Editing Enema (section)

===== Large volume enemas =====
{{anchor|Soapsuds enema}}
[[File:Soapsuds Enemas.jpg|thumb|Soapsuds enemas, one in an enema bucket with a nozzle typical for a cleansing enema, and another in an enema bag with a nozzle typical for a contrast enema]]

For emptying the entire colon as much as feasible<ref name="Fundamentals of Nursing Practice"/> deeper and higher enemas are utilized to reach large colon sections.<ref name="Pharmacological treatment"/> The colon dilates and expands when a large volume of liquid is injected into it. The colon reacts to that sudden expansion with general contractions, [[Peristalsis#Large intestine|peristalsis]], propelling its contents toward the rectum.<ref name= Biology_Online_Dictionary />

'''Soapsuds enema''' is a frequently used synonym for a large volume enema (although soap is not necessary for effectiveness).<ref name= Biology_Online_Dictionary />

A large volume enema may be used in a home setting to relieve occasional constipation, although medical care may be required for recurring or severe cases of constipation.<ref name= Biology_Online_Dictionary />

====== Water-based solutions ======

Plain water can be used, functioning mechanically to expand the colon, thus prompting evacuation.

[[saline (medicine)#Normal|Normal saline]] is least irritating to the colon. Like plain water, it simply functions mechanically to expand the colon, but having a neutral concentration gradient, it neither draws [[electrolyte]]s from the body, as happens with plain water, nor draws water into the colon, as occurs with phosphates. Thus, a salt water solution can be used when a longer retention period is desired, such as to soften an impaction.

[[Castile soap]] is commonly added because its irritation of the colon's lining increases the defecation urgency.<ref name=Safety_and_effectiveness>{{cite journal|title=Safety and effectiveness of large-volume enema solutions |author1=Marilee Schmelzer |author2=Lawrence R. Schiller |author3=Richard Meyer |author4=Susan M. Rugari |author5=Patti Case |date=November 2004 |journal=Applied Nursing Research |doi=10.1016/j.apnr.2004.09.010 |volume=17 |issue=4 |pages=265–274|pmid=15573335}}</ref> However, liquid handsoaps and detergents should not be used.<ref name=Biology_Online_Dictionary/>

[[Glycerol]] is a specific bowel mucosa irritant serving to induce peristalsis via a [[Osmotic laxative|hyperosmotic effect]].<ref name= Glycerol>{{cite web |url=https://www.drugs.com/cdi/glycerin-enema.html |title=Glycerin Enema |publisher=Drugs.com |access-date=2018-09-09}}</ref> It is used in a dilute solution, e.g., 5%.<ref>{{cite journal |vauthors=Bertani E, Chiappa A, Biffi R, Bianchi PP, Radice D, Branchi V, Spampatti S, Vetrano I, Andreoni B |title=Comparison of oral polyethylene glycol plus a large volume glycerine enema with a large volume glycerine enema alone in patients undergoing colorectal surgery for malignancy: a randomized clinical trial |journal=Colorectal Disease |volume=13 |issue=10 |pages=e327–e334 |year=2011 |pmid=21689356 |doi=10.1111/j.1463-1318.2011.02689.x |s2cid=32872781}}</ref>

====== Other solutions ======

Equal parts of milk and molasses were heated to slightly above normal body temperature.<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 |url-access=subscription }}</ref>

[[Mineral oil]] functions as a lubricant and stool softener, but may have side effects including rectal skin irritation and oil leakage.<ref>{{cite web |url=https://my.clevelandclinic.org/health/drugs/20248-mineral-oil-rectal-enema |title=Mineral Oil rectal enema |work=Drugs, Devices & Supplements |publisher=[[Cleveland Clinic]] |access-date=2019-04-01 }}</ref>