An enema is an injection of liquids into the colon via the anus. The most common form of enema is the use of large amounts of liquid to fill and flush the colon. Enema formulas can range from simple salt water to more complex herbal or medicinal preparations. Lesser known enemas include the introduction of oil into the colon for the purpose of lubrication and the elimination of particular symptoms.
Why do an Enema?
Enemas have been used as an efficient cleansing and healing practice for centuries. Both Allopathic and Alternative Medicine promote the use of enemas for restoring and maintaining health. The ancient healing science of Ayurveda, has valued the use of enemas in it’s cleansing therapy (panchakarma) for over 5000 years.
People may administer an enema for a variety of reasons such as:
- Relief from constipation
- Relief from gas and bloating
- Colon cleansing
- Reducing toxic load in the body
- Elimination of intestinal parasites
- Reduction of candida overgrowth
- Improving overall health and well-being
Giving yourself an enema is actually a very simple process. The steps below are outlined in detail to ensure that you get the most out of your enema. An enema can be an awkward procedure for some, but the more preparation you do and the more informed you are, the more comfortable your enema will be.
1. Buy your Enema Equipment
First, you will need an enema bag or canister; there are various types available:
Reusable Enema Bag – This bag can also double as a hot water bottle. It is sturdy, durable, and keeps your enema solution from cooling too fast. However, this bag can be difficult to clean. If you are using only water, or salt water, this bag will be okay with only a rinse, but this type of bag is not recommend if you are using other formulas because of the difficulty to clean inside the bag. Another drawback for some people is that you cannot see the fluid level in this bag.
Disposable Enema Bag – Even though it is called disposable, this bag can be used
multiple times if you rinse it out thoroughly. These have a wider opening at the top, making them easier to refill and to clean than the hot water type bag. The disposable bags are transparent and often have the fluid level indicators marked on the bag.
Enema Can – These cans are usually made of stainless steel and will easily last a lifetime. The tubing may need replacing at some point, but the cans themselves may be the best option if you plan to make enemas a regular part of your life. These are the easiest to clean after use, and the easiest to refill if you are doing a few consecutive enemas.
High-Volume Enema Bag – Most enema bags and containers are 1.5- 2L but high volume bags up to 4L are also available. Using a larger bag will eliminate the need to refill the bag if you are administering high-volume enemas. Although it is not recommended to administer a high-volume enema on your first try, this may be the bag for you if high-volume enemas are your ultimate goal. This bag holds a lot, but it is still a bag, so consider if the convenience of not having to refill the bag outweighs the extra effort for cleaning the bag.
Bulb Syringe – The bulb syringe is another option for an enema. Although they can be found in sizes that hold up to 750ml, most are under 500ml in volume and are somewhat useless if your goal is to cleanse your colon; they just don’t hold enough solution for this purpose. These bulbs are suitable for small children, but for an adult sized colon, stick with a larger container.
Another problem with the bulb syringe is that once it is in your rectum and you have squeezed it, if you release the pressure of your hand, the bulb will inflate, sucking fluid, or matter, back into the bulb. You have to hold a very firm grip on the bulb while the nozzle is in your rectum to avoid drawing anything back into the bulb.
The bulb syringe may be of interest if you would also like to try an oil enema. There are excellent benefits to be had from oil enemas, but this page is dedicated to larger volume enemas for the purpose of colon cleansing. See “How to Do and Oil Enema” for oil enema benefits and instructions.
Other things to consider when purchasing your enema equipment:
- Make sure whichever enema container you choose comes with a clamp on the end of the tube to help control the flow and to prevent fluid from leaking out when filling the enema container.
- Check that the nozzle (also called rectal tube) is smooth. Sharp or jagged edges may cause damage to the rectal lining.
- Most bags are made with latex, so if you have allergies, purchase a silicone bag or an enema can with latex-free tubing.
2. Choose an Enema Solution
You will need to know ahead of time what kind of enema solution you will use to ensure you have all the necessary ingredients for your enema. For your first enema, a salt water solution is best. Use 1tsp of pure sea salt per liter of water. Salt water is preferable to plain water because salt water is more neutral to the body. When plain water is held in the colon for longer periods, it draws electrolytes from the body. Repeated use of plain water enemas may cause electrolyte depletion. Keep your enema solution as simple as possible in the beginning, and then, when you are more comfortable with the procedure, you can explore other effective enema solutions and herbal enemas.
Make sure you use clean, filtered water in your enema. You do not want to introduce harmful bacteria or chlorine into your colon.
If you are doing a few successive enemas, in your last enema you may want to include some acidophilus powder in the solution. This will keep the large intestine populated with the beneficial flora and reduce the chance of over population of pathogenic organisms and candida.
When you become more experienced with enemas and want to try other solutions, refer to the page “7 natural enema solutions you can use at home”.
How much solution should you use?
That depends; certain enema solutions require less fluid, but if you are using a plain or salt water enema to relieve constipation 1-2 liters will suffice. If you are trying to achieve a deeper colon cleanse you will want to use more water. Keep in mind that most individuals will not be able to hold more that two liters of water the first time they administer an enema; you may have to build up the volume over a series of enemas. (Note that 1 liter equals approximately 1 quart).
If you have been fasting for a few days before your enema, you will be able to hold more solution. This is because there is no new waste entering the colon. If you are administering a series of enemas, you will find you can retain more solution each time as the colon gets cleaner.
If you are nervous about administering an enema, start with a low volume enema (about 500ml) for your first try. This will relieve any anxiety about the procedure, and then you can proceed to take in a higher volume of solution.
You might be surprised how much the colon can actually take in. Colon size does vary; an adult colon can hold between 3L and 6L of water. The average is about 4L. It is rare for most individuals to hold more than 3L, (unless they are on a cleansing or fasting regime) because there is usually a fair amount of fecal matter built up in the colon.
There is some fear of high-volume enemas, but these larger enemas have been advocated by many reputable Doctors throughout the last century and are regarded as completely safe if you follow common sense guidelines. In his book ‘The home handbook of domestic hygiene and rational medicine’ Dr. Kellogg recommends enemas ranging from 4-6L for a variety of conditions. High-volume enemas are used by many and are not to be feared.
Aside from professional colonics, high-volume enemas are the only way you will achieve an effective colon cleanse. It is often stated in health literature that if one uses enemas for the purpose of colon cleansing, it is essential to fill the colon completely to be effective. J. Parsons DSc, author of ‘Naturopathic practice’, recommends 5L as the average maximum for a thorough enema, stating that the results of your at-home-enema can be just as good as what you would experience with professional colonics.
Some practitioners even suggest that you should do a series of high volume enemas to obtain the best results. In his book ‘Back To Eden’ Dr. Kloss recommends repeating enemas until 4L can be held for 5-10 minutes. He suggests that one should repeat the high volume enema several times until what is evacuated is only the clear fluid, free of fecal matter. Dr. Swartout, author of ‘Modern Medical Counselor’, similarly states that one must hold as much water as possible, and repeat the procedure until a clear bowel movement is achieved.
Even though many Doctors recommend to keep going until what comes out is clear, a lot of the advice comes from before 1950 when diets consisted of primarily whole foods, and the colon was much cleaner in general. Today, the average person eats a fair amount of refined and processed foods. The average diet today is low in fiber, which causes more waste to accumulate in the colon. Even if you eat healthy now, poor eating habits in the past will have had an impact in the colon. Trying to get it all cleared out in one go, may be a bit overenthusiastic.
Even in very healthy individuals there is a limit. Dr. Moser, the author of ‘How and When to Be Your Own Doctor’, claims that the colon will begin to protest and will not accept any more than three successive enemas. This is a bit of a generalization; each person is different, but this is still a good guideline to keep in mind. If you are feeling tired, or if you are getting clear signals that it is time to stop cleansing, then stop. Even if the solution coming out is not entirely clear, it is better to take it easy, than to risk over-doing it. You can always repeat the procedure on another day when you colon is ready for more. Remember to listen to your body and do not overdo it!
Parsons offers very practical and cautious advice in his book ‘Naturopathic Practice’. He recommends building the enemas up successively, starting with no more than 500ml for your first enema and increasing daily by 500ml until you have reached the maximum of 4-5L. Choose a volume which feels safe and comfortable for you to start out with. If you find it was not enough, you can always add more. If you are part way through the procedure, and you find that you overestimated your colon’s current capacity, you can stop at any time; there is nothing to prove.
3. Prepare Yourself for the Enema
Don’t administer your enema at any random time; there are things to consider before starting the procedure. You most likely will not cause harm if you do your enema mid-day on a full stomach, but it’s not going to go as well as it would if you did it at the right time with a little preparation.
When is the best time to take an enema?
An enema should be done first thing in the morning on an empty stomach. Ideally, you should have a bowel movement before beginning your enema; it is not essential, but it will make the process more comfortable.
Plan to stay at home or somewhere you have easy access to a toilet for 1hr after the enema. Make sure you do not have any big plans the day you schedule your enema, as you may feel slightly depleted afterward.
Choose a day when you will not be interrupted. If you live with others, tell them your anticipated washroom schedule. Unless you are an exhibitionist, you’ll probably want to secure some private time for this.
What should you eat the day before an enema?
Dietary changes are not necessary, but preparing your bowels in this way will allow you to benefit more from your enema.
Fast on only fruits the day before you plan to do your enema. You can fast even longer if you wish, but fasting on fruits for even one day will ensure the stomach and small intestine are empty before you do your enema. This will make your enema more efficient and decrease the chance of nausea. It is not that common, but some people may experience nausea if they take an enema while there is food in the digestive system.
If you are unable to do a complete fruit fast the day before, then at least try to ingest only foods which are easily digestible. Stay away from flour products, meat, fish, eggs, cheese, potatoes, bananas, beans, and legumes.
Make sure to drink at least 3L of water the day before your enema. Avoid alcohol and carbonated beverages.
4. Prepare your Space and Equipment
Prepare the area where you will do your enema and get all of the necessary equipment ready. Having everything in order will make you feel more at ease.
Choose your Space
Pick a place to do your enema where you will be close to the toilet. Make sure it is a space where you are comfortable and can relax. A bathroom floor is a good option, or you can use your bed. Lay a few old towels on the floor for comfort and for catching any solution that may leak out. The room should be warm as you will probably want to be naked from the waist down.
You will need a place to hang the enema bag; a door handle or towel bar works well. Alternatively, you can install a hook at the appropriate height. If you are using a canister, you will need a countertop, table, or a ledge to place it on. The enema container should be 1.5-3 feet above the anus. The bag or canister should not sit more than 3 feet above the anus. If it is higher than this, the pressure and speed of flow may be too much and can cause discomfort. Also, be sure not place the container too low (under 1.5 feet) as the pressure will not be enough to allow all of the solution to flow into the colon.
Warm your solution to the appropriate temperature
Make sure the temperature of your enema is in the proper range before you insert it into your rectum. An enema that is too cold will cause abdominal cramping and cause you to evacuate too soon. An enema that is too hot may damage your intestinal lining. A comfortable temperature range is between 98 and 104˚ F (37-40˚C). When the temperature is right, it will feel comfortable inside your colon. If you get it just right, you may not even feel the water flowing in.
You can use a thermometer if you want to be accurate, but if you do not have a thermometer, then testing the temperature on the inside of your wrist will provide a good indication. It’s easy to discriminate which temperatures would feel comfortable or uncomfortable to inject into a delicate area of your body.
If you are planning to refill your enema bag, you may want to heat your refill slightly (only slightly!) warmer than your first bag. Unless you store it in a hot water style bag, the temperature will drop a little in the amount of time it takes for the first enema bag to be emptied into your colon.
Fill the bag
Once you have the right temperature, it is time to fill your enema container. Have everything you need in place and be ready for your enema before you fill your bag. The solution can cool quickly if you are using an enema can or a thin disposable bag. Before you fill your container, ensure that the tubing in secured to the container and that the clamp is closed tightly so you do not spill your solution out the other end.
Have the refill solution ready
If the enema container you are using is less than the volume you want to take in for one enema, then you will need to make sure it is possible for you to refill the bag while still injecting water. You can always have someone assist you in this.
You want to refill the enema bag before it empties completely; otherwise, you will risk injecting air into the colon. Make sure the solution which you are refilling the container with has been measured, so you do not take in too much. Keep the per-measured refill close to you, so you can quickly refill the bag. You may have to stand up or kneel with the tube still in your anus to refill; this is fine, just lay back down once the bag is refilled.
A fuss-free option is to fill 2 enema bags and have them hanging next to each other. When you empty one, all you need to do is remove one nozzle and replace it with the other.
5. Get Into Position
Once you have everything in place for your enema, it is time for you to get into position. There are three common enema positions:
- Left-side: This is the best position for taking an enema. Lay down on your left side. Keep the left leg straight and bend the right knee towards the chest, knee resting on the floor. You can rest your head on a pillow or the left arm. Your right arm will be able to reach your anus easily in this position, making inserting and removing the nozzle quite comfortable.
- On the back: Another common position. Lay on your back with the knees to the chest. Hands can rest on your knees. You can place a pillow under your head for comfort. It may be harder to reach the nozzle in this position.
- Buttocks up: Get onto your knees and elbows. The head should hang low and your buttocks will stick up in the air. It may be more comfortable to rest your head on your hands with your chest closer to the floor. You can place one or two pillows underneath your chest to make things more comfortable. Also, make sure there is enough cushioning under your knees and elbows. This position may be harder to relax in and does not provide as easy of reach to the anus as the left-side laying position. The nozzle also tends to slip out more in this position.
Everyone is different, so try the positions first and see which one you feel is most comfortable. It may take five minutes or longer for the enema bag to empty into your colon; you don’t want to have to strain to hold your position.
Whichever position you choose, make sure you can reach you anus easily. If you find you cannot reach your anus in any of the positions, you will have to get assistance with your enema.
You cannot do an enema sitting on the toilet or standing up because in these positions the solution may not flow into the entire colon and you will also have to work against gravity to retain the solution.
6. Prepare for Insertion
Before you insert the nozzle into your anus make sure there is no air in the tubing; if air enters the intestines it will be harder to retain the enema, and it may also cause uncomfortable cramping. You can make sure no air is left by unclamping the tube and letting a little of the enema solution spill out into a toilet or sink. Make sure the solution is coming out in a steady stream and no air bubbles are in the tubing. Clamp the tube to stop the flow.
You can administer this step as you are filling your bag, but keep in mind that any solution in the tubing will cool much faster than what is in the bag. To keep the temperature comfortable, administer this step just before you are ready to start your enema.
Check the position of the clamp; it should be placed a few inches up from the nozzle to ensure an easy reach.
Lubricate the anus and nozzle
You want to lubricate both the nozzle and your anus before insertion. Natural oils such as olive, coconut, almond, grapeseed, or sesame work well.
Relax and breathe
Now you are ready to insert the nozzle into the anus. Make sure you are relaxed. Take a few deep breaths or massage your anus if you are feeling nervous.
7. Insert and Let It Flow…
The tip of the nozzle should go passed your internal anal sphincter. About three inches is a good depth. Unclamp the tube and relax as the solution flows in. If the solution is not flowing, it is probably because the opening of the nozzle is blocked by the walls of the intestine. Pull the nozzle out of your anus just a little and the solution will begin to flow.
Keep you hand on the clamp to prevent the nozzle from slipping out and to make it easy to adjust the flow if you find the pressure to be too much. You can also hang the bag lower to reduce the pressure.
Remember to relax!
Stay relaxed as the solution continues to fill your colon. You will feel the stomach expanding; this is to be expected. The sensation of water filling and expanding the colon may be unpleasant or uncomfortable, but it will not be painful. You will get used to these sensations.
Don’t be in a rush to get all of the solution in; you want to make sure you are comfortable because this will increase your chances of being able to take it all in. You want to get as much of the solution in as possible, but if it enters too quickly, it could stimulate peristaltic action and make you evacuate too soon.
You may not be able to get all of the solution in on your first try; this is normal. If you are very constipated, and the colon is already quite full of fecal matter, you may not be able to take in that much. Take in what you can while remaining comfortable. There is no need to tolerate pain or high levels of discomfort; you can always administer another enema once you have evacuated.
Certain situations may arise as your colon fills up. There is nothing to worry about; they can all be relieved by simple measures.
Leaking: Leaking of enema solution from the anus is usually due to weak muscles in the rectal area. If it is only a small amount leaking, don’t worry, let it come out, you should have towels below you to soak up any leaks. If you think there is too much solution coming out, then stop the flow for 30 seconds, resume flow for 2-3 minutes, then rest and stop the flow again for 30 seconds. Continue in this manner to allow time for the solution to work it’s way deeper into the colon.
If you are laying on your side or your back, then switch to the knees down position. You are less likely to leak when the buttocks is high in the air.
Cramps: If cramps come, take a few deep breaths and relax. You can also try slowing the flow of the solution. If the cramps are more intense and you feel the need to evacuate, then clamp the tube to stop the flow and take a few moments to relax. The cramping will subside, usually in less than a minute, and you will be able to resume.
Pain: If you experience pain during your enema, it is usually because air was taken in with the enema. Clamp the tube to prevent any more solution from flowing in and try to dislodge the air. There are a few different methods to dislodge the air:
- Breath heavily so that your abdomen moves in and out, this will help any gas in the intestines to move around.
- Using your hand, press on the area where you are feeling the pain and massage the abdomen in a counter-clockwise direction.
- As a preventative, be careful when your solution is getting low; you do not want to empty your bag completely as you will risk air entering the colon.
8. Remove the Nozzle and Retain the Enema
When you have finished emptying the enema or when you have taken in as much solution that you can comfortably hold, clamp the tube and slowly remove the nozzle from your anus. Lay in a comfortable position on the floor.
Slightly clench the anus to ensure the solution does not leak out. Tightly folding a towel and pressing it against the anus will also assist in retaining the fluid. Alternatively, you can use a retention plug if your muscle control is weak, or you just want the feeling of extra security.
How long should you hold it in?
Try to hold the enema in for at least 10-15mins. It takes time for the stools to soften and for any impacted matter to break away from the walls of the colon. The longer you can retain it, the better the results will be.
It is often recommended to hold the enema for 30 minutes, or even longer. J. Parsons suggests the most thorough holding procedure: once the desired amount of solution has been injected into the colon, remain lying on the left side for 10 minutes. After, turn onto your back for 10 minutes, then lay on the right for 10min, then, if you can tolerate it, turn to lay on your abdomen for 10 minutes. Even though it’s hard to lay face down on the stomach with distended bowels, Parsons recommends remaining in the position for the full 10 minutes to ensure the loosening of the impacted fecal matter.
This will be a tough task in the beginning; if you make it to 10 minutes in any position you’re doing really well! If it is not possible to hold the solution in for more than a few minutes on your first try, don’t fret, your will be able to increase the maximum holding time with continued use.
Assist the movement of water with massage
While you are laying there, massage the abdomen in a counter-clockwise direction to assist the water to flow into the entire colon. Begin in the lower left corner of the abdomen and massage towards the ribcage to move the water up the descending colon. Next, massage across the upper abdomen to moving the water along the transverse colon and then massage down the right side of the abdomen to move the water into the ascending colon and the cecum area.
9. Evacuate the Enema
When your desired holding time has been reached, or you feel a strong urge to evacuate, get up and move to the toilet. The entire enema will not come out in the first evacuation, so stay close to a bathroom for the next 30-60 minutes.
After the first evacuation, you can either lay back down and administer more abdominal massage (this time in the opposite direction to assist the flow out of the colon), or you can do gentle twisting motions at the level of the abdomen to encourage more cleansing until the next urge comes. If you are familiar with the yogic technique nauli kriya, doing it at this time will promote further cleansing.
After you are finished evacuating your anus may be tender, apply some more oil to help soothe the area.
10. After the Enema
If there have been any spills on the towels, make sure to wash them separately and add disinfectant to your laundry cycle.
Clean and sanitize your enema equipment thoroughly. Boiling it for a few minutes is the simplest and most efficient method. Make sure to hang the bag and tubes to dry. It will take several days to dry completely. Never store your equipment while it is still wet as it may grow mold.
Keep your enema equipment reserved for your personal use only; do not share it with anyone else.
Rest and nourish the body
After you have made your last evacuations, lay down and rest for a while. If you have administered a large enema, you may feel slightly depleted; this feeling will pass if you nourish the body and take it easy for the remainder of the day.
After you have rested, you will probably want to eat something. Keep your meals light for the remainder of the day. Eat simple, nourishing foods such as rice, dahl, and steamed vegetables. Try avoid raw vegetables and fruits, pungent spices, dairy and meat. Avoid alcohol and caffeine, and drink plenty of fluids. You can resume your regular diet on the following day.
How often should you use an enema?
The recommended frequency or enemas depend on what you are trying to achieve.
Mae West and Veronica Lake, well-known actresses from the 1930’s and 40’s, both claimed that their heath and beauty was attributed to the daily use of high volume enemas. These women can be inspiring examples, but everyday use is probably a bit extreme for most people. It is better to exercise moderation and only administer daily enemas in the case of severe illnesses.
Daily enemas can be beneficial in the treatment of many chronic conditions, but do not attempt daily enemas for prolonged periods unless a knowledgeable health practitioner monitors you. Large enemas taken daily may upset the balance in the colon.
For general maintenance and colon health, the recommended frequency varies from one a week to once a month. Doctors such as Hartland Law, author of ‘Viavi Hygiene’, advocate an enema once a week whereas others state that once a month is sufficient in healthy individuals. It is best to practice moderation and start slowly; in time, you will know the frequency of use which is best for you.
Can enemas weaken the colon?
It is often claimed that repeated use of large enemas can weaken the colon. But the opposite is true. Dr. Moser, states that it is the frequent use of small volume enemas (1-2 cups) to induce a bowel movement, which can cause dependency and may even distend the rectum and sigmoid areas of the colon. She states that the high volume enemas which fill the entire colon, actually strengthen and tone the muscles of the colon, and with repeated use will increase peristalsis, reducing the transit time of feces in the colon.
Are enemas safe?
Yes, enemas are very safe and provide excellent health benefits. Complications are very rare in healthy adults. Use your equipment properly and within reasonable limits and you should have no problems. Read the precautions below to make sure you have no contraindications for enema therapy.
- Enema usage can result in dehydration, be sure to drink a lot of fluids the day you do your enema and replenish your electrolytes if you are using enemas on a regular basis.
Do not administer enemas if:
- You have undiagnosed abdominal pain
- You have tumors or a perforation in the rectum or colon
- There has been recent surgery to your colon or rectum
- You suffer from acute flare-up of Crohn’s disease, colitis, or diverticulitis
- You have a history of heart attacks, irregular heartbeat or renal failure
- You are less than seven months pregnant (after seven months check with your doctor before administering an enema)
- You suffer from a severe illness which causes weakness
Resources and Recommended Reading:
- Emmet Densmore M.D, How Nature Cures, Comprising a New System of Hygiene
- J. Hewlett-Parsons, Naturopathic practice
- Jethro Kloss, Back To Eden
- Dr. Isabelle A. Moser, How and When to Be Your Own Doctor
- Dr. Kellogg, The home handbook of domestic hygiene and rational medicine
- B. Macfadden, The Encyclopedia of Health and Physical Culture
- Dr. Swartout, Modern Medical Counselor
- Hartland Law MD, Viavi Hygiene
- Sanford Bennett, Old Age, Its Cause and Prevention
Photo: Michelle Grace