ENEMA ADMINISTRATION LECTURE AND DEMONSTRATION

 Defecation
 Peristalsis
 Gastrocolic REFLEX
 Valsalva maneuver

Question
Is the following
statement true or
false?
For defecation to
take place, all
structures of the
abdominal tract
must function in a
coordinated
manner.

BOWEL ELIMINATION OBSERVATIONS:
 Colour – brown, white, black/tarry,
coffee grounds red/melena, pale,
yellow, green,
 Amount - (if diarrhea)
 Consistency- soft, formed, liquid, hard
 Odour – may be affected by food,
infection
 Shape – should be shaped like the
rectum
 Size – Lg, med, sm
 Frequency- varies
 C/O Pain – constipation, nausea
 Constituents – undigested food, blood,
pus, worms, mucous

Component of Fecal
Matter
1.Water 75O %
2.Solid 25O %
a)Solidified components of the
digestive juices, undigested
fibers (e.g. cellulose) which are
insoluble, act as bowl irritants,
draw water out into the lumen,
clean out lower GIT, and are
correlated with a lower risk of
colon cancer.
b)Dead bacteria (20 %).
c) Fat (10-20 %).
d)Inorganic material (10-20%)

Properties:
 Colour; Normal feces has a dark
brown coIour1 (bilirubin in the
presence of bacteria will get oxidized
to urobilin which gives stool its
typical colour).
 Odor; The odor of feces is affected
significantly by the type of food
ingested and the bacterial flora of
the individual (of the main order
contributors H2S and mercaptens.
 Consistency; Normal feces are solid
to semi-solid depending on diet.
 80 - 170 g/day.

Factors Affecting Bowel
Elimination
• Age
• Infection
• Diet
• Fluid Intake
• Physical Activity
• Psychological factors
(Stress ...)
• Personal Habits/Daily Routine
• Position during Defecation
• Pain
• Pregnancy
• Diagnostic GI tests
• Surgery and Anesthesia
• Medications

Common Problems Associated
with the Elimination Of
Faeces
 Constipation
 Fecal Impaction
 Diarrhea
 Incontinence
 Flatulence
 Hemorrhoids

Conditions that cause
Diarrhea
 Emotional Stress
 Intestinal Infection
 Food Allergies
 Food Intolerance
 Tube Feedings (Enteral)
 Medications
 Laxatives
 Colon Disease
 Surgery

ADMINISTERING AN
ENEMA
Enema
 AN ENEMA administration is a technique used
to stimulate stool evacuation.
 It is a liquid treatment most commonly used to
relieve severe constipation.
 The process helps push waste out of the rectum
when you cannot do so on your own.
 Enemas are available for purchase at pharmacies
for home use, but you should ask a doctor or
nurse for specific instructions to avoid injury.
 Other types of enemas are administered to clean
out the colon and better detect colon cancer and
polyps.

 BARIUM ENEMA
 Barium is a metal used as a contrast for
x-ray imaging of the intestines.
 Gastroenterologists therefore prescribe
a barium enema to diagnose diseases
and conditions associated with the large
and small intestines, such as colon
cancer or inflammatory bowel disease.
 A barium enema is usually done in your
doctor's office or the radiology
department of a hospital.

TYPES OF CLEANSING ENEMA SOLUTION

ENEMA VARIES ACCORDING TO THE TEMPERATURE OF THE
WATER
1. COLD ENEMA:
 50ºf-65ºf (or 10ºC-18ºC). It is helpful in
decreasing fever and it is also beneficial in
inflammatory conditions of the colon,
especially in cases of dysentery, diarrhea,
ulcerative colitis, and hemorrhoids.
CAUTION:
a. Don't turn on the Enema nozzle fully. Take
10-15m time undergoing Enema practice.
b. In the case of ulcers and hemorrhoids, take
10gm of dried Neem leaves (powder) boiled in
1 liter of water, & then allow to cool. Strain this
water and then use it.

WATER
2.WARM ENEMA:
 97oF-100oF(or 36oC-38oC) is
recommended for general fitness and
well-being once a week. It helps to
cleanse the rectum of the
accumulated tassel matter. This is not
only the safest system for cleaning
the bowel but also improves the
peristaltic movement of the bowels
and thereby relieves constipation.

WATER
3. HOT ENEMA:
 104oF-115oF (or 40oC-45oC) is beneficial on sudden
occasions such as stoppage/obstruction of tassel matter
and intestinal gas in which you may also feeling be
mentally uncomfortable.
 Hot Water Enema is beneficial in relieving irritation
and pain due to inflammation or rectum, painful
hemorrhoid. It also helps leucorrhoea in women.
 It is also beneficial in general abdominal pain,
abdominal pain due to intestinal gas, and pain of
kidney, liver, and spleen.
CAUTION:
a. The quantity of water used should be ¼ - ½ liter and
the enema duration should be 10 minutes.
b. In the case of ulcers and hemorrhoids, boil 10 gm of
dried neem leaves (powder) in 1 liter of water, & then
allow to cool. Strain this water and then use.

WATER
4.GRADUATED ENEMA:
 In graduated Enema the amount
and temperature of water is slowly
decreased up to the 15th day. It is
started with 2 liters of water and
decreased by 125 ml per day up to
125 ml. on the 15th day. In the case
of temperature, it is slowly
decreased from 100o F to 70o F (i.e.
2o per day).
 It is highly beneficial in cases where
intestines are over dilated and it
improves intestinal function.

Equipment
■ Clean gloves
■ Water-soluble lubricant
■ Waterproof, absorbent pads
■ Toilet tissue
■ Bedpan, bedside commode, or access to toilet
■ Basin, washcloths, towel, and soap
■ IV pole
■ Stethoscope
Enema Bag Administration
■ Enema container with tubing and clamp
■ Appropriate-size rectal tube (adult: 22 to 30 Fr;
child: 12 to 18 Fr)
■ Correct volume of warmed (tepid) solution
(adult: 750 to
1000 mL; adolescent: 500 to 700 mL; school-age
child: 300 to
500 mL; toddler: 250 to 350 mL; infant: 150 to 250
mL)

ACTION RATIONALE
 Verify the order for the enema. Bring necessary
equipment to the bedside stand or overbed table.
Verifying the physician’s order is crucial to
ensuring that the proper enema is
administered to the right patient. Bringing
everything to the bedside conserves time
and energy. Arranging items nearby is
convenient, saves time, and avoids
unnecessary stretching and twisting of
muscles on the part of the nurse.
 Perform hand hygiene and put on PPE, if indicated. Hand hygiene and PPE prevent the spread
of microorganisms. PPE is required based
on transmission precaution
 Identify the patient. Identifying the patient ensures the right
patient receives the intervention and helps
prevent errors.
 Close curtains around the bed and close the door to
the room, if possible. Explain what you are going to
do and why you are going to do it to the patient.
This ensures the patient’s privacy.
Explanation relieves anxiety and facilitates
cooperation. The patient is better able to

ACTION RATIONALE
 Warm solution in amount ordered, and check
temperature with a bath thermometer, if available.
If bath thermometer is not available, warm to room
temperature or slightly higher, and test on inner
wrist. If tap water is used, adjust temperature as it
flows from faucet.
Warming the solution prevents chilling the patient,
which would add to the discomfort of the procedure.
The cold solution could cause cramping; too warm a
solution could cause trauma to the intestinal mucosa.
 Add enema solution to container. Release the clamp
and allow fluid to progress through the tube before
reclamping.
This causes any air to be expelled from the tubing.
Although allowing air to enter the intestine is not
harmful, it may further distend the intestine.
 Adjust bed to comfortable working height, usually
elbow height of the caregiver (VISN 8 Patient Safety
Center, 2009). Position the patient on the left side
(Sims’ position), as dictated by patient comfort and
condition. Fold top linen back just enough to allow
access to the patient’s rectal area. Place a
waterproof pad under the patient’s hip.
Having the bed at the proper height prevents back
and muscle strain. Sims’ position facilitates flow of
solution via gravity into the rectum and colon,
optimizing retention of solution. Folding back the
linen in this manner minimizes unnecessary exposure
and promotes the patient’s comfort and warmth. The
waterproof pad will protect the bed.
 Put on nonsterile gloves. Gloves prevent contact with contaminants and body
fluids

ACTION RATIONALE
 Elevate the solution so that it is no higher than 18
inches (45 cm) above the level of the anus. Plan to
give the solution slowly over a period of 5 to 10
minutes. Hang the container on an IV pole or hold
it at the proper height.
Gravity forces the solution to enter the intestine. The
amount of pressure determines the rate of flow and
pressure exerted on the intestinal wall. Giving the
solution too quickly causes rapid distention and
pressure, poor defecation, or damage to the mucous
membrane.
 Generously lubricate end of rectal tube 2 to 3
inches (5 to 7 cm). A disposable enema set may
have a prelubricated rectal tube.
Lubrication facilitates passage of the rectal tube
through the anal sphincter and prevents injury to the
mucosa.
 Lift buttock to expose anus. Slowly and gently
insert the enema tube 3 to 4 to inches (7 to 10 cm)
for an adult. Direct it at an angle pointing toward
the umbilicus, not bladder. Ask the patient to take
several deep breaths.
Good visualization of the anus helps prevent injury to
tissues. The anal canal is about 1 to 2 inches (2½ to 5
cm) long. The tube should be inserted past the
external and internal sphincters, but further insertion
may damage the intestinal mucous membrane. The
suggested angle follows the normal intestinal contour
and thus will help to prevent perforation of the bowel.
Slow insertion of the tube minimizes spasms of the
intestinal wall and sphincters. Deep breathing helps
relax the anal sphincters.

 Introduce the solution slowly over a period of 5 to
10 minutes. Hold tubing all the time that solution is
being instilled.
Introducing the solution slowly helps prevent rapid
distention of the intestine and a desire to defecate.
 Clamp tubing or lower container if patient has
desire to defecate or cramping occurs. Instruct the
patient to take small, fast breaths or to pant.
These techniques help relax muscles and prevent
premature expulsion of the solution.
 After the solution has been given, clamp tubing and
remove tube. Have paper towel ready to receive
tube as it is withdrawn.
Wrapping tube in paper towel prevents dripping of
solution.
 Return the patient to a comfortable position.
Encourage the patient to hold the solution until the
urge to defecate is strong, usually in about 5 to 15
minutes. Make sure the linens under the patient are
dry. Remove your gloves and ensure that the
patient is covered.
This amount of time usually allows muscle
contractions to become sufficient to produce good
results. Promotes patient comfort. Removing
contaminated gloves prevents the spread of
microorganisms.
 Raise side rail. Lower bed height and adjust head of
bed to a comfortable position.
Promotes patient safety.
 Remove additional PPE, if used. Perform hand
hygiene.
Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand

ACTION RATIONALE
 When patient has a strong urge to defecate, place
him or her in a sitting position on a bedpan or assist
to commode or bathroom. Offer toilet tissue, if not
in patient’s reach. Stay with patient or have call bell
readily accessible.
The sitting position is most natural and facilitates
defecation. Fall prevention is a high priority due to the
urgency of reaching the commode.
 Remind patient not to flush commode before nurse
inspects results of enema.
The nurse needs to observe and record the results.
Additional enemas may be necessary if the physician
has ordered enemas “until clear.”
 Put on gloves and assist the patient, if necessary,
with cleaning of the anal area. Offer washcloths,
soap, and water for handwashing. Remove gloves.
Gloves prevent contact with contaminants and body
fluids. Cleaning the anal area and proper hygiene
deter the spread of microorganisms.
 . Leave the patient clean and comfortable. Care for
equipment properly.
Bacteria that grow in the intestine can be spread to
others if equipment is not properly cleaned.
 Perform hand hygiene. Hand hygiene deters the spread of microorganisms.

EVALUATION
 Patient expels feces.
 Patient verbalizes decreased discomfort.
 Abdominal distention is absent.
 Patient remains free of any evidence of
trauma to the rectal mucosa or other adverse
effect.
DOCUMENTATION
 Document the amount and type of enema
solution used; amount, consistency, and color
of stool. Record abdominal assessment, pain
assessment, and assessment of perineal area.
Document the patient’s reaction to the
procedure.

GENERAL CONSIDERATIONS
• Rectal agents and rectal manipulation, including
enemas, should not be used with myelosuppressed
patients and/or patients at risk for
myelosuppression and mucositis. These
interventions can lead to the development of
bleeding, anal fissures, or abscesses, which are
portals for infection.
 If the patient experiences fullness or pain or if fluid
escapes around the tube, stop administration. Wait
30 seconds to a minute and then restart the flow at
a slower rate. If symptoms persist, stop
administration and contact the patient’s physician.
 If the enema has been ordered to be given “until
clear,” check with the physician before
administering more than three enemas. Severe
fluid and electrolyte imbalances may occur if the
patient receives more than three cleansing

ENEMA ADMINISTRATION LECTURE AND DEMONSTRATION

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