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Cleansing enemas act by stimulation of bowel activity through irritation of the lower bowel, and by distention with the volume of fluid instilled. When the enema is administered, the individual is usually lying on the left side, which places the sigmoid colon (lower portion of bowel) below the rectum and facilitates infusion of fluid. The length of time it takes to administer an enema depends on the amount of fluid to be infused. The amount of fluid administered will vary depending on the age and size of the person receiving the enema, however general guidelines would be:

  • Infant: 250 cc or less
  • Toddler and preschooler: 500 cc or less
  • School-aged child: 500-1,000 cc
  • Adult: 750-1,000 cc

Some may differentiate between high and low enemas. A high enema, given to cleanse as much of the large bowel as possible, is usually administered at higher pressure and with larger volume (1,000 cc), and the individual changes position several times in order for the fluid to flow up into the bowel. A low Enemas may be given for the following purposes: to remove feces when an individual is constipated, or to remove feces and cleanse the rectum in preparation for an examination, or prior to surgery to prevent contamination. There are two types of enemas: the high enema, given to cleanse the large bowel, and the low enema, to cleanse only the lower bowel.

Oil retention enemas serve to lubricate the rectum and lower bowel, and soften the stool. For adults, about 150-200 cc of oil is instilled, while in small children, 75-150 cc of oil is considered adequate. Salad oil or liquid petrolatum are commonly used at a temperature of 91°F (32.8°C). There are also commercially prepared oil retention enemas. The oil is usually retained for one to three hours before it is expelled.

The rectal tube used for infusion of the solution, usually made of rubber or plastic, has two or more openings at the end through which the solution can flow into the bowel. The distance to which the tube must be inserted is dependent upon the age and size of the patient. For adult, insertion is usually 3-4 in (7.5-10 cm); for children, approximately 2-3 in (5-7.5 cm); and for infants, only 1-1.5 in (2.5-3.75 cm). The rectal tube is lubricated before insertion with a water soluble lubricant to ease insertion and decrease irritation to the rectal tissues.

The higher the container of solution is placed, the greater the force in which the fluid flows into the patient. Routinely, the container should be no higher than 12 in (30 cm) above the level of the bed; for a high cleansing enema, the container may be 12-18 in (30-45 cm) above the bed level, because the fluid is to be instilled higher into the bowel.

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