Enemas for Constipation: Are They Harmful to Your Health?

Dr. Group
by Dr. Edward Group DC, NP, DACBN, DCBCN, DABFM
Published on
Woman with stomach discomfort from constipation and looking for an enema as a remedy.

An enema is a procedure where you insert liquid or air into your colon through the rectum to clear out the lower bowel contents, or in other words, your poo. After you squeeze the liquid or air into your nether regions, you will very shortly feel an overwhelming urge to defecate. Most often, people use enemas as quick relief for occasional constipation, but some people use them for colon cleansing and detox. Enemas are also used in medical settings before exams or surgery. The liquid in enemas ranges from sodium phosphate to mineral oil to coffee, but no matter which is used, the point is to quickly evacuate the feces from your lower colon.

Do Enemas Really Work?

If you want to know whether an enema will give you a bowel movement, the answer is a resounding yes. However, if what you really want to know is whether enemas are a good solution for constipation, that is another question altogether. If you rarely have constipation but something has jammed up the works and you have a wedding coming up, then an enema can quickly clear out your bowels. But, is it the best solution for most situations? Probably not, not to mention that enemas aren’t without risk. Performed improperly, they can cause issues such as:

  • Electrolyte Imbalances
  • Disrupting Your Gut Flora
  • Enema Dependency
  • Infections
  • Intestinal Damage

Those risks and the other things you need to consider will be covered throughout this article.

When Do You Use An Enema?

There are multiple reasons why people use enemas, from minor constipation to cleansing to medical procedures.

Enemas for Constipation

By far the most common use for enemas is for a frustrating case of occasional constipation, although enemas may not be the best solution. But if you have chronic or regular constipation, aim to figure out the true cause and solve that problem – whether through lifestyle choices, diet, or a medical issue that needs further investigation. Perhaps your diet contains too much-processed food or too much sugar and not enough fresh, fiber-filled fruits and vegetables. A poor diet also affects your gut flora, which in turn, affects digestion, mental wellness, and many other aspects of your health. As people age, constipation often becomes more of a problem.[1] Medical issues can also cause constipation. So, take some time to discern the real issue.

Enemas for Weight Loss

Some people use enemas as a method to speed weight loss. Using enemas for weight loss is actually one of the diagnostic criteria for eating disorders such as anorexia nervosa or bulimia.[2, 3] Eliminating your food more rapidly on a regular basis, whether through enemas or laxatives, can lead to an unhealthy relationship with food, your body, and your health. Please do not use enemas for weight loss. They do not work, and regular use brings a host of other issues including the health risks mentioned below.[4]

Enemas for Cleansing & Detox

Enemas are also sometimes used for detoxing or cleansing the colon. People who use enemas for cleansing may eat a liquid-only diet, or fast, or simply eat a healthy diet for a period of time, detoxing from sugar, wheat, and gluten, processed foods, dairy, or meat, and then perform an enema colon cleanse. An enema done after a detox diet can then flush out toxins. I personally think that a better option is something taken orally, whether an Epsom salt, or an oxygen-based colon cleanser. These options produce better results than enemas and don’t have any of the negative side effects.

Enemas for Medical Procedures

Physicians and other healthcare providers may perform an enema on you in a clinical setting, or they may give you one to self-administer. These can be liquid enemas, or a pneumatic enema, which pushes air up the lower colon, usually in order to perform a procedure or examine the bowel.

Types of Enemas

The most common disposable, at-home enemas are small plastic bottles that are filled with a liquid solution and equipped with a lubricated nozzle, which you insert into your bottom. Reusable enemas come in a kit which includes an enema bag or bucket, which you fill with liquid, and a tube with a nozzle at the end. Bags and buckets hold much more liquid than an enema bottle and produce a more thorough flush of the digestive system.

From disposable to reusable and from cleansing to retention enemas, there are a variety of types for various purposes and needs related to constipation, cleaning, and medical procedures. Many different solutions can be used to cleanse the bowels, which I discuss below.

Retention Enema vs. Cleansing Enemas

Cleansing enemas, in which the liquid leaves the bowel almost immediately after you insert it, are the most common type. When you buy an over-the-counter disposable enema, it is a cleansing enema. Most of these one-time-use enemas include a small plastic bottle pre-filled with a saline solution. The bottles have a lubricated nozzle which you insert into your bottom. After squeezing all the liquid into your nether regions, you may hold it in for as long as you can. Most people can only hold it for a few minutes before the solution stimulates peristalsis, the muscular contraction throughout the colon which moves fecal matter onward and outward. Once the liquid enters the rectum, massaging the abdomen can help loosen fecal matter.

With retention enemas, you strive to keep the liquid inside the bowel longer – at least 15 minutes and up to an hour. A special nozzle with a plastic piece blocks the exit, so to speak, to keep the liquid inside. This allows your body to absorb the enema liquid – whether coffee or a medical solution. Some people prefer to remove the nozzle and use a rectal plug to keep the liquid inside for an allotted time.

The volume of liquid used will vary by person. You can start with 4 cups in the enema bag or bucket, but may only be able to insert 2 cups. People generally are able to use more liquid with time, but no more than 3 or 4 cups should be used.

Bulb vs. Bucket & Bag Enemas

People who regularly use enemas may want to purchase one that can be cleaned and reused – though these carry a risk of infection if you do not clean them thoroughly. Reusable enemas include small enema syringes or bulbs, or enema kits that include a silicone or rubber enema bag or a bucket to hold liquid, a tube, and a nozzle. Bulbs only allow for a relatively small amount of liquid, comparable to the over-the-counter disposables. But they still do the trick!

For the bucket and bag enema kits, you fill up the bag or bucket with a liquid solution then place it above the body, so that once you insert the nozzle the liquid flows by gravity downwards and into the body. Of course, you should do this process in the bathroom so that you’re near the toilet.

Water Enemas

Because water is hypotonic (less salty) than body fluids, plain water enemas are not ideal. These can cause electrolytes to leave the body, potentially causing an electrolyte imbalance. If you must do a plain water enema, be sure that you use pure distilled water that has no risk of contamination with pathogens or parasites – or you may introduce them into your body. The water temperature should be similar to your body temperature – not too hot and not too cold. Between 98 and 104˚ F (37-40˚C) will feel ideal. But rather than pure water, salt or saline solution will make for a better enema.

As with other enemas, aim for between 2-4 cups of liquid, and retain up to 15 minutes or expel immediately.

Saline Solution Enema

Saline solution enemas will produce better results than plain water because they are approximately the same saltiness as the body, or slightly more so. Here’s a little chemistry lesson: when a solution you insert into your bowel is saltier than the body, water will flow from the body into the colon. If the enema fluid was hypotonic or less salty compared to the body’s fluids, it would be absorbed – which would defeat the purpose of an enema.

The most common over-the-counter at-home enema is Fleet brand, which contains sodium phosphate, also called Phospho-soda, although many other brands have the same ingredients. Be warned, phospho-soda enemas have been linked with severe kidney damage. As a result, the U.S. Food & Drug Administration has issued a warning about the use of sodium phosphate enemas use, as well as oral solutions taken for colonoscopy preparation that clean the bowels.[5] Never use more than one of these enemas within a 24 hour period.

Another type of saline enema is made with Epsom salt, also known as magnesium sulfate salt. If you have an enema bucket or bag, try 4 tablespoons of Epsom salt to two liters of distilled water. Once you squeeze the liquid inside of your rectum, it will make the bowels strongly contract. This will clean out the colon, expelling any impacted stool.

Mineral Oil Enema

When used in an enema, mineral oil acts as an emollient and stool softener, working on the fecal mass inside of the colon. Mineral oil, an unnatural petroleum product, works by helping stool retain water and lining the colon with oil and hence lubricating the fecal mass. Unfortunately, regular use of mineral oil enemas causes malabsorption of fat-soluble vitamins, as well as seepage and incontinence of the bowels.[6] Oil enemas are also a bit messier than water-based enemas. Some people will do a mineral oil retention enema, holding in the solution for one hour, followed by a cleansing enema with a water-based solution.

Most mineral oil enemas are pre-packaged, with one bottle containing 118ml of liquid. You can also use an enema syringe, which just inserts a specific amount of liquid into the rectum, very slowly so that it can soak into the fecal mass. These are commonly used in children. Unlike other enemas, oil enemas work overnight to soften the stool so the child – or whoever – can go to sleep and will wake up with the urge to defecate in the morning. As I said above, most people like to follow up with a cleansing enema afterward to eliminate the excess oil.

Apple Cider Vinegar Enema

Vinegar has been used to fight infections since the time of Hippocrates, the father of modern medicine, who lived from 460 to 377 BC. [7] Vinegar contains acetic acid, and studies have found it can offer an element of protection against Escherichia coli (E. coli) bacteria and other harmful organisms. Apple cider vinegar, in particular, contains probiotics, which promotes normalized digestion and elimination. Studies have also found vinegar can help normalize blood sugar levels.[8] Using it as an enema is a more recent phenomenon, and there are no studies indicating its specific benefits for this purpose.

The best recipe for an apple cider vinegar enema 3 cups of water and 3 tablespoons of ACV. Try to hold it inside your body for at least 5 minutes.

Coffee Enema

People love coffee; it is synonymous with going from zombie sleep mode to active and ready for the day. Coffee comes in caffeinated and decaf, regular drip and espresso. Not only is drinking coffee popular, but so are coffee enemas. Proponents not only claim it gives them a burst of caffeinated energy but also that it stimulates bile production through the colon wall. Some medical experts suggest that the “cafestol palmitate” in coffee stimulates glutathione S-transferase enzyme activity, which, in turn, stimulates bile excretion. One small pilot study found a coffee enema used in combination with polyethylene glycol (PEG) better prepped the bowels for a procedure than PEG alone.

Although coffee enemas are usually safe, if you have compromised kidney function, you should avoid it. There are at least two reports of death after a coffee enema, one from blood poisoning (septicemia) in a late-stage breast cancer, and one from electrolyte imbalance from too many enemas.[9] There are also reports of infection of the rectum and colon (proctocolitis). The colitis could be caused by the use of improperly cleaned enema equipment or from hot coffee (ouch!), and may not be specific to coffee enemas. Use common sense: do not put hot coffee up your bottom. If you choose to do a coffee enema, use it at a sensible room temperature.

To make a homemade coffee enema, brew 4 cups of distilled water with a fine grind coffee. Some people like to boil it on the stove for 15 minutes to ensure a very strong brew. If you boil on the stove, strain off the coffee grounds, and COOL it down completely before pouring it into your enema bag or bucket. You should do this as a retention enema, to ensure the coffee can interact with your colon.

Do Enemas Have Side Effects?

Most of the time enemas are safe, but you should be aware of the risks they carry. Two different published reviews of scientific studies found that no conclusive benefits associated with the use of enemas for constipation, but there were several documented complications and risks.[10, 11] The reviews found that enemas could be useful when healthcare providers are prepping for a medical examination of your colon and GI tract. That means that if you feel you need to do an enema, you should proceed with caution. There are real risks associated with using enemas on a regular basis for constipation.

Electrolyte Imbalances

In most enemas, the liquid used is hypertonic, which means that it’s saltier than the body’s fluids. Because our blood and body fluids are salty (saline), if you use a solution that is saltier, it may cause dehydration. Hypertonic enemas pull liquids out from the colon and body into the stool and then ultimately out of the body. Most of the time, you can counter this and stay hydrated by drinking enough water when performing an enema, but hypertonic enemas (like sodium phosphate ones) are not appropriate if you are dehydrated. On the other hand, plain water enemas are hypotonic (less salty) compared to the body and can cause electrolyte salts like sodium and potassium to leave the body in the feces, possibly leading to an electrolyte imbalance.

Disrupting Your Gut Flora

Any time you flush the feces out of the bowel, you disrupt the gut microbiota.[12] Most of the time, the gut flora recovers rapidly after cleansing or using an enema, but frequent enema use can cause more serious disruptions and issues, including infections.[13] The science linking gut microbes and health is both fascinating and advancing quickly. A healthy gut microbiota has been linked with mental wellness, overall health, vibrant-looking skin, and better digestion.[14, 15, 16]

Enema Dependency

If you turn to enemas to clean out your colon on a regular basis, this can lead to dependency, which is unhealthy. Whether it creates a physical dependency of the gastrointestinal system or just a mental need for them, this is not the healthiest solution for regular constipation or for cleansing.[17] Rather, a healthy diet, exercise, massage, and supplements may prove to be a better whole-body natural approach.

Infections

Enemas offered by spas, including colonics, often use shared equipment. If it is not properly cleaned and sterilized, you may risk getting an infection.[18] The same can happen with reusable at-home equipment. Enema use has been linked with proctocolitis, which is irritation of the rectal lining and colon.

You need to properly sterilize any part of a reusable enema that touches your rectum. The good news is that rather than putting it in your dishwasher along with the dishes, experts recommend using hydrogen peroxide, vinegar, and water, or soap and hot water to sterilize enema equipment.

Intestinal Damage

Another safety issue with enema use is possible perforation of the intestinal wall. Perforation is a more common problem with colonics, in which large volume of water is pushed through the intestinal tract to clear it out.[19] Older people are at a higher risk for perforations because the colon wall thins with age. Puncturing a hole in the intestines during an enema naturally increases the risk of infection within the body, which is called sepsis.

Blood in Your Stool After an Enema

If you insert the enema gently and with a lubricant, you should not see blood in your stool after administering an enema. If you do, it could indicate an underlying medical issue. If you have hemorrhoids, the enema could cause a minor tear in these small, engorged veins. But if you continue to find blood in your stool, this could be damage to the intestinal wall or something else, and you should seek medical advice.

Better Remedies for Occasional Constipation

  • Increase your fiber intake
  • Drink more water
  • Consume probiotic foods or supplements
  • Take digestive enzymes
  • Perform a colon cleanse

In truth, enemas should not be used for chronic constipation. There are many natural remedies for constipation, whether eating a plant-based diet with some bowel movement-inducing fruits like prunes, increasing your fiber intake, or getting enough exercise. Although drinking water will not necessarily reduce constipation if you are fully hydrated, it can help if you have minor dehydration. Taking a supplement with multiple strains and species of probiotic microbes, as well as prebiotic fiber for the probiotics to munch on, can make a huge difference when it comes to healthy bowel movements. Digestive enzymes may help your body make better use of your food, and colon cleansing can also help to ensure you do not have impacted stool and maintain healthy intestines.

To naturally and gently resolve occasional constipation without using laxatives, try Oxy-Powder®. This gentle colon cleanser is safe, effective, and doesn’t cause nausea or the sort of embarrassing emergencies that send you scrambling for the nearest toilet. Even better, try the Colon Cleanse Kit. It has everything you need to cleanse your entire digestive tract of toxins and impacted fecal matter in less than a week.

What’s Your Story?

Have you used an enema to remedy occasional constipation or as a cleanse? What solution did you use and why? Leave a comment below and tell us about your experience.

References (19)
  1. De Giorgio R, et al. “Chronic constipation in the elderly: a primer for the gastroenterologist.” BMC Gastroenterol. 2015;15,130.
  2. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders.” National Collaborating Centre for Mental Health (UK). British Psychological Society. 2004. Accessed 14 May 2018.
  3. Walsh JME, et al. “Detection, Evaluation, and Treatment of Eating Disorders The Role of the Primary Care Physician.” J Gen Intern Med. 2000;15(8),577–590.
  4. Jacobson RM et al. “Serum electrolyte shifts following administration of sodium phosphates enema.” Gastroenterol Nurs. 2010;33(3),191-201.
  5. FDA Drug Safety Communication: FDA warns of possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation.” U.S. Food & Drug Administration. 8 Jan. 2014. Accessed 14 May 2018.
  6. Portalatin M, Winstead N. “Medical Management of Constipation.” Clin Colon Rectal Surg. 2012;25(1),12–19.
  7. Johnston CS, Gaas CA. “Vinegar: Medicinal Uses and Antiglycemic Effect.” MedGenMed. 2006;8(2),61.
  8. Mitrou P, et al. “The role of acetic acid on glucose uptake and blood flow rates in the skeletal muscle in humans with impaired glucose tolerance.” Eur J Clin Nutr. 2015;69(6),734-9.
  9. Kim ES, et al. “Coffee Enema for Preparation for Small Bowel Video Capsule Endoscopy: A Pilot Study.” Clin Nutr Res. 2014; 3(2),134-141.
  10. 10 Davies C. “The use of phosphate enemas in the treatment of constipation.” Nursing Times. 2004;100(18),32-35.
  11. Bowers B. “Evaluating the evidence for administering phosphate enemas.” Brit J Nurs. 2006;15(6),378-81.
  12. Gorkiewicz, G, et al. “Alterations in the Colonic Microbiota in Response to Osmotic Diarrhea.” PLoS One. 2013; 8(2): e55817.
  13. Ismail AS, Hooper, LV. “Epithelial Cells and Their Neighbors. IV. Bacterial contributions to intestinal epithelial barrier integrity.” Am J Physiol Gastrointest Liver Physiol. 2005; 289,G779-G784.
  14. Bowe WP, Logan AC. “Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future?” Gut Pathog. 2011;3,1.
  15. Scott KP, et al. “Manipulating the gut microbiota to maintain health and treat disease.” Microb Ecol Health Dis. 2015;26,10.3402/mehd.v26.25877.
  16. Bested AC, et al. “Intestinal microbiota, probiotics and mental health: from Metchnikoff to modern advances: Part I – autointoxication revisited.” Gut Pathogens 2013;5,5.
  17. Muller-Lissner SA, et al. “Myths and Misconceptions About Chronic Constipation.” Am J Gastroenterol. 2005;100(1),232-42.
  18. Lee CJ, et al. “Coffee enema induced acute colitis.” Korean J Gastroenterol. 2008;52,251–254.
  19. Niv G, et al. “Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable.” Int J Gen Med. 2013;6,323–328.

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