Administering an Enema

EQUIPMENT
Prepackaged enema or enema container
Disposable gloves
Water-soluble jelly
Waterproof pad
Bath blanket
Bedpan or commode
Washcloth and towel
Basin
Toilet tissue

PROCEDURE
Nursing Action Rationale
Preparatory phase
1. Assess the patient's bowel habits (last 1.Enema should not be given
bowel movement, laxative usage, bowel if there is a suspicion of
patterns) and physical condition appendicitis or bowel
(hemorrhoids, mobility, external sphincter obstruction.
control).
2. Provide for privacy, and explain procedure 2.Provides comfort.
to patient.
Performance phase
1. Wash hands. 1.Promotes hygiene.
2. Place patient on left side with right knee 2.Allows for enema solution to
flexed (Sims' position). Place waterproof pad flow by gravity along the
underneath patient, and cover with bath natural curve of the sigmoid
blanket. colon and rectum.
3. Place bedpan or bedside commode in 3.Allows for easy accessibility.
position for patients who cannot ambulate
to the toilet or who may have difficulty with
sphincter control.
4. Remove plastic cover over tubing, and 4.Prevents trauma and eases
lubricate tip of enema tubing 3-4 inches application.
(7.5-10 cm) unless prepackaged (tip is
already lubricated). Even prepackaged
enema may need more lubricant.
5. Apply disposable gloves.
6. Separate buttocks, and locate rectum.
7. Instruct patient that you will be inserting 7.Allows for patient relaxation
tubing and to take slow, deep breaths. and readiness.
8. Insert tubing 3-4 inches for adult patients. 8.Prevents tissue trauma of
rectum.
9. Slowly instill the solution using a clamp and 9.Rapid infusion can cause
the height of the container to adjust flow colon distention and
 rate if using an enema bag and tubing. For cramping. Container
high enemas, raise enema container 12-18 elevated past 12-18 inches
inches (30.5-45.5 cm) above anus; for low and controller on tubing not
enemas, 12 inches. If using a prepackaged regulated contribute to rapid
enema, slowly squeeze the container until infusion.
all solution is instilled.
1 Lower container or clamp tubing if patient
0. complains of cramping.
1 Withdraw rectal tubing after all enema 1 “Until clear” means
1. solution has been instilled or until clear 1. until results do not contain
(usually not more than three enemas). fecal matter and are clear.
1 Instruct patient to hold solution as long as 1 Promotes better results.
2. possible and that a feeling of distention 2.
may be felt.
1 Discard supplies in the appropriate trash 1 Maintains hygiene,
3. receptacle. 3. minimizes patient
embarrassment.
1 Assist patient on the bedpan or to the 1 Prompt action will prevent
4. bedside commode or toilet when urge to 4. soiling.
defecate occurs.
1 Observe enema return for amount, fecal1 If enema has not had
5. content. Instruct patient not to flush toilet
5. sufficient time to absorb,
until the nurse has seen the results. result may be mostly clear
with little fecal material.
NURSING ALERT Enemas should not be given routinely to treat
constipation because they disrupt normal defecation reflexes and
the patient becomes dependent.

Follow-up phase
1. Document the type of enema given,
volume, and results on the appropriate
chart forms.
2. Assess and document presence or absence 2.Relief of abdominal
of abdominal distention after enema was distention indicates success
given. of gas relief.
3. Assist the patient with washing perineum 3.Fecal soiling may result,
and rectal area, if indicated; may also need especially in bedridden
a clean gown or linen change. patients.

Purposes of Enema Administration

 Bowel preparation for diagnostic tests or surgery to empty the bowel of
fecal content
 Delivery of medication into the colon (such as enemas containing
neomycin to decrease the bowel's bacteria count or a kayexalate
enema to decrease the serum potassium level)
 To soften the stool (oil-retention enemas)
 To relieve gas (tidal, milk and molasses, or Fleet's enemas)
 Promote defecation and evacuate feces from the colon for patients
with constipation or an impaction