Here are some typical questions and answers (FAQs) regarding enemas:
What are the benefits?
For those that successfully administer enemas, most reported that the severity of LARS symptoms are eliminated or significantly reduced, including clustering and incontinence, for the period between enemas. Some of those living with LARS report that they can go up to 48 hours without a bowel movement and a need to perform another enema.
What are the goals?
While each individual must determine their goals, clearly we want a reduction and hopefully elimination of the severe LARS symptoms and improved quality of life. For you, this may mean the ability to return to work, reduce the time on the toilet, minimize the time “thinking about it,” etc.. An enema, in combination with diet, medication, physical activity and mindfulness training, is a tool available to help meet your goals.
Are enemas safe? Are there risks associated with enemas?
Enemas have been used to aid evacuation for centuries and when performed properly, are considered safe. However, inserting a foreign object into the rectum creates the possibility of causing physical injury to this area and therefore you must be certain, by speaking to a medical professional, that there are no physical issues in your specific case.
Always make sure that the enema equipment is clean before every use. Replace any components that have any sign of wear, stain or damage to avoid any possibility of injury or infection.
Are enemas painful?
Enemas should never be painful. If you encounter any pain, stop immediately and consult your doctor. Inserting the nozzle is generally not painful although it is uncomfortable for most people. With time and practice, this discomfort decreases.
What should I do if I get cramping?
Cramping is common as the water is flowing into the colon. To help prevent cramping, ensure that there are no air bubbles in the enema hose by releasing some of the water into the toilet before inserting the nozzle. Also, make sure that the water temperature is near body temperature but not higher than 105F. Use a thermometer to help determine the correct water temperature if you are unsure. If you get cramping during the enema, it can usually be halted quickly by stopping the flow of water for a few seconds. Once the cramps end, allow the water to flow again. Most importantly- relax your mind and body and take deep cleansing breaths.
I have painful hemorrhoids so can I do enemas?
If you have hemorrhoids consult your doctor about them. In most cases, external hemorrhoids are caused by excessive straining while having a bowel movement. If enemas are performed regularly and successfully, it is possible that external hemorrhoids will diminish or be prevented, as straining is normally eliminated. However, inserting the nozzle when an external hemorrhoid exists may be highly uncomfortable and cause bleeding. Again, speak with your doctor who may recommend a treatment for this condition.
How often should I do enemas?
Enema frequency is dependant on the transit time, ie the time it takes for food to pass through your digestive system after it has been eaten. Everyone is different as transit time can vary significantly and therefore the frequency requires some trial/error. If you normally need to go to the toilet daily prior to your cancer diagnosis, then start performing enemas every 24 hours. Ideally, the timing of the enema should occur before stool has travelled to the “rectum” area as after this time, it will be more difficult for enema water to flow into the colon and you will likely start to cluster.
However depending on your physical/medical condition, diet, amount of exercise, etc, many people can perform the enema every 36 or 48 hours. Be patience and “listen” to your body in order to determine the best cycle for you.
When is the best time of day to do enemas?
Most people that perform enemas report that the time of day has little/no effect on the success of the enema. Therefore, decide what is best for you after some experience. Again, practice and “listening” to your body will guide your schedule.
Is there a risk of dependency?
This is a difficult and complex question to answer as very little evidence exists to confirm or refute the matter. For LARS patients, the symptoms and their severity change over time. Doctors have advised that changes can be expected for the first 2 years after reversal and therefore many hope that normal bowel function will return within this period of time and therefore, many patients will endure LARS symptoms in hopes of regaining normal function. It can also be stated that very few LARS patients that have severe symptoms for at least 6 months have actually reported a normal return of bowel function. So while it can be reasonably assumed that frequent enemas can and likely will alter “normal” bowel function and lead to dependency, the alternative appears to be continued LARS symptoms. Our recommendation for you is to speak with other people who are living with LARS, and read all the medical literature available. You should also speak with your doctor to determine the best strategy for you.
How much water is required?
Typically, use 4-6 cups of clean water. Some people have success with 8 cups and others are fine with as little as 2 cups. The amount of water that you can hold in your lower colon that will result in a successful enema is highly individual. Feel free to experiment.
What can I do if the water leaks out too soon?
This is a common issue particularly soon after reversal as your pelvic muscles are not yet strong enough to properly close the anal canal. Pelvic floor therapy and exercise will improve this.
You can also use a retention nozzle which has an inflatable bubble at the tip. Air is used to inflate this tip once it is inserted so that it creates a seal. This also has the benefit of allowing the user to sit on the toilet, rather than lying on the floor, as the water flows in.
Here is an image of a typical retention nozzle showing the balloon in the inflated position. There are 2 inlet ports, 1 for the warm water and the other for connection to an air syringe to inflate or deflate the balloon.
I have difficulty lying down on the floor to do an enema. What can I do?
Lying down can be difficult for some people while others do not have a suitable space available in their homes. The alternative is to use a retention nozzle, as described immediately above, which allows you to sit on the toilet during the enema process. This system relies on either a bag or bucket to hold water above your abdomen, a hose with a clamp to control the water flow, and the inflatable nozzle to seal the nozzle once inserted into the rectum.
How do I clean-up after the enema?
Follow the recommendations of the manufacturer but in general, thoroughly clean the bag, hose and nozzle with clean soapy water before and after each use. Allow these to air-dry after each use. If there are any signs of discoloration or odor, dispose of these items and replace with new components. Always have spare components available.
Where can I buy an enema kit and what should I use?
Online retailers sell enema kits. Silicon is generally an excellent material. Check the reviews before purchasing. Ask others who are using enemas successfully for examples and suggestions on which they are using.