Enema

Introduction

• Introduction of fluid into rectum and colon distends the bowel and stimulates normal expulsive reflexes.

Uses

• Evacuation of feces for:
  • Treatment of constipation .
  • Management of some poisonings , ie binding of toxin in bowel lumen and removal from body.
  • Treatment of hepatic encephalopathy , ie removal of toxins from large bowel to prevent absorption and binding of ammonia in gut.
• Preparation for:
  • Surgical procedures.
  • Colonoscopy .
  • Radiographic studies, eg intravenous urethrography .
  • Drug administration.
  • Administration of radiographic contrast agents.
  • Nutrient administration.
• As part of lower gastrointestinal contrast study .

Advantages

• Simple.
• Equipment readily available in practice.
• Rapid procedure.
• Effective if performed well.

Disadvantages

• Very messy.
• If poorly done can be worse than not performing at all.

Preparation

• Time to gather equipment.

Requirements

Materials required

Minimum equipment

• Soft rubber tube with rounded tip to administer fluid to colon.
• Higginson's pump.

Ideal equipment

• Specialized enema equipment (comprising tube with attached container).

Minimum consumables

• Enema solution:
  • Water or saline (up to 1 liter depending on size of dog), for evacuation of bowel.
    Addition of soap, glycerine or liquid oil to solution may improve efficacy.
  • Commercial enema solution preparation.
  • Medication.
  • Contrast media.
• Water-soluble lubricant.
• Disposable glove.
• Large syringe for administering enema solution.

Ideal consumables

• Container to connect to enema tubing for solution administration.

Sequelae

Reasons for treatment failure

• Inability to pass enema tube sufficiently far into colon.
• Severe constipation.
• May need to perform under anesthesia to remove concreted feces in severe obstipation.