees bent and your arms resting comfortably.
3. Lubricate the enema tube and gently insert it into your rectum, squeezing the enema so that the contents can enter your rectum.
4. Wait in that position until you feel the need to move your bowels. Try to hold the enema in for at least five minutes to achieve maximum benefit.

“It’s important to make sure you hold onto the enema until the urge to defecate is strong,” Curtin says.

While enemas can be a useful tool for treating severe constipation, they do come with some risks and are not meant for frequent use.

“Like any other medication, enemas can be abused,” Curtin says. “Too much enema use can lead to anorectal pain disorders. Generally, you should avoid using enemas regularly, unless instructed to by your doctor.”

The Risks of an Enema

People with colorectal cancer, an enlarged and distended colon that may be more prone to perforation, or active inflammatory bowel disease should avoid using enemas unless a doctor prescribes one, Pothuri says. Sometimes anti-inflammatory medications are given via enema route for treatment of proctitis and colitis.

When an Enema Can Help

When used correctly and occasionally, enemas have some advantages. They work faster than oral laxatives, usually triggering a bowel movement within minutes. That could be especially useful for severe constipation or fecal impaction when other treatments haven’t worked.

Because of the risks associated with enemas, doctors generally recommend trying other ways of treating constipation first, such as dietary changes and laxatives. If you have any questions about the safety of enemas, it’s best to consult your doctor.

Before considering an enema, make sure you’ve tried the following options.

High-Fiber Diet

“Generally, your doctor will first start by recommending dietary changes,” Curtin says. Adding fiber to your diet increases the bulk of your stool, speeding up its passage through the digestive system.

Curtin says that patients who are constipated should aim for 20 to 30 grams of daily fiber. A good starting point is to add more fruits and vegetables into your diet, as well as whole grains, which are some high-fiber foods. Only around 5 percent of Americans get the recommended amount of fiber.

Fiber Supplements

If adding fiber to your diet through high-fiber foods is not working, there are also fiber supplements available. Over-the-counter supplemental fiber, such as Metamucil, may help. Talk to your doctor to learn if this is a good option for you.

Staying Hydrated

Drinking enough water is vitally important for overall health, including digestion. “The main purpose of the colon is to reabsorb water from the stool, and if you are dehydrated more water will be taken in, leading to harder-to-pass stools,” Curtin says.

Note that not all this fluid has to be water. You can also include nutrient-rich foods and beverages like fruit, vegetables, juice, and tea. Also, it’s important to spread out the fluids over the day. Alcohol and caffeinated drinks can cause dehydration, so you’ll want to avoid those if you’re constipated.

Laxatives

Lifestyle Changes

So, if that is a concern, talk to your doctor, who may adjust your dose or switch your prescription.

Prescription Drugs

Some prescription drugs are also available to treat chronic constipation. Your healthcare provider will work with you to decide which one is best for you. If there’s a structural problem in your colon that’s causing your constipation, your doctor might recommend surgery in very severe and refractory cases.

Call your doctor to talk through your options if constipation is a new issue for you or you’ve been constipated for more than a few weeks.