Enema#Punitive usage

The principal medical usages of enemas are:

As bowel stimulants, enemas are employed for the same purposes as orally administered laxatives: to relieve constipation; to treat fecal impaction; to empty the colon before a medical procedure such as a colonoscopy. When oral laxatives are not indicated or sufficiently effective, enemas may be a sensible and necessary measure.

A large volume enema{{cite web |url=https://www.merriam-webster.com/medical/high%20enema|title=high enema |website=Medical Dictionary |publisher=Merriam-Webster |access-date=17 February 2018}} can be given to cleanse as much of the colon as possible of feces.{{cite web |title=Administering an Enema |url=http://intranet.tdmu.edu.ua/data/kafedra/internal/meds/prac_skills_alg/Care%20of%20patients/Administering%20an%20Enema.htm |website=Care of patients |date=14 July 2015 |publisher=Ternopil State Medical University |access-date=17 February 2018 |url-status=dead |archive-date=23 February 2018 |archive-url=https://web.archive.org/web/20180223111015/http://intranet.tdmu.edu.ua/data/kafedra/internal/meds/prac_skills_alg/Care%20of%20patients/Administering%20an%20Enema.htm}}{{cite web |url=http://www.peoi.org/Courses/Coursesen/nursepractice/ch/ch12e1.html |title=Types of Enemas |website=Fundamentals of Nursing Practice |publisher=Professional Education, Testing and Certification Organization International |author=Rhodora Cruz |access-date=17 February 2018}} However, a low enema is generally useful only for stool in the rectum, not in the intestinal tract.{{cite web |url=https://www.merriam-webster.com/medical/low%20enema|title=low enema |website=Medical Dictionary |publisher=Merriam-Webster |access-date=17 February 2018}}

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.

{{anchor|Soapsuds enema}}

File:Soapsuds Enemas.jpg

For emptying the entire colon as much as feasible deeper and higher enemas are utilized to reach large colon sections. The colon dilates and expands when a large volume of liquid is injected into it. The colon reacts to that sudden expansion with general contractions, peristalsis, propelling its contents toward the rectum.

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.

Plain water can be used, functioning mechanically to expand the colon, thus prompting evacuation.

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 electrolytes 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.{{cite journal|title=Safety and effectiveness of large-volume enema solutions |author1=Marilee Schmelzer |author2=Lawrence R. Schiller |author3=Richard Meyer |author4=Susan M. Rugari |author5=Patti Case |date=November 2004 |journal=Applied Nursing Research |doi=10.1016/j.apnr.2004.09.010 |volume=17 |issue=4 |pages=265–274|pmid=15573335}} However, liquid handsoaps and detergents should not be used.

Glycerol is a specific bowel mucosa irritant serving to induce peristalsis via a hyperosmotic effect.{{cite web |url=https://www.drugs.com/cdi/glycerin-enema.html |title=Glycerin Enema |publisher=Drugs.com |access-date=2018-09-09}} It is used in a dilute solution, e.g., 5%.{{cite journal |vauthors=Bertani E, Chiappa A, Biffi R, Bianchi PP, Radice D, Branchi V, Spampatti S, Vetrano I, Andreoni B |title=Comparison of oral polyethylene glycol plus a large volume glycerine enema with a large volume glycerine enema alone in patients undergoing colorectal surgery for malignancy: a randomized clinical trial |journal=Colorectal Disease |volume=13 |issue=10 |pages=e327–e334 |year=2011 |pmid=21689356 |doi=10.1111/j.1463-1318.2011.02689.x |s2cid=32872781}}

Equal parts of milk and molasses were heated to slightly above normal body temperature.{{Cite journal|last1=Nicholls|first1=Pam Hufford|last2=Metules|first2=Terri J|date=April 2001|title=Some old-fashioned enemas still work and are still used|journal=RN|volume=64|pages=80}} Neither the milk sugars and proteins nor the molasses are absorbed in the lower intestine, thus keeping the water from the enema in the intestine.{{cite journal | url=https://med.virginia.edu/pediatrics/about/clinical-and-patient-services/patient-tutorials/chronic-constipation-encopresis/treatment-of-chronic-constipation | title=Treatment of Chronic Constipation | volume=58 | issue=4 | pages=503–512 | journal=Clinical and Patient Services > Tutorials for Patients & Families | access-date=12 September 2018 | bibcode=1954NYASA..58..503I | last1=Ingelfinger | first1=Franz J. | year=1954 | doi=10.1111/j.1749-6632.1954.tb45865.x | pmid=29831395 | pmc=5251364 }}{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }} Studies have shown that milk and molasses enemas have a low complication rate when used in the emergency department{{cite journal |url=https://www.jem-journal.com/article/S0736-4679(15)00059-1/fulltext |title=Safety and Efficacy of Milk and Molasses Enemas in the Emergency Department |volume=48 |issue=6 |pages=667–70 |author1=Gary M. Vilke |author2=Gerard DeMers |author3=Nilang Patel |author4=Edward M. Castillo |date=June 2015 |journal=The Journal of Emergency Medicine |publisher=American Academy of Emergency Medicine |access-date=2019-03-19 |pmid=25850633 |doi=10.1016/j.jemermed.2015.01.035 |s2cid=9638496 }} and are safe and effective with minimal side effects.{{cite journal |url=https://www.jenonline.org/article/S0099-1767(13)00413-3/fulltext |title=Milk and Molasses Enemas: Clearing Things Up |author1=Kimberley Wallaker |author2=Ezio Fortuna |author3=Stuart Bradin |author4=Michelle Macy |author5=Michelle Hassan |author6=Rachel Stanley |date=November 2014 |journal=Journal of Emergency Nursing |volume=40 |issue=6 |pages=546–551 |publisher=The Emergency Nurses Association |access-date=2019-03-19 |pmid=24182894 |doi=10.1016/j.jen.2013.08.012 }}

Mineral oil functions as a lubricant and stool softener, but may have side effects including rectal skin irritation and oil leakage.{{cite web |url=https://my.clevelandclinic.org/health/drugs/20248-mineral-oil-rectal-enema |title=Mineral Oil rectal enema |work=Drugs, Devices & Supplements |publisher=Cleveland Clinic |access-date=2019-04-01 }}

File:Enema prepared, disposable.jpg

{{ATC codes lead|A|06|Drugs for constipation}}

:A06AG01 Sodium phosphate

:A06AG02 Bisacodyl

:A06AG03 Dantron, including combinations

:A06AG04 Glycerol

:A06AG06 Oil

:A06AG07 Sorbitol

:A06AG10 Docusate sodium, including combinations

:A06AG11 Sodium lauryl sulfoacetate, including combinations

:A06AG20 Combinations

{{Expand section|date=March 2019}}

In alphabetical order

• Arachis oil (peanut oil) enema is useful for softening stools which are impacted higher than the rectum.{{cite web |url=http://www.nhsgrampian.org/nhsgrampian/GJF_general_new.jsp;jsessionid=9D853EB1A4631954DC26F785F611F2B1?pContentID=4659&p_applic=CCC&pElementID=522&pMenuID=7&p_service=Content.show& |title=NHS Grampian Medicines Management – Laxatives |date=2011 |work=NHS Grampian Campaign |publisher=National Health Service |access-date=4 March 2019 }}{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }}
• Bisacodyl stimulates enteric nerves to cause colonic contractions.{{cite book |doi=10.1002/14356007.a15_183 |chapter=Laxatives |title=Ullmann's Encyclopedia of Industrial Chemistry |year=2000 |last1=Engelhorn |first1=Robert |last2=Seeger |first2=Ernst |last3=Zwaving |first3=Jan H. |isbn=3527306730 }}{{cite web |url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=324e61eb-8f6b-48d7-85c2-b1b5642691c9 |title=Label: FLEET- bisacodyl enema |access-date=3 March 2019}}
• Dantron is a stimulant drug and stool softener{{cite book |doi=10.1016/B978-1-4377-1015-1.00018-7 |chapter=Constipation during active cancer therapy |title=Supportive Oncology |year=2011 |last1=Sykes |first1=Nigel P. |pages=177–186 |isbn=9781437710151 }} used alone or in combinations in enemas.{{cite web |url=https://www.whocc.no/atc_ddd_index/?code=A06AG&showdescription=yes |title=A06AG Enemas |date=13 December 2018 |work=WHO Collaborating Centre for Drug Statistics Methodology |publisher=World Health Organization |access-date=3 March 2019}} Considered to be a carcinogen{{cite web |url=https://ntp.niehs.nih.gov/pubhealth/roc/listings/index.html?substance=Danthron |title=Report on Carcinogens, Fourteenth Edition |date=November 2016 |work=Report on Carcinogens |publisher=National Toxicology Program, Department of Health and Human Services (HHS) |access-date=3 March 2019}} its use is limited, e.g., restricted in the UK to patients who already have a diagnosis of terminal cancer and not used at all in the USA.
• Docusate{{cite web |url=https://www.nursingtimes.net/clinical-archive/medicine-management/docusate-sodium-18-12-2004/ |title=Docusate sodium|date=18 December 2004}}{{Cite web |url=https://www.drugs.com/cdi/colace-microenema.html|title=Colace Microenema: Indications, Side Effects, Warnings|website=Drugs.com}}
• Glycerol has a hyperosmotic effect and can be used as a small-volume (2–10 ml) enema (or suppository).
• Mineral oil is used as a lubricant because most of the ingested material is excreted in the stool rather than absorbed by the body.{{Cite web |title=206. Food-grade mineral oil (FAO Nutrition Meetings Report Series 48a) |url=https://inchem.org/documents/jecfa/jecmono/v48aje08.htm |archive-url=https://web.archive.org/web/20070806023007/http://inchem.org/documents/jecfa/jecmono/v48aje08.htm|url-status=dead|archive-date=6 August 2007 |website=inchem.org}}
• Sodium phosphate.{{cite web |url=https://www.drugs.com/cdi/sodium-phosphates-enema.html |title=Sodium Phosphates Enema |access-date=3 March 2019}}{{cite web |url=https://medlineplus.gov/druginfo/meds/a614018.html |title=Sodium Phosphate Rectal |access-date=3 March 2019}} Also known by the brand name Fleet. Available at drugstores; usually self-administered. Buffered sodium phosphate solution draws additional water from the bloodstream into the colon to increase the effectiveness of the enema. But it can irritate the colon, causing intense cramping or "griping."{{cite web |title=Fleet Enema Side Effects |url=https://www.drugs.com/sfx/fleet-enema-side-effects.html |website=www.drugs.com |publisher=Drugs.com |access-date=July 12, 2021}} Fleet enemas usually cause a bowel movement in 1 to 5 minutes. Known adverse effects.
• Sorbitol pulls water into the large intestines, causing distention, stimulating the bowels' normal forward movement. Sorbitol is found in some dried fruits and may contribute to the laxative effects of prunes.{{cite journal |last1=Stacewicz-Sapuntzakis |first1=Maria |last2=Bowen |first2=Phyllis E. |last3=Hussain |first3=Erum A. |last4=Damayanti-Wood |first4=Bernadette I. |last5=Farnsworth |first5=Norman R. |title=Chemical Composition and Potential Health Effects of Prunes: A Functional Food? |journal=Critical Reviews in Food Science and Nutrition |date=July 2001 |volume=41 |issue=4 |pages=251–286 |doi=10.1080/20014091091814 |pmid=11401245 |s2cid=31159565 }} and is available for taking orally as a laxative.{{cite web|url=http://www.cancer.org/docroot/CDG/content/CDG_sorbitol.asp |title=ACS :: Cancer Drug Guide: sorbitol |archive-url=https://web.archive.org/web/20070630001051/http://www.cancer.org/docroot/CDG/content/CDG_sorbitol.asp |archive-date=2007-06-30}}{{Cite web | url=https://www.webmd.com/drugs/2/drug-10305/sorbitol/details |title = Drugs & Medications}} As an enema for constipation, the recommended adult dose is 120 mL of 25-30% solution, administered once.{{cite web |url=https://reference.medscape.com/drug/sorbitol-342033|title= Sorbitol| access-date=3 March 2019}} Note that Sorbitol is an ingredient of the MICROLAX Enema.

====== Compounded from multiple ingredients ======

{{Expand section|date=March 2019}}

In alphabetical order of the original brand names

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,{{cite web |url=https://www.news-medical.net/drugs/Klyx.aspx |title=Klyx |date=March 2017 |work=NHS Grampian Campaign |publisher=National Health Service |access-date=4 March 2019 |archive-date=6 March 2019 |archive-url=https://web.archive.org/web/20190306043511/https://www.news-medical.net/drugs/Klyx.aspx |url-status=dead }} developed by Ferring B.V.

Micralax (not to be confused with MICROLAX®){{cite web |url=https://www.medicines.org.uk/emc/product/9099/pil |title=NHS Grampian – Laxatives |date=16 May 2011 |work=Latest medicine updates |publisher=electronic Medicines Compendium (eMC) |access-date=4 March 2019}}

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;{{cite web |url=https://www.nps.org.au/medical-info/medicine-finder/microlax-enema |title=Microlax Enema |date=2018 |work=NPS MedicineWise |publisher=National Prescribing Service |access-date=4 March 2019}} which was initially tested in preparation for sigmoidoscopy.{{cite journal |author=W. Lieberman|year=1964|title=Rapid patient preparation for sigmoidoscopy by microenema.|journal=American Journal of Proctology|volume=15|pages=138–41|pmid=14139893}}

Micolette Micro-enema® contains 45 mg sodium lauryl sulphoacetate, 450 mg per 5 ml sodium citrate BP, and 625 mg glycerol BP{{cite web |url=https://www.medicines.org.uk/emc/product/4569/smpc |title=Micolette Micro-enema |date=10 July 2015 |work=Latest medicine updates |access-date=4 March 2019}} and is a small volume stimulant enema suitable where large-volume enemas are contra-indicated.

{{Main|Transanal irrigation}}

TAI, also termed retrograde irrigation, is designed to assist evacuation using a water enema{{cite journal|last1=Emmanuel|first1=A V|last2=Krogh|first2=K|last3=Bazzocchi|first3=G|last4=Leroi|first4=A-M|last5=Bremers|first5=A|last6=Leder|first6=D|last7=van Kuppevelt|first7=D|last8=Mosiello|first8=G|last9=Vogel|first9=M|last10=Perrouin-Verbe|first10=B|last11=Coggrave|first11=M|last12=Christensen|first12=P|title=Consensus review of best practice of transanal irrigation in adults|journal=Spinal Cord|date=20 August 2013|volume=51|issue=10|pages=732–738|doi=10.1038/sc.2013.86|pmid=23958927|doi-access=free}} as a treatment for persons with bowel dysfunction, including fecal incontinence or constipation, especially obstructed defecation. By regularly emptying the bowel using transanal irrigation,[http://www.nature.com/sc/journal/v51/n10/pdf/sc201386a.pdf], Consensus review of best practice of transanal irrigation in adults A V Emmanuel et al. Spinal Cord 2013. controlled bowel function is often re-established to a high degree, thus enabling a consistent bowel routine development. Its effectiveness varies considerably, some individuals experiencing complete control of incontinence but others reporting little or no benefit.

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.{{Cite journal |last1=Spinelli |first1=Michele |last2=Sampogna |first2=Gianluca |last3=Rizzato |first3=Luigi |last4=Spinelli |first4=Antonella |last5=Sammartano |first5=Fabrizio |last6=Cimbanassi |first6=Stefania |last7=Montanari |first7=Emanuele |last8=Chiara |first8=Osvaldo |date=2021-04-23 |title=The Malone antegrade continence enema adapting a transanal irrigation system in patients with neurogenic bowel dysfunction |journal=Spinal Cord Series and Cases |volume=7 |issue=1 |pages=34 |doi=10.1038/s41394-021-00397-3 |issn=2058-6124 |pmc=8065210 |pmid=33893272}}

{{Main|Bowel management}}

Patients who have a bowel disability, a medical condition which impairs control of defecation, e.g., fecal incontinence or constipation,{{cite web|title=Bowel Management After Spinal Cord Injury|url=http://www.sci-info-pages.com/bowel.html|website=sci-info-pages.com|date=2 June 2019|language=en}} can use bowel management techniques to choose a predictable time and place to evacuate. Without bowel management, such persons might either suffer from the feeling of not getting relief or soil themselves.

While simple techniques might include a controlled 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

File:Barium Contrast Enema.jpg

In a lower gastrointestinal series an enema that may contain barium sulfate powder or a water-soluble contrast agent is used in the radiological imaging of the bowel. Called a barium enema, such enemas are sometimes the only practical way to view the colon relatively safely.

Failure to expel all of the barium may cause constipation or possible impaction{{cite web |url=https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/barium_enema_92,P07687 |title=aGastroenterology Tests and Procedures – Barium Enema |work=Health Library |publisher=Johns Hopkins School of Medicine |access-date=2019-04-01 }} 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.{{cite web |url=http://www.swmedcenter.com/index.php/services-2/diagnostic-imaging/bariumgastroview-enema/ |title=Barium/Gastroview Enema |work=Our Services |publisher=Southwest Medical Center in Liberal, Kansas, USA |access-date=2019-04-01 }}

The administration of substances into the bloodstream. This may be done in situations where it is undesirable or impossible to deliver a medication by mouth, such as antiemetics given to reduce nausea (though not many antiemetics are delivered by enema). Additionally, several anti-angiogenic agents, which work better without digestion, can be safely administered via a gentle enema.

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.

• Traveller's diarrhea's symptoms treated with an enema of sodium butyrate, organic acids, and A-300 silicon dioxide can be successfully decreased with lack of observed side effects.
• Shigellosis treatment benefits from adjunct therapy with butyrate enemas, promoting healing of the rectal mucosa and inflammation, but not helping in clinical recovery from shigellosis. Use of an 80 ml of a sodium butyrate isotonic enema administered every 12 hours has been studied and found effective.{{cite journal |title= Efficacy of sodium butyrate adjunct therapy in shigellosis: a randomized, double-blind, placebo-controlled clinical trial |journal = BMC Infectious Diseases|volume = 12|pages = 111|date = 10 May 2012 |publisher = U.S. Department of Health & Human Services, National Institutes of Health (NIH) |pmc = 3447723|last1 = Raqib|first1 = R.|last2 = Sarker|first2 = P.|last3 = Mily|first3 = A.|last4 = Alam|first4 = N. H.|last5 = Arifuzzaman|first5 = A. S.|last6 = Rekha|first6 = R. S.|last7 = Andersson|first7 = J.|last8 = Gudmundsson|first8 = G. H.|last9 = Cravioto|first9 = A.|last10 = Agerberth|first10 = B.|pmid = 22574737|doi = 10.1186/1471-2334-12-111 | doi-access=free }}

• There have been a few cases in remote or rural settings, where rectal fluids have been used to rehydrate a person. Benefits include not needing to use sterile fluids.{{cite journal |last1=Tremayne |first1=Vincent |title=Proctoclysis: emergency rectal fluid infusion |journal=Nursing Standard |date=23 September 2009 |volume=24 |issue=3 |pages=46–48 |doi=10.7748/ns2009.09.24.3.46.c7271 |pmid=19856644 }}
• Introducing healthy bacterial flora through infusion of stool, known as a fecal microbiota transplant, was first performed in 1958 employing retention enemas. Enemas remained the most common method until 1989, when alternative administration means were developed.{{cite journal |last1=Bakken |first1=Johan S. |last2=Borody |first2=Thomas |last3=Brandt |first3=Lawrence J. |last4=Brill |first4=Joel V. |last5=Demarco |first5=Daniel C. |last6=Franzos |first6=Marc Alaric |last7=Kelly |first7=Colleen |last8=Khoruts |first8=Alexander |last9=Louie |first9=Thomas |last10=Martinelli |first10=Lawrence P. |last11=Moore |first11=Thomas A. |last12=Russell |first12=George |last13=Surawicz |first13=Christina |author14=Fecal Microbiota Transplantation Workgroup |title=Treating Clostridium difficile Infection With Fecal Microbiota Transplantation |journal=Clinical Gastroenterology and Hepatology |date=December 2011 |volume=9 |issue=12 |pages=1044–1049 |doi=10.1016/j.cgh.2011.08.014 |pmid=21871249 |pmc=3223289 }} As of 2013, colonoscope implantation has been preferred over fecal enemas because by using the former method, the entire colon and ileum can be inoculated, but enemas reach only to the splenic flexure.{{cite journal |title=Fecal microbiota transplantation: past, present and future |issue=1 |pages=79–84 |author=Olga C. Aroniadis |author2=Lawrence J. Brandt |date=January 2013 |journal=Current Opinion in Gastroenterology |volume=29 |publisher=Lippincott Williams & Wilkins |doi=10.1097/MOG.0b013e32835a4b3e |pmid=23041678 |s2cid=39943619 |doi-access=free }}
• A patient unable to be fed otherwise can be nourished by an enteral administration of predigested foods, which is known as a nutrient enema.{{cite web |url=https://medical-dictionary.thefreedictionary.com/nutrient+enema |title=nutrient enema |work=The Free Dictionary |publisher=TheFreeDictionary.com |access-date=2019-05-01 }} This treatment is ancient, dating back at least to the second century CE when documented by Galen, and commonly used in the Middle Ages,{{cite journal |vauthors=Short AR, Bywaters HW |title=Amino-Acids and Sugars in Rectal Feeding |journal=Br Med J |volume=1 |issue=2739 |pages=1361–1367 |date=June 1913 |pmid=20766702 |pmc=2299894 |doi=10.1136/bmj.1.2739.1361 |jstor=25302025}} remaining a common technique in 19th century,{{cite journal |vauthors=Mackenzie JW |title=The nutrient enema |journal=Arch. Dis. Child. |volume=18 |issue=93 |pages=22–27 |date=March 1943 |pmid=21032242 |pmc=1987791 |doi=10.1136/adc.18.93.22}} and as recently as 1941 the U. S. military's manual for hospital diets prescribes their use.{{cite web |url=https://collections.nlm.nih.gov/ext/dw/33320860R/PDF/33320860R.pdf |title=War Department Technical Manual Hospital Diets |date=October 13, 1941 |work=Technical Manuals |publisher=United States Department of War |access-date=2019-05-01 }} Nutrient enemas have been superseded in modern medical care by tube feeding and intravenous feeding.{{Citation needed|reason=|date=May 2019}}
• Enemas have been used around the time of childbirth; however, there is no evidence that this practice is beneficial and it is now discouraged.{{cite web |url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010611/ |title = Enemas during labour |date = 4 July 2013 |website = Cochrane Database of Systematic Reviews: Plain Language Summaries |publisher = National Institutes of Health (NIH) |access-date = 14 June 2016 }}

Improper administration of an enema can cause electrolyte imbalance (with repeated enemas) or ruptures to the bowel or rectal tissues which can be unnoticed as the rectum is insensitive to pain,{{cite journal |last1=Lee |first1=Seokyoun |last2=Kwon |first2=Jungnam |last3=Lee |first3=Junhee |title=Rectal perforations caused by cleansing enemas in chronically constipated patients: Two case reports |journal=SAGE Open Medical Case Reports |date=8 July 2020 |volume=8 |pages=2050313X20938251 |doi=10.1177/2050313X20938251 |pmid=32685153 |pmc=7346698 }} resulting in internal bleeding. However, these occurrences are rare in healthy, sober adults. Internal bleeding or rupture may expose the individual to infections from intestinal bacteria. Blood resulting from tears in the colon may not always be visible, but can be distinguished if the feces are unusually dark or have a red hue. If intestinal rupture is suspected, medical assistance should be obtained immediately.{{Cite encyclopedia |title=Enema administration |encyclopedia=Encyclopedia of Nursing and Allied Health |first=Mary Elizabeth |last=Martelli |url=http://findarticles.com/p/articles/mi_gGENH/is_/ai_2699003276.htm |access-date=11 January 2008 |via=FindArticles |url-status=dead |archive-date=23 January 2008 |archive-url=https://web.archive.org/web/20080123073414/http://findarticles.com/p/articles/mi_gGENH/is_/ai_2699003276.htm}} Frequent use of enemas can cause laxative dependency.{{Cite web |url=https://www.webmd.com/drugs/2/drug-14831/fleet-enema-rectal/details |title=Fleet Enema Rectal: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing |website=WebMD}}

The enema tube and solution may stimulate the vagus nerve, which may trigger an 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 rupture.

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 pathologies where the pathology contributes to the risk of bowel perforation.{{cite web|title=Colon Hydrotherapy |website=Aetna IntelliHealth |url=http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358752.html?d=dmtContent |date=1 July 2005 |access-date=23 April 2007 |url-status=dead |archive-url=https://web.archive.org/web/20070807002412/http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358752.html?d=dmtContent |archive-date=7 August 2007 }}

Recent research has shown that ozone water, which is sometimes used in enemas, can immediately cause microscopic colitis.{{cite journal |vauthors = Eliakim R, Karmeli F, Rachmilewitz D, Cohen P, Zimran A |title = Ozone Enema: A Model of Microscopic Colitis in Rats |journal = Digestive Diseases and Sciences |volume = 46 |issue = 11 |pages = 2515–20 |date = 4 January 2004 |pmid = 11713963 |doi = 10.1023/A:1012348525208 |s2cid = 11489322 }}

A recent case series{{cite journal |vauthors = Ori Y, Rozen-Zvi B, Chagnac A, Herman M, Zingerman B, Atar E, Gafter U, Korzets A |title = Fatalities and Severe Metabolic Disorders Associated With the Use of Sodium Phosphate Enemas |journal = Archives of Internal Medicine |volume = 172 |issue = 3 |pages = 263–5 |year = 2012 |pmid = 22332159 |doi = 10.1001/archinternmed.2011.694 }} of 11 patients with five deaths illustrated the danger of phosphate enemas in high-risk patients.

Enema entered the English language c. 1675 from Latin in which, in the 15th century, it was first used in the sense of a rectal injection, from Greek ἔνεμα (énema), "injection", itself from ἐνιέναι (enienai) "to send in, inject", from ἐν (en), "in" + ἱέναι (hienai), "to send, throw".{{cite web |url=https://www.etymonline.com/search?q=enema |title=enema (n.) |work=Online Etymology Dictionary |publisher=Douglas Harper of the LNP Media Group |access-date=2019-04-15 }}

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",{{cite web |url=https://www.etymonline.com/search?q=clyster |title=clyster (n.) |work=Online Etymology Dictionary |publisher=Douglas Harper of the LNP Media Group |access-date=2019-12-29 }} also spelled glister in the 18th century.{{cite book |author=Benjamin Rush |title=Medical observations and inquiries |volume=3 |year=1769 |pages=250, 251, 252 |work=By a Society of Physicians in London |location=London |url=https://archive.org/details/s9id13413710/ |access-date=2022-01-22 |edition=The Second }} It is a generally archaic word used more particularly for enemas administered using a clyster syringe.

The first mention of the enema in medical literature is in the Ancient Egyptian Ebers Papyrus ({{circa|1550}} BCE). One of the many types of medical specialists was a Nery-Pehuyt, the Shepherd of the Anus. Enemas administered many medications.Magner, A History of Medicine:31 There was a Keeper of the Royal RectumMagner, A History of Medicine:30 who may have primarily been the pharaoh's enema maker. According to Egyptian mythology, the god Thoth invented the enema.Magner, A History of Medicine:26

File:Afrikanische Holzplastik.jpg

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

The Olmec used trance-inducing substances ceremonially from their middle preclassic period (10th through 7th centuries BCE) through the Spanish Conquest. These were ingested via enemas administered using jars, among other routes.

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.{{cite journal |title=Hallucinogenic drugs in pre-Columbian Mesoamerican cultures |volume=30 |issue=1 |pages=42–49 |author=F. J. Carod-Artal |date=2011-07-01 |journal=Neurología |doi=10.1016/j.nrleng.2011.07.010 |pmid=21893367 |doi-access= }} 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{{cite journal |vauthors = de Smet PA, Hellmuth NM |title = A multidisciplinary approach to ritual enema scenes on ancient Maya pottery |journal = J Ethnopharmacol |volume = 16 |issue = 2–3 |pages = 213–62 |year = 1986 |pmid = 3528674 |doi = 10.1016/0378-8741(86)90091-7 }}

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.{{Citation |last1 = Hurt |first1 = Raymond |last2 = Barry |first2 = J. E. |last3 = Adams |first3 = A. P. |last4 = Fleming |first4 = P. R. |title = The History of Cardiothoracic Surgery from Early Times |publisher = Informa Health Care |page=120 |year = 1996 |isbn = 978-1850706816 |url=https://books.google.com/books?id=ShLvi_kRQtQC}}{{Citation |doi = 10.2307/2843888 |last = Nordenskiold |first = Erland |title = The American Indian as an Inventor |jstor = 2843888 |journal = Journal of the Royal Anthropological Institute |volume = 59 |page=277 |year = 1929}}

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 Babylonia, by 600 BCE, enemas were in use. However, it appears that initially they were in use because of a belief that the demon of disease would be driven out of the body by utilizing an enema.Friedenwald & Morrison, Part I:77 Babylonian and Assyrian tablets c. 600 BCE bear cuneiform inscriptions referring to enemas.{{cite journal |last1=Page |first1=Sidney G. |title=A Comparative Clinical Study of Several Enemas |journal=Journal of the American Medical Association |date=2 April 1955 |volume=157 |issue=14 |pages=1208–1210 |doi=10.1001/jama.1955.02950310034008 |pmid=14353661 }}

In China, c. 200 CE, Zhang ZhongjingRedirected from Chang Chung-ching, the name used in the reference---> 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.

File:The Enema MET DP818226.jpg, ca. 1632–33]]

Hippocrates (460–370 BCE) frequently mentions enemas, e.g., "if the previous food which the patient has recently eaten should not have gone down, give an enema if the patient be strong and in the prime of life, but if he be weak, a suppository should be administered, should the bowels be not well moved on their own accord."Friedenwald & Morrison, 'Part I:71

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,{{cite book|author=Soranus|translator=Owsei Temkin |title=Soranus' Gynecology|date=1956|publisher=JHU Press|pages=62–67|isbn=9780801843204}} 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,{{cite web |url=http://www.rpharms.com/museum-pdfs/21-enemas.pdf |title = Information Sheet:21 Enemas |website = Information Sheets |publisher = Museum of the Royal Pharmaceutical Society, London |url-status=dead |archive-url=https://web.archive.org/web/20160306155528/https://www.rpharms.com/museum-pdfs/21-enemas.pdf |archive-date=2016-03-06 |access-date=2020-01-03 }} and also Galen mentions enemas in several contexts.{{Citation |last = Mattern |first = Susan P. |year = 2008 |title = Galen and the Rhetoric of Healing |publisher = Johns Hopkins University Press |location = Johns Hopkins University Press, Maryland, USA |isbn=978-0-8018-8835-9 |pages = 31, 145, 149 |url = https://books.google.com/books?id=5IXlOC1_liEC }}

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.{{Citation needed|date=July 2020}}

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.{{Citation needed|date=July 2020}}

File:Klistierbank1.JPG (18th century; Medical History Museum, University of Zurich)]]

File:Clyster syringes.jpg

Beginning in the 17th century, enema apparatus was chiefly designed for self-administration at home, and many were French as enemas enjoyed wide usage in France.

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.{{cite journal |doi=10.1136/adc.66.1_Spec_No.78 |title=Francois Mauriceau (1637-1709) and maternal posture for parturition |year=1991 |last1=Dunn |first1=P. M. |journal=Archives of Disease in Childhood |volume=66 |issue=1 Spec No |pages=78–79 |pmid=1996901 |pmc=1590357 }}

Clysters were administered for symptoms of constipation and, with more questionable effectiveness, stomach aches and other illnesses.{{when|date=July 2020}}{{Citation needed|date=July 2020}}{{Cite journal |title= Chronic Constipation: Current Treatment Options|date=2011 |pmc=3206558 |last1=Liu |first1=L. W. |journal=Canadian Journal of Gastroenterology |volume=25 |issue=Suppl B |pages=22B–28B |doi=10.1155/2011/360463 |pmid=22114754 |doi-access=free }}

File:A monkey rejects the old style clyster for his new 'clyso-pompe', which he fills with opium and marshmallow Wellcome V0011775.jpg

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.{{cite web |url=https://www.bcmj.org/special-feature/special-feature-tobacco-smoke-enemas |title=Special feature: Tobacco smoke enemas |author=Sterling Haynes |date=December 2012 |work=British Columbia Medical Journal |publisher=Doctors of BC |access-date=2019-03-29 }} 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 ailments, the foremost of which were stomach aches and constipation.{{cite journal |last1=Clemens |first1=Katri E. |last2=Faust |first2=Markus |last3=Jaspers |first3=Birgit |last4=Mikus |first4=Gerd |title=Pharmacological treatment of constipation in palliative care |journal=Current Opinion in Supportive and Palliative Care |date=June 2013 |volume=7 |issue=2 |pages=183–191 |doi=10.1097/SPC.0b013e32835f1e17 |pmid=23478431 |s2cid=3283246 }}

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, [http://rouvroy.medusis.com/docs/1004.html 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.{{cite web |url=http://www.newsadvance.com/content/tncms/assets/v3/eedition/5/3d/53db44b6-01db-594c-9ed2-a6b4881fb211/537a39dec336e.pdf.pdf |title=Fleet |date=2014-04-27 |work=A Supplement to The News & Advance |publisher=The News & Advance |access-date=2020-01-03 |archive-date=3 January 2020 |archive-url=https://web.archive.org/web/20200103203637/http://www.newsadvance.com/content/tncms/assets/v3/eedition/5/3d/53db44b6-01db-594c-9ed2-a6b4881fb211/537a39dec336e.pdf.pdf |url-status=dead }}

The term "colonic irrigation" is commonly used in gastroenterology to refer to the practice of introducing water through a colostomy or a surgically constructed conduit as a treatment for constipation.{{cite journal |last1=Locke |first1=G.Richard |last2=Pemberton |first2=John H. |last3=Phillips |first3=Sidney F. |title=AGA technical review on constipation |journal=Gastroenterology |date=December 2000 |volume=119 |issue=6 |pages=1766–1778 |doi=10.1053/gast.2000.20392 |pmid=11113099 |doi-access=free }} The Food and Drug Administration has ruled that colonic irrigation equipment is not approved for sale for general well-being{{cite web |title = Subpart F—Therapeutic Devices Sec. 876.5220 Colonic irrigation system |website = Code of Federal Regulations, Title 21 Food and Drugs, Subchapter H – Medical Devices, Part 876 – Gastroenterology-Urology Devices |date = 1 April 2007 |url = http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=876.5220 |publisher = FDA }} and has taken action against many distributors of this equipment, including a Warning Letter.{{cite web |author = Department of Health and Human Services |title = Warning letter to Dotolo Research Corp |url = https://www.casewatch.net/fdawarning/prod/1999/dotolo.shtml |format = reprint by Casewatch |date = 21 July 1999 |publisher = FDA |access-date = 31 December 2007 }}

{{Main|Colon cleansing}}

The same term is also used in alternative medicine where it may involve the use of substances mixed with water to detoxify the body. Practitioners believe the accumulation of fecal matter in the large intestine leads to ill health.{{cite journal |author = Whorton J |title = Civilisation and the colon: constipation as the "disease of diseases" |journal = BMJ |volume = 321 |issue = 7276 |pages = 1586–9 |year = 2000 |pmid = 11124189 |pmc = 1119264 |doi = 10.1136/bmj.321.7276.1586 }} This resurrects the old medical concept of autointoxication which was orthodox doctrine until the end of the 19th century but has now been discredited.{{cite journal |last1=Ernst |first1=E. |title=Colonic Irrigation and the Theory of Autointoxication: A Triumph of Ignorance over Science |journal=Journal of Clinical Gastroenterology |date=June 1997 |volume=24 |issue=4 |pages=196–198 |doi=10.1097/00004836-199706000-00002 |pmid=9252839 |doi-access=free }}{{cite journal |author = Kaiser |title = The Case Against Colonic Irrigation |journal = California Morbidity |issue = 38 |year = 1985 }}{{cite journal |vauthors = Chen TS, Chen PS |title = Intestinal autointoxication: a medical leitmotif |journal = Journal of Clinical Gastroenterology |volume = 11 |issue = 4 |pages = 434–41 |year = 1989 |pmid = 2668399 |doi = 10.1097/00004836-198908000-00017 }}

In the late 19th century, Dr. John Harvey Kellogg made sure that every patient's bowel was plied with water, from above and below. His favorite device was an enema machine ("just like one I saw in Germany") that could run fifteen gallons of water through a person's bowel in seconds. Every water enema was followed by a pint of yogurt—half was eaten, the other half was administered by enema "thus planting the protective germs where they are most needed and may render most effective service." The yogurt served to replace "the intestinal flora" of the bowel, creating what Kellogg claimed was a completely clean intestine.{{cite web |url=http://www.museumofquackery.com/amquacks/kellogg.htm |title=Dr. John Harvey Kellogg |website=Great American Quacks |publisher=Museum of Quackery |access-date=12 February 2018}}

Chlorine dioxide enemas have been fraudulently marketed as a medical treatment, primarily for autism. This has resulted, for example, in a six-year-old boy needing to have his colon removed and a colostomy bag fitted,{{cite web |url=https://www.mirror.co.uk/news/uk-news/secret-facebook-group-reveals-how-10944477 |title=Secret Facebook group reveals how parents use bleach enemas on autistic children in bid to 'cure' disability |author=Sophie Norri |author2=Lucy Clarke-Billings |date=2017-08-08 |work=Daily Mirror |publisher=Reach plc |access-date=2019-03-24 }}{{cite web |url=https://metro.co.uk/2017/08/07/mother-investigated-for-giving-son-bleach-enema-to-cure-his-autism-6834610/ |title=Mother 'investigated for giving son bleach enema to "cure" his autism' |author=Toby Meyjes |date=2017-08-07 |work=Metro (British newspaper) |publisher=DMG Media |access-date=2019-03-24 }} complaints to the FDA reporting life-threatening reactions,{{cite web |url=https://abc7news.com/news/group-of-socal-parents-secretly-try-to-cure-kids-with-autism-using-bleach/1578833/ |title=Group of SoCal parents secretly try to cure kids with autism using bleach |author=Lisa Bartley |date=2016-10-29 |work=ABC 7 News |publisher=American Broadcasting Company |access-date=2019-03-24 }} and even death.{{cite web |title=The fake cures for autism that can prove deadly |url=https://www.theguardian.com/society/2016/jul/13/fake-cures-autism-prove-deadly |author=Frances Ryan |date=2016-07-13 |work=The Guardian |access-date=2019-03-24 }}

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.{{cite web |title=The truth about chlorine dioxide and other miracle cures for autism |url=https://www.health24.com/Natural/Therapies/the-truth-about-chlorine-dioxide-and-other-miracle-cures-for-autism-20151111 |date=2015-11-11 |work=Health24 |access-date=2019-03-24 }}{{cite web |url=https://www.autism.com/statement_mms |title=Warning Against Chlorine Dioxide Use |author=Sidney Baker |author2=Ali Carine |author3=Suruchi Chandra |author4=Kelly M. Barnhill |author5=John Green |author6=Maya Shetreat-Klein |author7=Vicki Kobliner |author8=Dana Laake |author9=Elizabeth Mumper |author10=Nancy O'Hara |author11=William Parker |date=2015-07-12 |work=Autism is Treatable |publisher=Autism Research Institute |access-date=2019-03-24 |archive-date=30 March 2019 |archive-url=https://web.archive.org/web/20190330220822/https://www.autism.com/statement_mms |url-status=dead }} Oral and rectal use of the solution has also been promoted as a cure for HIV, malaria, viral hepatitis, influenza, common colds, acne, cancer, Parkinson's, and much more.

Chlorine dioxide is a potent and toxic bleach{{cite web |title=PubChem Database. Chlorine dioxide, CID=24870 |url=https://pubchem.ncbi.nlm.nih.gov/compound/chlorine_dioxide#section=Human-Toxicity-Excerpts |work=PubChem |publisher=National Center for Biotechnology Information |access-date=2019-03-24 }} that is relabeled for "medicinal purposes" to a variety of brand names including, but not limited, to MMS, Miracle Mineral Supplement, and CD protocol.{{cite web|date=12 March 2015|website=vice.com |url=https://www.vice.com/en_us/article/kwxq3w/pararchiveents-are-giving-their-children-bleach-enemas-to-cure-them-of-autism-311|title=The Parents Who Give Their Children Bleach Enemas to 'Cure' Them of Autism |access-date=2019-03-24}} For oral use, the doses recommended on the labeling can cause nausea, vomiting, diarrhea, and potentially life-threatening dehydration.{{cite web|title=FDA Warns Consumers of Serious Harm from Drinking Miracle Mineral Solution (MMS)|date=3 February 2011|publisher=U.S. Food and Drug Administration |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm220747.htm|archive-url=https://web.archive.org/web/20110203232945/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm220747.htm|archive-date=3 February 2011|access-date=2019-03-24|url-status=dead}}

No clinical trials have been performed to test the health claims made for chlorine dioxide, which originate from former Scientologist Jim Humble{{cite web|url=https://uk.news.yahoo.com/parents-making-children-drink-bleach-160057178.html|title=Parents Are Making Their Children Drink Bleach to 'Cure' Them of Autism|date=22 March 2019|work=Newsweek/Yahoo News}} in his 2006 self-published book, The Miracle Mineral Solution of the 21st Century{{cite book |title=The Miracle Mineral Solution of the 21st Century|publisher=Jim Humble|year=2006|author=Jim Humble}} (self published) and from anecdotal reports. Humble coined the name MMS. Sellers sometimes describe MMS as a water purifier to circumvent medical regulations.{{cite news | first = Erik | last = Jensen | title = Deadly chemical being sold as miracle cure | date = 2010-01-09 | url = http://www.smh.com.au/national/deadly-chemical-being-sold-as-miracle-cure-20100108-lyvl.html | work = The Sydney Morning Herald |access-date=2019-03-24}} 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.{{cite press release |publisher= International Federation of Red Cross and Red Crescent Societies |date= 15 May 2013 |title= IFRC strongly dissociates from the claim of a 'miracle' solution to defeat malaria |url= http://www.ifrc.org/en/news-and-media/opinions-and-positions/opinion-pieces/2013/ifrc-strongly-dissociates-from-the-claim-of-a-miracle-solution-to-defeat-malaria/ |access-date= 2019-03-24 |archive-date= 24 February 2021 |archive-url= https://web.archive.org/web/20210224162551/https://www.ifrc.org/en/news-and-media/opinions-and-positions/opinion-pieces/2013/ifrc-strongly-dissociates-from-the-claim-of-a-miracle-solution-to-defeat-malaria/ |url-status= dead }}

{{Main|Coffee enema}}

Well documented as having no proven benefits and considered by medical authorities as rash and potentially dangerous is an enema of coffee.

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,{{cite web |publisher = American Cancer Society |url = http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/ManualHealingandPhysicalTouch/colon-therapy |date = 11 January 2008 |access-date = 13 May 2011 |title = Colon Therapy |archive-date = 24 April 2015 |archive-url = https://web.archive.org/web/20150424180208/http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/ManualHealingandPhysicalTouch/colon-therapy |url-status = dead }}{{cite journal |vauthors = Margolin KA, Green MR |title = Polymicrobial enteric septicemia from coffee enemas |journal = The Western Journal of Medicine |volume = 140 |issue = 3 |page = 460 |year = 1984 |pmid = 6710988 |pmc = 1021723 }}{{cite journal |vauthors = Eisele JW, Reay DT |title = Deaths related to coffee enemas |journal = JAMA: The Journal of the American Medical Association |volume = 244 |issue = 14 |pages = 1608–1609 |year = 1980 |pmid = 7420666 |doi = 10.1001/jama.1980.03310140066036 }}{{cite journal |vauthors = Keum B, Jeen YT, Park SC, Seo YS, Kim YS, Chun HJ, Um SH, Kim CD, Ryu HS |title = Proctocolitis Caused by Coffee Enemas |journal = The American Journal of Gastroenterology |volume = 105 |issue = 1 |pages = 229–230 |year = 2010 |pmid = 20054322 |doi = 10.1038/ajg.2009.505 |s2cid = 19156781 }}{{cite web |publisher = Memorial Sloan Kettering Cancer Center |url = http://www.mskcc.org/mskcc/html/69283.cfm |title = Livingston-Wheeler Therapy |date = 9 May 2011 |access-date = 13 May 2011 }}William T. Jarvis, Ph.D., National Council Against Healthcare Fraud, "[http://www.ncahf.org/articles/c-d/caquackery.html Cancer Quackery]". Accessed 11 July 2012.{{cite journal |title = Campylobacter sepsis associated with "nutritional therapy"--California |journal = MMWR Morb. Mortal. Wkly. Rep. |volume = 30 |issue = 24 |pages = 294–5 |year = 1981 |pmid = 6789105 |author1 = Centers for Disease Control (CDC) }}{{cite journal |vauthors = Keum B, Jeen YT, Park SC, Seo YS, Kim YS, Chun HJ, Um SH, Kim CD, Ryu HS |title = Proctocolitis caused by coffee enemas |journal = Am. J. Gastroenterol. |volume = 105 |issue = 1 |pages = 229–30 |year = 2010 |pmid = 20054322 |doi = 10.1038/ajg.2009.505 |s2cid = 19156781 }}{{Excessive citations inline|date=December 2024}} and deaths related to coffee enemas have been documented.{{cite journal |vauthors=Eisele JW, Reay DT |title=Deaths related to coffee enemas |journal=JAMA |volume=244 |issue=14 |pages=1608–9|date=October 1980 |pmid=7420666 |doi=10.1001/jama.1980.03310140066036}}

Gerson therapy includes administering enemas of coffee,{{cite web |title=The Gerson Institute — Alternative Cancer Treatment |url=http://www.gerson.org/g_therapy/default.asp |archive-date=1 April 2003 |archive-url=https://web.archive.org/web/20030401121651/http://gerson.org/g_therapy/default.asp}} as well as of castor oil and sometimes of hydrogen peroxide or of ozone.{{cite journal |vauthors=Weitzman S |title=Alternative Nutritional Cancer Therapies|journal=International Journal of Cancer|volume=78|pages=69–72|year=1998| issue=S11| doi=10.1002/(SICI)1097-0215(1998)78:11+<69::AID-IJC20>3.0.CO;2-7| pmid=9876483|s2cid=20633344 |doi-access=free}}

Some proponents of alternative medicine have claimed that coffee enemas have an anti-cancer effect by "detoxifying" metabolic products of tumors{{cite journal |vauthors = Lee CJ, Song SK, Jeon JH, Sung MK, Cheung DY, Kim JI, Kim JK, Lee YS |title = Coffee enema induced acute colitis |journal = The Korean Journal of Gastroenterology = Taehan Sohwagi Hakhoe Chi |volume = 52 |issue = 4 |pages = 251–254 |year = 2008 |pmid = 19077527 }} but there is no medical scientific evidence to support this.{{cite journal |vauthors = Shils ME, Hermann MG |title = Unproved dietary claims in the treatment of patients with cancer |journal = Bull N Y Acad Med |volume = 58 |issue = 3 |pages = 323–40 |date = April 1982 |pmid = 7052177 |pmc = 1805327 }}{{cite journal |author = Cassileth B |title = Gerson regimen |journal = Oncology (Williston Park, N.Y.) |volume = 24 |issue = 2 |page = 201 |date = February 2010 |pmid = 20361473 }}

File:Inflatable enema nozzle in harness 01.jpg activities.]]

{{Main|Klismaphilia}}

Enjoyment of enemas is known as klismaphilia, which medically is classified as a paraphilia.[http://arquivo.pt/wayback/20080224093721/http://www.psychologytoday.com/conditions/paraphilias.html Paraphilias] from [http://www.psychologytoday.com Psychology Today]{{cite journal|last=Denko|first=JD.|date=April 1973|title=Klismaphilia: enema as a sexual preference. Report of two cases|journal=Am J Psychother|volume=27|pages=232–50 | issue=2|pmid=4704017|doi=10.1176/appi.psychotherapy.1973.27.2.232}} A person with klismaphilia is a klismaphile.

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.{{cite journal|last=Denko|first=JD.|date=April 1976|title=Amplification of the erotic enema deviance|journal=Am J Psychother|volume=30|pages=236–55 | issue=2|pmid=937588|doi=10.1176/appi.psychotherapy.1976.30.2.236}}

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."{{Citation | last1 = Kinsey | first1 = Alfred Charles | title = Sexual Behavior in the Human Female | publisher = Indiana University Press | place = Bloomington, Indiana, U.S.A. | year = 1953 | isbn = 978-0-253-33411-4 }}

Besides klismaphilia, the intrinsic enjoyment of enemas, there are other uses of enemas in sexual play., Klismaphilia:76

File:5000 ml Enema Bag with Dildo Nozzle Filled Hanging in Tree.jpg, ready to inject into a recipient on the ground beneath.]]

Enemas are sometimes used in sadomasochistic activitiesBrame et al., Different loving – The World of Sexual Dominance and Submission:513,516Agnew, 2000:74,77,78,79 for erotic humiliationBrame et al., Different loving – The World of Sexual Dominance and Submission:515,516,520 or for physical discomfort.Brame et al., Different loving – The World of Sexual Dominance and Submission:513,517

{{Main|Rectal douching}}

Another sexual use for enemas is to empty the rectum as a prelude to other anal sexual activities such as anal sex,Agnew, 2000:76 possibly reducing risk of infection.

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{{cite journal |last1=Javanbakht |first1=Marjan |last2=Stahlman |first2=Shauna |last3=Pickett |first3=Jim |last4=LeBlanc |first4=Marc-André |last5=Gorbach |first5=Pamina M |title=Prevalence and types of rectal douches used for anal intercourse: results from an international survey |journal=BMC Infectious Diseases |date=December 2014 |volume=14 |issue=1 |pages=95 |doi=10.1186/1471-2334-14-95 |pmid=24555695 |pmc=4015843 |doi-access=free }} although rectal douching before anal sex may increase the risk of transferring HIV,{{cite journal|last1=Carballo-Diéguez|first1=Alex|last2=Bauermeister|first2=José A.|last3=Ventuneac|first3=Ana|last4=Dolezal|first4=Curtis|last5=Balan|first5=Ivan|last6=Remien|first6=Robert H.|title=The Use of Rectal Douches among HIV-uninfected and Infected Men who Have Unprotected Receptive Anal Intercourse: Implications for Rectal Microbicides|journal=AIDS and Behavior|volume=12|issue=6|year=2007|pages=860–866|issn=1090-7165|doi=10.1007/s10461-007-9301-0|pmid=17705033|pmc=2953367}} hepatitis B,{{cite journal|last1=Schreeder|first1=M. T.|last2=Thompson|first2=S. E.|last3=Hadler|first3=S. C.|last4=Berquist|first4=K. R.|last5=Zaidi|first5=A.|last6=Maynard|first6=J. E.|last7=Ostrow|first7=D.|last8=Judson|first8=F. N.|last9=Braff|first9=E. H.|last10=Nylund|first10=T.|last11=Moore|first11=J. N.|last12=Gardner|first12=P.|last13=Doto|first13=I. L.|last14=Reynolds|first14=G.|title=Hepatitis B in Homosexual Men: Prevalence of Infection and Factors Related to Transmission|journal=Journal of Infectious Diseases|volume=146|issue=1|year=1982|pages=7–15|issn=0022-1899|doi=10.1093/infdis/146.1.7|pmid=7086206}} and other diseases.{{cite journal |title=Lymphogranuloma venereum proctitis in men who have sex with men is associated with anal enema use and high-risk behavior |last1=de Vries |first1=Henry J.C. |last2=van der Bij |first2=Akke K. |last3=Fennema |first3=Johan S.A. |last4=Smit |first4=Colette |last5=de Wolf |first5=Frank |last6=Prins |first6=Maria | last7=Coutinho | first7=Roel A. | last8=MorrÉ | first8=Servaas|journal=Sexually Transmitted Diseases |date=2008 |volume=35 |issue=2 |pages=203–208 |doi=10.1097/OLQ.0b013e31815abb08 |pmid=18091565 |s2cid=2065170 |url=https://dare.uva.nl/personal/pure/en/publications/lymphogranuloma-venereum-proctitis-in-men-who-have-sex-with-men-is-associated-with-anal-enema-use-and-highrisk-behavior(6b9b21d8-9369-4f55-a0e5-c6804db29083).html |doi-access=free }}

{{Main|Alcohol enema}}

Noting that deaths have been reported from alcohol poisoning via enemas,{{cite web |url = http://darwinawards.com/darwin/darwin2007-13.html |title = The Enema Within |access-date = 11 January 2008 |year = 2008 |publisher = Darwin Awards }} an alcohol enema can be used to very quickly instill alcohol into the bloodstream, absorbed through the membranes of the colon. However, great care must be taken as to the amount of alcohol used. Only a small amount is needed as the intestine absorbs the alcohol far more quickly than the stomach.

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.{{cite journal |vauthors = de Boer AG, Moolenaar F, de Leede LG, Breimer DD |title = Rectal drug administration: clinical pharmacokinetic considerations |journal = Clin Pharmacokinet |volume = 7 |issue = 4 |pages = 285–311 |year = 1982 |pmid = 6126289 |doi = 10.2165/00003088-198207040-00002 |s2cid = 41562861 }}

All across Mesoamerica ritual enemas were employed to consume psychoactive substances, e.g., balché, alcohol, tobacco, peyote, and other hallucinogenic drugs and entheogens, most notably by the Maya, thus attaining more intense trance states more quickly. Mayan classic-period sculpture and ceramics depict hallucinogenic enemas used in rituals. Some tribes continue the practice today.{{cite book|last=Diamond |first=Jared M.|title=The Third Chimpanzee: The Evolution and Future of the Human Animal (P.S.)|url=https://archive.org/details/thirdchimpanzee00jare_0|url-access=registration|publisher=Harper Perennial|location=New York, N.Y.|year=1992|page=432|isbn=978-0-06-084550-6}}; pp. 201

With historical roots in the Indian subcontinent, enemas in Ayurveda, called Basti or Vasti, form part of Panchakarma procedure in which herbal medicines are introduced rectally.{{cite web|url=http://chakrapaniayurveda.com/basti/|title=Basti: Medicated Enema Therapy}}

Enemas have also been forcibly applied as a means of punishment.

Political dissenters in post-independence Argentina were given enemas of chili pepper and turpentine.{{cite book|author= Domingo Faustino Sarmiento|title= Facundo: Civilización y barbarie|translator= Kathleen Ross|year= 1845 |publication-date= 2003|page= 210|publisher= University of California Press|isbn=0-520-23980-6}} Turpentine enemas are very harsh purgatives.{{cite web|url=https://www.biology-online.org/dictionary/Turpentine_enema|title=Turpentine enema|website=Biology-Online Dictionary|publisher=Biology-Online|access-date=2019-04-20}}

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.{{cite news|last1=Rushe|first1=Dominic|last2=MacAskill|first2=Ewen|last3=Cobain|first3=Ian|last4=Yuhas|first4=Alan|last5=Laughland|first5=Oliver|title=Rectal rehydration and waterboarding: the CIA torture report's grisliest findings|url=https://www.theguardian.com/us-news/2014/dec/09/cia-torture-report-worst-findings-waterboard-rectal|access-date=13 March 2015|agency=The Guardian|date=9 December 2014}} Enemas, officials said, are uncomfortable and degrading.{{cite web|url=https://www.nytimes.com/2005/01/01/us/fresh-details-emerge-on-harsh-methods-at-guantanamo.html|title=Fresh Details Emerge on Harsh Methods at Guantánamo|author=Neil A. Lewis|date=2005-01-01|department=Archives – 2005|work=The New York Times|access-date=2019-04-20}} 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 {{sic}} tube we had" wrote an officer,{{cite web|url=https://www.theguardian.com/us-news/2014/dec/09/cia-report-rectal-feeding-detainees|title=Controversial 'rectal feeding' technique used to control detainees' behaviour|date=9 December 2014|work=The Guardian|access-date=2019-04-20}} and "violent enemas" is how a detainee described what he received.{{cite web|url=https://www.nytimes.com/2015/06/06/opinion/a-detainee-describes-more-cia-torture.html|title=A Detainee Describes More C.I.A. Torture|author=The Editorial Board |date=2015-06-05|department=Editorial|work=The New York Times|access-date=2019-04-22}}

In the Dionysus' satyr play Limos, Silenus attempts to give an enema to Heracles.{{cite book|last=Shaw|first=Carl A.|date=2014|title=Satyric Play: The Evolution of Greek Comedy and Satyr Drama|page=15|location=Oxford, England|publisher=Oxford University Press|isbn=978-0-19-995094-2}}

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!"{{cite web|url=http://shakespeare.mit.edu/othello/full.html|title=Othello, the Moore of Venice|author=William Shakespeare|date=1603|access-date=2019-03-27}}

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?"{{cite web|url=https://the-mercurian.com/2018/05/10/moliere-at-versailles/|title=?Molière at Versailles|author=Molière|date=2018-05-10|work=Theater in Translation|publisher=The Mercurian|access-date=2020-07-18}}

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."{{cite book|last=Orwell |first=George |title=1984|year=1949|location=New York|publisher=Harcourt, Brace and Company|isbn=9780151660353|url=https://archive.org/details/1984orwe00orwe|url-access=registration}}

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.".{{cite web|url=https://www.nytimes.com/2014/03/09/books/review/whats-it-like-reading-peyton-place-today.html|title=What's It Like Reading 'Peyton Place' Today?|author=Thomas Mallon |author2=Anna Holmes |date=2014-03-04|department=Book Review|work=The New York Times|access-date=2019-04-18}} As a teenager, the boy enjoys receiving enemas from his mother.{{cite web|url=https://exlibrisregina.com/2016/09/20/my-return-to-peyton-place/|title=My Return to Peyton Place|author=R. Saint Claire|date=2016-09-20|work=Ex Libris Regina|publisher=R. Saint Claire|access-date=2019-04-18|archive-url=https://web.archive.org/web/20190219184420/https://exlibrisregina.com/2016/09/20/my-return-to-peyton-place/|archive-date=February 19, 2019|url-status=dead}}

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."{{cite web |url=https://www.nytimes.com/2011/10/16/magazine/a-girl-not-named-sybil.html|title=A Girl Not Named Sybil |author=Debbie Nathan|date=2011-10-14|work=The New York Times Magazine|access-date=2019-04-21}}

In The Right Stuff, during flight training astronaut Alan Shepard retains a barium enema,{{cite web|url=https://www.nytimes.com/1983/10/21/movies/film-right-stuff-on-astronauts.html|title='Right Stuff,' on astronauts|author=Vincent Canby|date=1983-10-21|department=Film|work=The New York Times|access-date=2019-03-27}} given two floors away from a toilet, embarrassedly riding a public elevator wearing a hospital gown and holding the enema bag with its tip still inserted in him.{{cite web|url=https://teachwithmovies.org/the-right-stuff/|title=The Right Stuff|publisher=Teach with Movies|access-date=2019-03-27}}{{cite web|url=https://www.imdb.com/title/tt0086197/characters/nm0001277|title=The Right Stuff|website=IMDb|access-date=2019-03-27}}

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.{{cite web|title=Water Power|work=Adult DVD Talk|url=https://www.adultdvdtalk.com/review/waterpower}}

The lyrics of Frank Zappa's song The Illinois Enema Bandit are concerned with Michael H. Kenyon's sexual assaults which included administering involuntary enemas.{{cite web|url=https://idnc.library.illinois.edu/cgi-bin/illinois?a=d&d=DIL19750609.2.2|title=Enema bandit suspect faces hearing today|author=Mick Ireland|date=1975-06-09|work=Illinois Digital Newspaper Collections|publisher=University of Illinois at Urbana–Champaign|access-date=2019-03-27}}

The album cover of Enema of the State by blink-182 features a nurse who seems to be preparing to give a medical procedure.

A {{convert|365|kg|lb|abbr=off|adj=on}} brass statue of a syringe enema bulb held aloft by three cherubs stands in front of the "Mashuk" spa in the settlement of Zheleznovodsk in Russia. Inspired by the 15th century Renaissance painter Botticelli, it was created by a local artist who commented, "An enema is an unpleasant procedure as many of us may know. But when cherubs do it, it's all right." When unveiled on 19 June 2008, a banner on one of the spa's walls declared "Let's beat constipation and sloppiness with enemas." The spa lying in the Caucasus Mountains region, known for dozens of spas that routinely treat digestive and other complaints with enemas of mineral spring water, the director commented "An enema is almost a symbol of our region."{{cite web|url=https://www.reuters.com/article/us-russia-enema-art/russian-monument-to-enemas-inspired-by-botticelli-idUSL1982017120080619|title=Russian monument to enemas inspired by Botticelli|date=2008-06-19|work=Reuters Life!|publisher=Reuters|access-date=2019-04-12}}{{cite web|url=https://www.nbcnews.com/id/wbna25265056|title=Enema monument unveiled Russian resort|date=2008-06-19|website=NBC News|access-date=2019-04-12}} It is the only known monument to the enema.{{cite web|url=https://www.atlasobscura.com/places/monument-to-enemas|title=Monument to Enemas|work=Places|publisher=Atlas Obscura|access-date=2019-04-12}}

{{clear}}

{{Portal|Medicine}}

• Bowel management
• Dry enema
• Fecal microbiota transplant
• Harris flush (sin. carminative enema)
• Murphy drip
• Nutrient enema
• Tobacco smoke enema
• Transanal irrigation

{{reflist|30em}}

Sources

• {{cite journal|last=Agnew|first=Jeremy|title=Klismaphilia—A Physiological Perspective|journal=American Journal of Psychotherapy|date=October 1982|volume=36|issue=4|pages=554–566|doi=10.1176/appi.psychotherapy.1982.36.4.554|pmid=7158678}}
• {{cite journal|last=Agnew|first=Jeremy|title=Klismaphilia|journal=Venereology|date=January 2000|volume=13 |issue=2 |url=https://search.informit.org/doi/10.3316/INFORMIT.558902640693864}}
• {{cite book|last1=Brame|first1=Gloria|author-link=Gloria Brame|last2=Brame|first2=William D.|last3=Jacobs|first3=Jon|title=Different loving – The World of Sexual Dominance and Submission|year=1993|publisher=Villard Books|isbn=978-0-6797-6956-9}}
• {{cite book|last=Cullingworth|first=Charles James|author-link=Charles James Cullingworth|title=A Manual of Nursing, Medical and Surgical|year=1883|publication-date=2009|publisher=Cambridge University Press|location=Cambridge, England|isbn=978-1-4590-1939-3|url=https://books.google.com/books?id=Y48NQgAACAAJ}}
• {{cite journal|title=The History of the Enema with Some Notes on Related Procedures (Part I)|journal=Bulletin of the History of Medicine|volume=8|issue=1|pages=68–114|date=January 1940|publisher=Johns Hopkins University Press|last1=Friedenwald|first1=Julius|last2=Morrison|first2=Samuel|jstor=44442727}}
• {{cite journal|title=The History of the Enema with Some Notes on Related Procedures (Part II)|journal=Bulletin of the History of Medicine|volume=8|issue=2|pages=239–276|date=February 1940|publisher=Johns Hopkins University Press|last1=Friedenwald|first1=Julius|last2=Morrison|first2=Samuel|jstor=44442727}}
• {{cite book|last=Magner|first=Lois|title=A History of Medicine|year=1992|publisher=CRC Press|location=Boca Raton, Florida|isbn=978-0-8247-8673-1|url=https://books.google.com/books?id=qtUzscI9_VIC}}
• {{cite book|last1=Parsons|first1=Lee Allen|last2=Carlson|first2=John B.|title=The Face of Ancient America: The Wally and Brenda Zollman Collection of Precolumbian Art|year=1988|publisher=Indianapolis Museum of Art|location=Indianapolis, Indiana, United States|isbn=978-0-936260-24-2|url=https://books.google.com/books?id=65rDywk341QC}}
• {{cite journal|title=The Drug Lore of ASCLEPIADES of Bithynia|last=Scarborough |first=John|date=1975 |journal=Pharmacy in History|volume=17|issue=2|pages=43–57|jstor=41108902|pmid=11609880}}

{{Commons category|Enema (colorectal)}}

{{cite web|url=https://www.tabers.com/tabersonline/view/Tabers-Dictionary/758080/0/enema|title=A professional nursing instructional video demonstrating administering a cleansing enema|website=Taber's Medical Dictionary|publisher=K. A. Davis Company|access-date=July 17, 2014|url-access=limited}}

{{Dosage forms|state=expanded}}

{{authority control}}

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Category:Alternative medicine

Category:Anal eroticism

Category:Anus

Category:BDSM equipment

Category:Constipation

Category:Digestive system

Category:Dosage forms

Category:Drug delivery devices

Category:Drugs acting on the gastrointestinal system and metabolism

Category:Evidence-based medicine

Category:Gastroenterology

Category:Health care

Category:Large intestine

Category:Laxatives

Category:Medical anthropology

Category:Rectum

Category:Routes of administration

Category:Self-care

Category:Sexual health

Category:Torture