Feeling bound up? You may be tempted to use an enema for constipation, but... not so fast. Our post discusses reasons for caution.

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Being constipated stinks—your bowel movements are dry, almost painful to pass, with little relief. Worse yet, you can manage to push something through only a couple of days a week. You feel bloated, fatigued, and just plain uncomfortable. It’s all you can think about. And, after a week or so, you’ll do almost anything just to have a normal bowel movement—even giving yourself an enema for constipation.

Well, we hope you consult your physician rather than reach for an enema, as it is important to rule out an more serious underlying condition. For constipation, there are so many better choices than a home “DIY” enema involving mixtures you find on the Internet. Even a commercial enema product is a wiser move.

Using an enema for constipation is considered one of the oldest medical remedies still in use today. But just because it’s still in use doesn’t mean it’s still best, especially if you’re reaching for a home enema kit. Any enema procedure, but especially a home enema, can end up doing more harm than good.

How an Enema Works

When you use an enema for constipation—or anything else, for that matter—you’re forcing fluid up into the large intestine through the rectum in a direction counter to the direction those organs are designed to work. You’ll likely notice your rectum isn’t very cooperative, as you gently push the tube into it and then force the fluid from the enema bag into your colon. And “gently push” is extremely important; don’t force it. Done properly, though, the results should appear in about five minutes. It’s just not something you want to do regularly, especially just so you can be regular.

An enema procedure is invasive. Period. It can damage the tissue in the rectum and intestine, possibly causing the colon to not perform properly. A tear could require surgery. Depending on the solution used, an enema can disrupt the natural beneficial digestive bacteria in your colon and/or introduce harmful bacteria, which may upset your digestive process.

If you use a home enema, even if it’s a so-called cleansing enema or a commercial enema—and you have feelings of nausea, bleeding, cramping, or diarrhea afterward—you should seek medical help immediately. Dehydration is sometimes seen after an enema procedure. An embolism (blockage) is rare, but possible, and very serious. Colon cleansing or irrigation to remove toxins from your colon is not helpful and may be harmful.

Yes, enemas are routinely used as part of your preparation for a colonoscopy because your intestines need to be “squeaky” clean in order for the doctor to check for polyps and growths. This is usually done once or twice a decade, of course. A medical enema may also be prescribed for those suffering from irritable bowel disease, but again, it’s not routine. And, yes, your doctor might recommend an enema for constipation, but rarely before trying other treatments.

Are Water Enemas Safe?

A quick Internet search will bring up a host of solutions—some a bit disturbing—that are used for enemas, including cold tap water, warm water, soapy water, lemon juice, olive oil, coffee, salt water, milk, laxatives (often bisacodyl, the drug found in Dulcolax and other commercial products), and mineral oil. Not all of these selections are healthy, and some can be harmful to use as an enema for constipation or any other reason. Warm water or saline is probably your best choice.

A study from Applied Nursing Research looked at colonic cleansing, fluid absorption, and discomfort following tap water and soapsuds enemas. They found that the soapsuds produced greater output than tap water and was tolerated as well as just water. They also found that patients who received the water enemas actually retained more fluid than was eliminated.

If you’re going to use a home enema kit, it’s extremely important to follow the instructions that accompany the kit, as they may vary.

The safest choice for an enema procedure is generally a disposable commercial product, such as the Fleet Enema, a small-volume enema that contains either bisacodyl, saline, or mineral oil. The product works within two to 15 minutes.

Some of the water and chemicals from the enema is absorbed into the bloodstream, so it is important not to repeat too often. FDA issued a warning in 2014 “that using more than one dose in 24 hours of over-the-counter (OTC) sodium phosphate drugs (used in some commercial enemas) to treat constipation can cause rare but serious harm to the kidneys and heart, and even death.”

How to Treat Constipation

Most physicians will recommend you try a laxative for constipation, especially chronic constipation, for example:

• A bulk or fiber agent (such as Metamucil or Citrucel), which holds water in the intestines to make stools softer
• An osmotic laxative (such as Milk of Magnesia or MiraLax), which causes the intestines to secrete water into the colon and make the stool softer
• A stool softener (such as Colace), which moisturizes the stool
• Stimulants (such as Dulcolax or Senokot), which results in muscle contractions in the intestines to help move the stool through.

There are healthy dietary and lifestyle changes you can make to combat chronic constipation as well:

• Drink plenty of water
• Increase dietary fiber, which increases water in the intestines, to help avoid enemas for constipation and reap more healthy benefits, including lowering blood sugar, controlling weight, and lowering cholesterol.
• Add prunes and prune juice to your breakfast fare. They’ve been used for constipation for centuries and are considered by some to be a stronger choice than fiber.
• Chamomile tea can help relax the muscles in your colon to help move the stool through.
• Exercise is a big factor in constipation. You basically need to get moving to, well, get moving.

When to Call Your Doctor for Constipation

• You have a change in bowel habits
• You have blood in your stool.
• You are taking a long time to have a bowel movement.
• You are having less than three bowel movements a week.
• You are passing hard and painful stools.
• You don’t feel like you have empties your bowel after your bowel movements.

RECOMMENDED FOR YOU

• Home Remedies for Constipation
• Constipation Remedies Needed? Try Magnesium
• What Helps Constipation? Know the Causes and Find Relief
• How to Treat an Impacted Bowel

SOURCES

1. NIH
2. Mayo Clinic

This article was originally published in 2017. It is regularly updated.