Enema administration

Most commonly, enemas are used to relieve and treat constipation. The National Institute for Health and Care Excellence (NICE, 2023) defines constipation as a symptomatic disorder of unsatisfactory defaecation due to difficulty or infrequency of passing stools that is a change to the individual's normal bowel pattern. Early assessment and treatment of constipation is necessary to prevent long-term implications such as:

• faecal loading
• impaction or retention
• haemorrhoids
• anal fissures
• distension
• loss of sensory and motor functions (NICE, 2023)

Indications for the use of enemas include to:

• Evacuate the bowel before surgery, X-ray or for bowel examinations such as an endoscopy
• Treat severe constipation when less invasive methods have failed
• Administer prednisolone for patients with rectal and rectosigmoidal ulcerative colitis or rectal and rectosigmoidal Crohn's disease (NICE, 2023)

The use of enemas is contraindicated in patients with a paralytic ileus or chronic obstruction. It is also contraindicated where administration may cause

All enemas must be prescribed and checked against the prescription before administration (Lister et al, 2020). It is important that the procedure is clearly explained and understood by the patient to ensure that informed consent is gained (Nursing and Midwifery Council (NMC), 2018).

Administration of medications via the rectal route can be embarrassing for the patient; it is essential that nurses maintain privacy and dignity at all times. A moving and handling risk assessment should be completed before treatment to establish if additional equipment is required.

There are various types of enemas (Table 1) used for constipation, which should only be prescribed following a full biological, psychological and sociological assessment of the patient (NICE, 2023). Enemas are licensed for occasional use only; the patient should always be reassessed following administration and the effects evaluated (Pegram et al, 2008; NICE, 2023). Administration of an enema must be performed by a practitioner

Before administration of an enema, it is essential to correctly assemble all the necessary equipment. This should include:

• the patient's prescription
• the patient's care plan and chart
• the enema
• a jug of hot water
• disposable gloves and apron
• a protective cover (waterproof pad)
• lubricating gel
• gauze squares
• commode, bedpan, toilet paper
• clinical waste bag

Administration of enemas is an invasive technique. Nurses need to carry out a full assessment of the patient prior to this procedure and only administer an enema if they have the appropriate knowledge and skills. Respect for the patient's privacy and dignity should be maintained at all times and a full reassessment must take place following the procedure.

The procedure for administering an enema is outlined below:

1. Confirm the patient's identity. Explain and discuss the full procedure
2. Assess the patient's specific requirements and the reason for intervention. If the patient is constipated, a full physical, psychological and social assessment should be completed (NICE, 2023)
3. Check the prescription chart to ensure the enema has been correctly prescribed and that the patient's details match the chart
4. Check for any allergies (use particular caution with arachis oil enemas)
5. Wash hands and put on apron and gloves. This is to ensure that hygiene and

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3.4 take appropriate action to ensure privacy and dignity at all times

6. Use evidence-based, best practice approaches for meeting needs for care and support with bladder and bowel health, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

6.5 administer enemas and suppositories and undertake rectal examination and manual evacuation when appropriate

Lister S, Hofland J, Grafton H. The Royal Marsden Manual of clinical nursing procedures: professional edition. 10th edn. Chichester: Wiley-Blackwell; 2020:249-251

National Institute for Health and Care Excellence (NICE). Constipation: management. 2023. https://cks.nice.org.uk/topics/constipation/ (accessed 9 January 2024)

Nursing and Midwifery Council. The Code. 2018. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (accessed 9 January 2024)

Peate I. How to administer an enema. Nurs Stand. 2015;30(14):34–36. https://doi.org/10.7748/ns.30.14.34.s43 

Pegram A, Bloomfield J, Jones A. Safe use of rectal suppositories and enemas with adult patients. Nurs Stand. 2008;22(38):39–41. https://doi.org/10.7748/ns2008.05.22.38.39.c6564