Enema
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Image:Combination enema and douche syringe.jpg Image:Rectal bulb syringe.jpg
An enema (plural enemata or enemas) is the procedure of introducing liquids into the rectum and colon via the anus. Enemas can be carried out for medical reasons (as a treatment for constipation), as part of alternative therapies, and also for erotic purposes, particularly as part of BDSM activities. In earlier times, they were often known as clysters.
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Medical usage
The main medical usages of enemas are:
- As a laxative. The patient expels feces along with the enema in the toilet after administration. Enemas may be used to relieve constipation and fecal impaction, although in many medical settings their use has been largely replaced by oral laxatives and laxative suppositories. Laxative enemas may consist of water, which works primarily as a mechanical laxative; sodium phosphate solution, which draws additional water from the bloodstream into the colon and increases the effectiveness of the enema; or mineral oil, which functions as a lubricant and stool softener. Other types of solutions are available as well. In the past soap was a common additive to enemas, but it has largely fallen out of use because of the risk of chemical-induced colitis as well as the ready availability of other enema preparations that are more effective than soap.
- Cleaning the lower bowel prior to a medical or surgical procedure such as sigmoidoscopy or colonoscopy. Enemas used for this purpose are commonly the sodium phosphate variety.
- The administration of substances into the bloodstream. This may be done in situations where it is undesirable or impossible to deliver a medication by mouth, such as antiemetics given to reduce nausea (though not all antiemetics are delivered by enema). An enema may also be used for hydration purposes. See also route of administration.
- The topical administration of medications into the rectum, such as corticosteroids and mesalamine used in the treatment of inflammatory bowel disease. Administration by enema avoids having the medication pass through the entire gastrointestinal tract, therefore simplifying the delivery of the medication to the affected area and limiting the amount that is absorbed into the bloodstream.
- A barium enema is used as a contrast substance in the radiological imaging of the bowel.
In certain countries such as the United States, customary enema usage went well into the 20th century; it was thought a good idea to cleanse the bowel in case of fever; also, pregnant women were given enemas prior to labor so as to reduce the risk of feces being passed during contractions as well as inducing contractions. This latter usage has since been largely abandoned, in part because the health benefits are unclear and because women generally found the procedure unpleasant.
Application
Most enemas are packaged in single-use bottles that come with a nozzle attached to the top; some are administered using disposable bags connected to disposable tubing. In medical environments reusable enema equipment is now rare because of the difficulty and expense of disinfecting it. For home use disposable bottles are common, but reusable rubber or vinyl bags or enema bulbs may also be used. In former times, enemas were frequently administered using clyster syringes. Regardless of the administration medium, the water for the enema should be as near as possible to body temperature.
Effect
At first, the flow of water causes pressure in the rectum and an urge to release. It comes in waves, but is easily held back. Then, there is a feeling of pressure in the lower abdomen. It starts gradually, but slowly builds until there is a feeling like a balloon is gradually being inflated.
The feeling of inflation gradually moves up the left side up the descending colon and then across the middle in the transverse colon, and then down the right side in the ascending colon. The pressure causes a cramping sensation which gradually becomes more intense. The abdomen expands and takes on a pregnant look as the water pushes outward and fills all available space.
Towards the end of the procedure, there is a feeling of immense inflation and peristalsis coupled with strong pressure in the rectum. Withholding the enema allows for greater saturation of the water into fecal material, but can be extremely difficult. Most people cannot retain an enema for more than 5 minutes, although 15 minutes is recommended for best results. When the water is released, there is an extremely explosive bowel movement that completely empties the lower intestinal tract over a period of about 15 minutes.
Non-medical usage
The paraphilia directed towards enemas is known as klismaphilia. Enemas are available as a service from many practitioners in the sex industry to cater to klismaphiliac desires, and may be used as part of BDSM activities.
A small enema may be taken prior to anal sex or annilingus in order to remove feces, thus reducing bacterial transmission and risk of infection.
Ritual use
Ritual enemas were practiced by the Maya and many other Central American and South American Indian tribes; some tribes have continued the practice to the present day. Substances used in the enemas include alcohol, tobacco, peyote, and other hallucinogenic drugs and entheogens. While the precise nature of the substances used by the Maya are unknown except from pictures of pots containing bubbling liquids, it is presumed these contained alcohol or other drugs.
Colonic irrigation
Colonic irrigation or colon hydrotherapy is a large enema which cleanses the whole colon. It was in vogue for hygienic purposes at the beginning of the 20th century (see John Harvey Kellogg) and remains popular as an alternative health therapy in most parts of the world. Advocates believe that, when carried out by trained personnel using sterile equipment, it can be a safe and valuable tool for eliminating toxins from the body and restoring normal muscular activity in the colon. However, there have been cases of intestinal perforation due to improperly done colonic irrigation.
References
- M. R. Strict, Intimate Invasion: The Erotic Ins & Outs of Enema Play, Greenery Press, 2004. ISBN 1890159514.de:Einlauf (Medizin)