Enema

Definition

An enema is a procedure in which fluid is instilled into the rectum and colon to stimulate defecation, cleanse the bowel before procedures, or administer medication.

Types

• Cleansing: Tap water, normal saline, soap suds. 500 to 1000 mL.
• Oil retention: Softens impacted stool; retain 30 minutes.
• Medicated: Kayexalate (hyperkalemia), lactulose (hepatic encephalopathy), steroid (IBD).
• Fleet/hypertonic: Small volume; draws water into bowel.

Technique

Position patient in left Sims' position (promotes flow via anatomy of sigmoid colon). Lubricate tube tip, insert 3 to 4 inches (adult), administer fluid slowly to avoid cramping. Encourage retention for 10 to 15 minutes (or as appropriate for type). Instruct patient to relax and breathe through abdominal discomfort.

Nursing Considerations

Avoid in suspected bowel perforation, recent surgery, and undiagnosed abdominal pain. Monitor for vagal response (bradycardia, syncope) during insertion. Use caution with electrolyte-disturbing enemas (Fleet in renal failure).

NCLEX Relevance

Left Sims position is classic for enema administration.