Enema: Difference between revisions

{{Short description|Injection of fluid into rectum, typically en route to largethe intestinecolon}}

In standard medicine, the most frequent uses of enemas are to relieve constipation and for bowel cleansing before a medical examination or procedure;<ref name= Biology_Online_Dictionary>{{cite web |url = http://www.biology-online.org/dictionary/Soapsuds_enema |title = Soapsuds enema |website = Biology-Online Dictionary |publisher = Biology-Online |access-date = 6 August 2014 }}</ref> also, they are employed as a [[lower gastrointestinal series]] (also called a barium enema),<ref name=NIH_barium>{{cite web MedlinePlusEncyclopedia|url = https://www.nlm.nih.gov/medlineplus/ency/article/003817.htm |title = Barium enema |website = MedlinePlus |publisher = U.S. Department of Health & Human Services – National Institutes of Health (NIH) |access-date = 6 August 2014 }}</ref> to treat [[Travelers' diarrhea|traveler's diarrhea]],<ref name= Travellers_Diarrhea>{{cite journal |title= Management of traveller's diarrhoea with a combination of sodium butyrate, organic acids, and A-300 silicon dioxide |journal = Przeglad Gastroenterologiczny|volume = 9|issue = 5|pages = 285–290|date = 19 October 2014 |publisher = U.S. Department of Health & Human Services, National Institutes of Health (NIH) |pmc = 4223117|last1 = Krokowicz|first1 = L.|last2 = MacKiewicz|first2 = J.|last3 = Wejman-Matela|first3 = A.|last4 = Krokowicz|first4 = P.|last5 = Drews|first5 = M.|last6 = Banasiewicz|first6 = T.|pmid = 25396003|doi = 10.5114/pg.2014.46164}}</ref> as a vehicle for the administration of food, water or medicine, as a stimulant to the general system, as a local application and, more rarely, as a means of reducing body temperature,<ref name=Cullingworth_introduction /> as treatment for [[encopresis]], and as a form of [[Management of dehydration|rehydration therapy]] (proctoclysis) in patients for whom [[intravenous therapy]] is not applicable.<ref>{{cite journal |doi = 10.1016/S0885-3924(97)00367-9 |last1 = Bruera |first1 = E |last2 = Pruvost |first2 = M |last3 = Schoeller |first3 = T |last4 = Montegjo |first4 = G |last5 = Watanabe |first5 = S |date = April 1998 |title = Proctoclysis for Hydration of Terminally Ill Cancer Patients |journal = Journal of Pain and Symptom Management |volume = 15 |issue = 4 |pages = 216–9 |pmid=9601155|doi-access = free }}</ref>

A large volume of enema<ref>{{cite web |url=https://www.merriam-webster.com/medical/high%20enema|title=high enema |website=Medical Dictionary |publisher=Merriam-Webster |access-date=17 February 2018}}</ref> can be given to cleanse as much of the colon as possible of feces.<ref>{{cite web |title=Administering an Enema |url=http://intranet.tdmu.edu.ua/data/kafedra/internal/meds/prac_skills_alg/Care%20of%20patients/Administering%20an%20Enema.htm |website=Care of patients |date=14 July 2015 |publisher=Ternopil State Medical University |access-date=17 February 2018 |url-status=dead |archive-date=23 February 2018 |archive-url=https://web.archive.org/web/20180223111015/http://intranet.tdmu.edu.ua/data/kafedra/internal/meds/prac_skills_alg/Care%20of%20patients/Administering%20an%20Enema.htm}}</ref><ref name="Fundamentals of Nursing Practice">{{cite web |url=http://www.peoi.org/Courses/Coursesen/nursepractice/ch/ch12e1.html |title=Types of Enemas |website=Fundamentals of Nursing Practice |publisher=Professional Education, Testing and Certification Organization International |author=Rhodora Cruz |access-date=17 February 2018}}</ref> However, a low enema is generally useful only for stool in the rectum, not in the intestinal tract.<ref>{{cite web |url=https://www.merriam-webster.com/medical/low%20enema|title=low enema |website=Medical Dictionary |publisher=Merriam-Webster |access-date=17 February 2018}}</ref>

Such enemas' mechanism consists of the volume of the liquid causing a rapid expansion of the intestinal tract in conjunction with, in the case of certain solutions, irritation of the intestinal [[mucosa]] which stimulates peristalsis and lubricates the stool to encourage a bowel movement.<ref name=Nursing_and_Allied_Health/> An enema's efficacy depends on several factors including the volume injected and the temperature and the contents of the infusion.<ref name="Pharmacological treatment"/> In order for the enema to be effective the patient should retain the solution for five to ten minutes, as tolerated.<ref name=Biology_Online_Dictionary/><ref name=Nursing_and_Allied_Health/> or, as some nursing textbooks recommend, for five to fifteen minutes or as long as possible.<ref name=Safety_and_effectiveness/>

Equal parts of milk and molasses heated together to slightly above normal body temperature have been used.<ref>{{Cite journal|last1=Nicholls|first1=Pam Hufford|last2=Metules|first2=Terri J|date=April 2001|title=Some old-fashioned enemas still work and are still used|journal=RN|volume=64|pages=80}}</ref> Neither the milk sugars and proteins nor the molasses are absorbed in the lower intestine, thus keeping the water from the enema in the intestine.<ref>{{cite journal | url=https://med.virginia.edu/pediatrics/about/clinical-and-patient-services/patient-tutorials/chronic-constipation-encopresis/treatment-of-chronic-constipation | title=Treatment of Chronic Constipation | volume=58 | issue=4 | pages=503–512 | journal=Clinical and Patient Services > Tutorials for Patients & Families | access-date=12 September 2018 | bibcode=1954NYASA..58..503I | last1=Ingelfinger | first1=Franz J. | year=1954 | doi=10.1111/j.1749-6632.1954.tb45865.x | pmid=29831395 | pmc=5251364 }}{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> Studies have shown that milk and molasses enemas have a low complication rate when used in the [[emergency department]]<ref>{{cite journal |url=https://www.jem-journal.com/article/S0736-4679(15)00059-1/fulltext |title=Safety and Efficacy of Milk and Molasses Enemas in the Emergency Department |volume=48 |issue=6 |pages=667–70 |author1=Gary M. Vilke |author2=Gerard DeMers |author3=Nilang Patel |author4=Edward M. Castillo |date=June 2015 |journal=The Journal of Emergency Medicine |publisher=American Academy of Emergency Medicine |access-date=2019-03-19 |pmid=25850633 |doi=10.1016/j.jemermed.2015.01.035 |s2cid=9638496 }}</ref> and are safe and effective with minimal side effects.<ref>{{cite journal |url=https://www.jenonline.org/article/S0099-1767(13)00413-3/fulltext |title=Milk and Molasses Enemas: Clearing Things Up |author1=Kimberley Wallaker |author2=Ezio Fortuna |author3=Stuart Bradin |author4=Michelle Macy |author5=Michelle Hassan |author6=Rachel Stanley |date=November 2014 |journal=Journal of Emergency Nursing |volume=40 |issue=6 |pages=546–551 |publisher=The Emergency Nurses Association |access-date=2019-03-19 |pmid=24182894 |doi=10.1016/j.jen.2013.08.012 }}</ref>

* [[Peanut oil|Arachis oil (peanut oil)]] enema is useful for softening stools which are impacted higher than the rectum.<ref name="NHS_Laxativives">{{cite web |url=http://www.nhsgrampian.org/nhsgrampian/GJF_general_new.jsp;jsessionid=9D853EB1A4631954DC26F785F611F2B1?pContentID=4659&p_applic=CCC&pElementID=522&pMenuID=7&p_service=Content.show& |title=NHS Grampian Medicines Management – Laxatives |date=2011 |work=NHS Grampian Campaign |publisher=National Health Service |access-date=4 March 2019 }}{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

Klyx contains [[docusate sodium]] 1&nbsp;mg/mL and sorbitol solution (70%) (crystallising) 357&nbsp;mg/mL and is used for faecal impaction or constipation or for colon evacuation prior medical procedures,<ref>{{cite web |url=https://www.news-medical.net/drugs/Klyx.aspx |title=Klyx |date=March 2017 |work=NHS Grampian Campaign |publisher=[[National Health Service]] |access-date=4 March 2019 |archive-date=6 March 2019 |archive-url=https://web.archive.org/web/20190306043511/https://www.news-medical.net/drugs/Klyx.aspx |url-status=dead }}</ref> developed by [[Ferring Pharmaceuticals|Ferring B.V.]]

Micolette Micro-enema® contains 45&nbsp;mg sodium lauryl sulphoacetate, 450&nbsp;mg per 5 ml sodium citrate BP, and 625&nbsp;mg glycerol BP<ref>{{cite web |url=https://www.medicines.org.uk/emc/product/4569/smpc |title=Micolette Micro-enema |date=10 July 2015 |work=Latest medicine updates |publisher=Latest medicine updates |access-date=4 March 2019}}</ref> and is a small volume stimulant enema suitable where large-volume enemas are contra-indicated.<ref name=NHS_Laxativives/>

The term ''retrograde irrigation'' distinguishes this procedure from the [[Malone antegrade continence enema]], where irrigation fluid is introduced into the colon proximal to the anus via a surgically created irrigation port.<ref>{{Cite journal |last1=Spinelli |first1=Michele |last2=Sampogna |first2=Gianluca |last3=Rizzato |first3=Luigi |last4=Spinelli |first4=Antonella |last5=Sammartano |first5=Fabrizio |last6=Cimbanassi |first6=Stefania |last7=Montanari |first7=Emanuele |last8=Chiara |first8=Osvaldo |date=2021-04-23 |title=The Malone antegrade continence enema adapting a transanal irrigation system in patients with neurogenic bowel dysfunction |journal=Spinal Cord Series and Cases |volume=7 |issue=1 |pages=34 |doi=10.1038/s41394-021-00397-3 |issn=2058-6124 |pmc=8065210 |pmid=33893272}}</ref>

In a [[lower gastrointestinal series]] an enema that may contain [[Barium sulphate#Radiocontrast agent|barium sulfate]] powder or a water-soluble [[contrast agent]] is used in the [[Röntgen X-ray|radiological]] imaging of the bowel. Called a ''barium enema'', such enemas are sometimes the only practical way to ''view'' the colon in a relatively safe manner.<ref name=NIH_barium />

* [[Shigellosis]] treatment benefits from adjunct therapy with butyrate enemas, promoting healing of the rectal mucosa and inflammation, but not helping in clinical recovery from shigellosis. Use of an 80 ml of a sodium butyrate isotonic enema administered every 12 hours has been studied and found effective.<ref>{{cite journal |title= Efficacy of sodium butyrate adjunct therapy in shigellosis: a randomized, double-blind, placebo-controlled clinical trial |journal = BMC Infectious Diseases|volume = 12|pages = 111|date = 10 May 2012 |publisher = U.S. Department of Health & Human Services, National Institutes of Health (NIH) |pmc = 3447723|last1 = Raqib|first1 = R.|last2 = Sarker|first2 = P.|last3 = Mily|first3 = A.|last4 = Alam|first4 = N. H.|last5 = Arifuzzaman|first5 = A. S.|last6 = Rekha|first6 = R. S.|last7 = Andersson|first7 = J.|last8 = Gudmundsson|first8 = G. H.|last9 = Cravioto|first9 = A.|last10 = Agerberth|first10 = B.|pmid = 22574737|doi = 10.1186/1471-2334-12-111 | doi-access=free }}</ref>

* Introducing healthy bacterial flora through infusion of stool, known as a [[fecal microbiota transplant]], was first performed in 1958 employing retention enemas. Enemas remained the most common method until 1989, when alternative means of administration were developed.<ref>{{cite journal |last1=Bakken |first1=Johan S. |last2=Borody |first2=Thomas |last3=Brandt |first3=Lawrence J. |last4=Brill |first4=Joel V. |last5=Demarco |first5=Daniel C. |last6=Franzos |first6=Marc Alaric |last7=Kelly |first7=Colleen |last8=Khoruts |first8=Alexander |last9=Louie |first9=Thomas |last10=Martinelli |first10=Lawrence P. |last11=Moore |first11=Thomas A. |last12=Russell |first12=George |last13=Surawicz |first13=Christina |author14=Fecal Microbiota Transplantation Workgroup |title=Treating Clostridium difficile Infection With Fecal Microbiota Transplantation |journal=Clinical Gastroenterology and Hepatology |date=December 2011 |volume=9 |issue=12 |pages=1044–1049 |doi=10.1016/j.cgh.2011.08.014 |pmid=21871249 |pmc=3223289 }}</ref> As of 2013, [[colonoscope]] implantation has been preferred over fecal enemas because by using the former method, the entire colon and ileum can be inoculated, but enemas reach only to the [[splenic flexure]].<ref>{{cite journal |title=Fecal microbiota transplantation: past, present and future |issue=1 |pages=79–84 |author=Olga C. Aroniadis |author2=Lawrence J. Brandt |date=January 2013 |journal=Current Opinion in Gastroenterology |volume=29 |publisher=[[Lippincott Williams & Wilkins]] |doi=10.1097/MOG.0b013e32835a4b3e |pmid=23041678 |s2cid=39943619 |doi-access=free }}</ref>

Improper administration of an enema can cause electrolyte imbalance (with repeated enemas) or ruptures to the bowel or rectal tissues which can be unnoticed as the rectum is insensitive to pain,<ref name=enemapain>{{cite journal |last1=Lee |first1=Seokyoun |last2=Kwon |first2=Jungnam |last3=Lee |first3=Junhee |title=Rectal perforations caused by cleansing enemas in chronically constipated patients: Two case reports |journal=SAGE Open Medical Case Reports |date=8 July 2020 |volume=8 |pages=2050313X20938251 |doi=10.1177/2050313X20938251 |pmid=32685153 |pmc=7346698 }}</ref> resulting in internal [[bleeding]]. However, these occurrences are rare in healthy, [[sobriety|sober]] adults. Internal bleeding or rupture may leave the individual exposed to infections from intestinal bacteria. Blood resulting from tears in the colon may not always be visible, but can be distinguished if the feces are unusually dark or have a red hue. If intestinal rupture is suspected, medical assistance should be obtained immediately.<ref name=Nursing_and_Allied_Health>{{Cite encyclopedia |title=Enema administration |encyclopedia=Encyclopedia of Nursing and Allied Health |first=Mary Elizabeth |last=Martelli |url=http://findarticles.com/p/articles/mi_gGENH/is_/ai_2699003276.htm |access-date=11 January 2008 |via=[[FindArticles]] |url-status=dead |archive-date=23 January 2008 |archive-url=https://web.archive.org/web/20080123073414/http://findarticles.com/p/articles/mi_gGENH/is_/ai_2699003276.htm}}</ref> Frequent use of enemas can cause laxative dependency.<ref>{{Cite web |url=https://www.webmd.com/drugs/2/drug-14831/fleet-enema-rectal/details |title=Fleet Enema Rectal: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing |website=WebMD}}</ref>

In parts of Africa the [[calabash]] gourd is used traditionally to administer enemas. On the Ivory Coast the narrow neck of the gourd filled with water is inserted the patient's rectum and the contents are then injected by means of an attendant's forcible oral inflation, or, alternatively, a patient may self-administer the enema by using suction to create a negative pressure in the gourd, placing a finger at the opening, and then upon anal insertion, removing the finger to allow atmospheric pressure to effect the flow. In South Africa, [[Bhaca]] people used an ox horn to administer enemas.<ref>Annals of the South African Museum, page 18</ref> Along the upper Congo River an enema apparatus is made by making a hole in one end of the gourd for filling it, and using a resin to attach a hollow cane to the gourd's neck. The cane is inserted into the anus of the patient who is in a posture that allows gravity to effect infusion of the fluid.<ref>Friedenwald & Morrison, 'Part I:75-76</ref>

As further described below in [[Enema#Religious rituals|religious rituals]], the [[Maya civilization|Maya]] in their late classic age (7th through 10th centuries CE) used enemas for, at least, ritual purposes, Mayan sculpture and ceramics from that period depicting scenes in which, injected by syringes made of gourd and clay, ritual hallucinogenic enemas were taken.<ref name=Hallucinogenic_pre-Columbian>{{cite journal |title=Hallucinogenic drugs in pre-Columbian Mesoamerican cultures |volume=30 |issue=1 |pages=42–49 |author=F. J. Carod-Artal |date=2011-07-01 |journal=Neurología |publisher=Science Direct |doi=10.1016/j.nrleng.2011.07.010 |pmid=21893367 |doi-access=free }}</ref> In the Xibalban court of the God D, whose worship included ritual cult paraphernal, the Maya illustrated the use of a characteristic enema bulb syringe by female attendants administering clysters ritually.<ref>Parsons and Carlson:92</ref><ref name="pmid3528674">{{cite journal |vauthors = de Smet PA, Hellmuth NM |title = A multidisciplinary approach to ritual enema scenes on ancient Maya pottery |journal = J Ethnopharmacol |volume = 16 |issue = 2–3 |pages = 213–62 |year = 1986 |pmid = 3528674 |doi = 10.1016/0378-8741(86)90091-7 }}</ref>

=== Modern westernWestern ===

Clysters were administered for symptoms of constipation and, with more questionable effectiveness, stomach aches and other illnesses.{{when|date=July 2020}}{{Citation needed|date=July 2020}}<ref>{{Cite webjournal |title=NIH Chronic Constipation: Current Treatment Options|urldate=https://www2011 |pmc=3206558 |last1=Liu |first1=L.ncbi W.nlm.nih |journal=Canadian Journal of Gastroenterology |volume=25 |issue=Suppl B |pages=22B–28B |doi=10.gov1155/pmc/articles/PMC32065582011/360463 |pmid=22114754 |doi-access=free }}</ref>

Clysters were a favourite medical treatment in the [[bourgeoisie]] and [[nobility]] of the Western world up to the 19th century. As medical knowledge was fairly limited at the time, purgative clysters were used for a wide variety of [[ailment]]s, the foremost of which were [[stomach ache]]s and constipation.<ref name="Pharmacological treatment">{{cite journal |last1=Clemens |first1=Katri E. |last2=Faust |first2=Markus |last3=Jaspers |first3=Birgit |last4=Mikus |first4=Gerd |title=Pharmacological treatment of constipation in palliative care |journal=Current Opinion in Supportive &and Palliative Care |date=June 2013 |volume=7 |issue=2 |pages=183–191 |doi=10.1097/SPC.0b013e32835f1e17 |pmid=23478431 |s2cid=3283246 }}</ref>

In the early 20th century the disposable [[Enema#microenema|microenema]], a squeeze bottle, was invented by [[Charles Browne Fleet]].<ref>{{cite web |url=http://www.newsadvance.com/content/tncms/assets/v3/eedition/5/3d/53db44b6-01db-594c-9ed2-a6b4881fb211/537a39dec336e.pdf.pdf |title=Fleet |date=2014-04-27 |work=A Supplement to The News & Advance |publisher=[[The News & Advance]] |access-date=2020-01-03 |archive-date=3 January 2020 |archive-url=https://web.archive.org/web/20200103203637/http://www.newsadvance.com/content/tncms/assets/v3/eedition/5/3d/53db44b6-01db-594c-9ed2-a6b4881fb211/537a39dec336e.pdf.pdf |url-status=dead }}</ref>

The term "colonic irrigation" is commonly used in [[gastroenterology]] to refer to the practice of introducing water through a colostomy or a surgically constructed conduit as a treatment for constipation.<ref name="pmid11113099">{{cite journal |last1=Locke |first1=G.Richard |last2=Pemberton |first2=John H. |last3=Phillips |first3=Sidney F. |title=AGA technical review on constipation |journal=Gastroenterology |date=December 2000 |volume=119 |issue=6 |pages=1766–1778 |doi=10.1053/gast.2000.20392 |pmid=11113099 |doi-access=free }}</ref> The [[Food and Drug Administration]] has ruled that colonic irrigation equipment is not approved for sale for the purpose of general well-being<ref>{{cite web |title = Subpart F—Therapeutic Devices Sec. 876.5220 Colonic irrigation system |website = Code of Federal Regulations, Title 21 Food and Drugs, Subchapter H – Medical Devices, Part 876 – GatroenterologyGastroenterology-Urology Devices |date = 1 April 2007 |url = http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=876.5220 |publisher = FDA }}</ref> and has taken action against many distributors of this equipment, including a [[FDA Warning Letter|Warning Letter]].<ref>{{cite web |author = Department of Health and Human Services |title = Warning letter to Dotolo Research Corp |url = https://www.casewatch.net/fdawarning/prod/1999/dotolo.shtml |format = reprint by Casewatch |date = 21 July 1999 |publisher = FDA |access-date = 31 December 2007 }}</ref>

The same term is also used in [[alternative medicine]] where it may involve the use of substances mixed with water in order to [[Detoxification (alternative medicine)|detoxify]] the body. Practitioners believe the accumulation of fecal matter in the large intestine leads to ill health.<ref name="pmid11124189">{{cite journal |author = Whorton J |title = Civilisation and the colon: constipation as the "disease of diseases" |journal = BMJ |volume = 321 |issue = 7276 |pages = 1586–9 |year = 2000 |pmid = 11124189 |pmc = 1119264 |doi = 10.1136/bmj.321.7276.1586 }}</ref> This resurrects the old medical concept of ''autointoxication'' which was orthodox doctrine up to the end of the 19th century but which has now been discredited.<ref name=Ernst>{{cite journal |last1=Ernst |first1=E. |title=Colonic Irrigation and the Theory of Autointoxication: A Triumph of Ignorance over Science |journal=Journal of Clinical Gastroenterology |date=June 1997 |volume=24 |issue=4 |pages=196–198 |doi=10.1097/00004836-199706000-00002 |pmid=9252839 |doi-access=free }}</ref><ref>{{cite journal |author = Kaiser |title = The Case Against Colonic Irrigation |journal = California Morbidity |issue = 38 |year = 1985 }}</ref><ref name = Chen>{{cite journal |vauthors = Chen TS, Chen PS |title = Intestinal autointoxication: a medical leitmotif |journal = Journal of Clinical Gastroenterology |volume = 11 |issue = 4 |pages = 434–41 |year = 1989 |pmid = 2668399 |doi = 10.1097/00004836-198908000-00017 }}</ref>

A coffee enema can cause numerous maladies including [[infections]], [[sepsis]] (including [[campylobacter]] sepsis), severe [[Electrolyte disturbance|electrolyte imbalance]], [[colitis]], polymicrobial enteric sepsis, [[proctocolitis]], [[salmonella]], [[brain abscess]], and heart failure,<ref name=colitis /><ref name="acs">{{cite web |publisher = [[American Cancer Society]] |url = http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/ManualHealingandPhysicalTouch/colon-therapy |date = 11 January 2008 |access-date = 13 May 2011 |title = Colon Therapy |archive-date = 24 April 2015 |archive-url = https://web.archive.org/web/20150424180208/http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/ManualHealingandPhysicalTouch/colon-therapy |url-status = dead }}</ref><ref>{{cite journal |vauthors = Margolin KA, Green MR |title = Polymicrobial enteric septicemia from coffee enemas |journal = The Western Journal of Medicine |volume = 140 |issue = 3 |page = 460 |year = 1984 |pmid = 6710988 |pmc = 1021723 }}</ref><ref name=deaths>{{cite journal |vauthors = Eisele JW, Reay DT |title = Deaths related to coffee enemas |journal = JAMA: The Journal of the American Medical Association |volume = 244 |issue = 14 |pages = 1608–1609 |year = 1980 |pmid = 7420666 |doi = 10.1001/jama.1980.03310140066036 }}</ref><ref>{{cite journal |vauthors = Keum B, Jeen YT, Park SC, Seo YS, Kim YS, Chun HJ, Um SH, Kim CD, Ryu HS |title = Proctocolitis Caused by Coffee Enemas |journal = The American Journal of Gastroenterology |volume = 105 |issue = 1 |pages = 229–230 |year = 2010 |pmid = 20054322 |doi = 10.1038/ajg.2009.505 |s2cid = 19156781 }}</ref><ref>{{cite web |publisher = [[Memorial Sloan Kettering Cancer Center]] |url = http://www.mskcc.org/mskcc/html/69283.cfm |title = Livingston-Wheeler Therapy |date = 9 May 2011 |access-date = 13 May 2011 }}</ref><ref>William T. Jarvis, Ph.D., National Council Against Healthcare Fraud, "[http://www.ncahf.org/articles/c-d/caquackery.html Cancer Quackery]". Accessed 11 July 2012.</ref><ref name="pmid6789105">{{cite journal |title = Campylobacter sepsis associated with "nutritional therapy"--California |journal = MMWR Morb. Mortal. Wkly. Rep. |volume = 30 |issue = 24 |pages = 294–5 |year = 1981 |pmid = 6789105 |author1 = Centers for Disease Control (CDC) }}</ref><ref name="pmid20054322">{{cite journal |vauthors = Keum B, Jeen YT, Park SC, Seo YS, Kim YS, Chun HJ, Um SH, Kim CD, Ryu HS |title = Proctocolitis caused by coffee enemas |journal = Am. J. Gastroenterol. |volume = 105 |issue = 1 |pages = 229–30 |year = 2010 |pmid = 20054322 |doi = 10.1038/ajg.2009.505 |s2cid = 19156781 }}</ref> and deaths related to coffee enemas have been documented.<ref>{{cite journal |vauthors=Eisele JW, Reay DT |title=Deaths related to coffee enemas |journal=JAMA |volume=244 |issue=14 |pages=1608–9|date=October 1980 |pmid=7420666 |doi=10.1001/jama.1980.03310140066036}}</ref>

Klismaphiles may perceive pleasure from a large, water -distended belly, or the feeling of internal pressure. An enema fetish may include the sexual attraction to the involved equipment, processes, environments, situations, or scenarios,<ref>Brame et al., ''Different loving – The World of Sexual Dominance and Submission'':517</ref> Klismaphiles can gain satisfaction of enemas through fantasies, by actually receiving or giving one, or through the process of eliminating steps to being administered one (e.g., under the pretence of being constipated).<ref name="Denko"/>

That some women use enemas while masturbating was documented by [[Alfred Kinsey]] in "''Sexual Behavior in the Human Female." He stated,'': "There were still [are] other masturbatory techniques which were regularly or occasionally employed by some 11 percent of the females in the sample ... enemasDouches, andstreams of running water, vibrators, urethral insertions, enemas, other anal insertions, ...sado-masochistic activity, and still other methods were occasionally employed, but none of them in any appreciable number of cases."<ref>{{Citation | last1 = Kinsey | first1 = Alfred Charles | title = Sexual Behavior in the Human Female | publisher = Indiana University Press | place = Bloomington, Indiana, U.S.A. | year = 1953 | isbn = 978-0-253-33411-4 }}</ref>

[[File:5000 ml Enema Bag with Dildo Nozzle Filled Hanging in Tree.jpg|thumb|right|upright=1|A filled 5 litre enema bag connected to a bored [[dildo]], ready to inject into a recipient on the ground beneath.]]

Another sexual use for enemas is to empty the rectum as a prelude to other anal sexual activities such as [[anal sex]], [[anilingus]], and [[Pegging (sexual practice)|pegging]],<ref name="Agnew, 2000:76">Agnew, 2000:76</ref> possibly reducing risk of infection.

Rectal douching is a common practice among people who take a receptive role in anal sex<ref name="JavanbakhtStahlman2014">{{cite journal |last1=Javanbakht |first1=Marjan |last2=Stahlman |first2=Shauna |last3=Pickett |first3=Jim |last4=LeBlanc |first4=Marc-André |last5=Gorbach |first5=Pamina M |title=Prevalence and types of rectal douches used for anal intercourse: results from an international survey |journal=BMC Infectious Diseases |date=December 2014 |volume=14 |issue=1 |pages=95 |doi=10.1186/1471-2334-14-95 |pmid=24555695 |pmc=4015843 |doi-access=free }}</ref> although rectal douching before anal sex may increase the risk of transferring [[HIV]],<ref name="Carballo-DiéguezBauermeister2007">{{cite journal|last1=Carballo-Diéguez|first1=Alex|last2=Bauermeister|first2=José A.|last3=Ventuneac|first3=Ana|last4=Dolezal|first4=Curtis|last5=Balan|first5=Ivan|last6=Remien|first6=Robert H.|title=The Use of Rectal Douches among HIV-uninfected and Infected Men who Have Unprotected Receptive Anal Intercourse: Implications for Rectal Microbicides|journal=AIDS and Behavior|volume=12|issue=6|year=2007|pages=860–866|issn=1090-7165|doi=10.1007/s10461-007-9301-0|pmid=17705033|pmc=2953367}}</ref> [[hepatitis B]],<ref name="SchreederThompson1982">{{cite journal|last1=Schreeder|first1=M. T.|last2=Thompson|first2=S. E.|last3=Hadler|first3=S. C.|last4=Berquist|first4=K. R.|last5=Zaidi|first5=A.|last6=Maynard|first6=J. E.|last7=Ostrow|first7=D.|last8=Judson|first8=F. N.|last9=Braff|first9=E. H.|last10=Nylund|first10=T.|last11=Moore|first11=J. N.|last12=Gardner|first12=P.|last13=Doto|first13=I. L.|last14=Reynolds|first14=G.|title=Hepatitis B in Homosexual Men: Prevalence of Infection and Factors Related to Transmission|journal=Journal of Infectious Diseases|volume=146|issue=1|year=1982|pages=7–15|issn=0022-1899|doi=10.1093/infdis/146.1.7|pmid=7086206}}</ref> and other diseases.<ref>{{cite journal |title=Lymphogranuloma venereum proctitis in men who have sex with men is associated with anal enema use and high-risk behavior |last1=de Vries |first1=Henry J.C. |last2=van der Bij |first2=Akke K. |last3=Fennema |first3=Johan S.A. |last4=Smit |first4=Colette |last5=de Wolf |first5=Frank |last6=Prins |first6=Maria | last7=Coutinho | first7=Roel A. | last8=MorrÉ | first8=Servaas|journal=Sexually Transmitted Diseases |date=2008 |volume=35 |issue=2 |pages=203–208 |doi=10.1097/OLQ.0b013e31815abb08 |pmid=18091565 |s2cid=2065170 |url=https://dare.uva.nl/personal/pure/en/publications/lymphogranuloma-venereum-proctitis-in-men-who-have-sex-with-men-is-associated-with-anal-enema-use-and-highrisk-behavior(6b9b21d8-9369-4f55-a0e5-c6804db29083).html |doi-access=free }}</ref>

In Molière's play ''[[The Imaginary Invalid]]'', Argan, a severe [[hypochondriac]], is addicted to enemas as indicated by such lines as when Bĕralde asks, "Can't you be one moment without a purge?"<ref>{{cite web|url=https://the-mercurian.com/2018/05/10/moliere-at-versailles/|title=?Molière at Versailles|author=Molière|date=2018-05-10|work=Theater in Translation|publisher=The Mercurian|access-date=2020-07-18}}</ref>

''[[Water Power (film)|Water Power]]'' is a film loosely based on the real-life exploits of [[Michael H. Kenyon]], an [[United States|American]] [[criminal]] who pleaded guilty to a decade-long series of [[armed robbery|armed robberies]] of female victims, some of which involved [[sexual assault]]sassaults in which he would give them enemas.<ref>{{cite web|title=Water Power|work=Adult DVD Talk|url=https://www.adultdvdtalk.com/review/waterpower}}</ref>