Enema techniques

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Enema Techniques

Contents

Enema Temperature

Most people find that a warm water enema can be held more easily than a cold one. Use a very warm enema to fill yourself with the maximum amount of water possible and a cool water enema to force out water and material stuck in your bowel. The temperatures given are that of the water as it is poured into the bag. It cools off a bit before it gets into the colon. Don't try to judge temperature with your fingers, they're too unreliable. If you don't want to use a thermometer, use your tongue; it's a fairly reliable reference for body temperature.

  • Cool water is 30 - 35 degrees C ( 86 - 95 degrees F )
  • Warm water is 40 - 42 degrees C ( 104 - 108 degrees F )
  • Hot water is 43 - 45 degrees C ( 110 - 113 degrees F )
  • Don't take water any hotter than 45 C or 113 F or you can scald the colon. You can take it as cold as you can stand, some take crushed ice enemas, but I suspect most people couldn't even accept water that cold into their bowel.


Anatomy of the Colon

The anus is the external sphincter that closes off the rectum from the outside of the body. It can easily stretch to about 1 inch diameter, and can be stretched wider if you go about it slowly.

The rectum is a powerful muscular organ about 5 inches long, with a sphincter at each end. The sigmoid colon is a looped section of the bowel just above the rectum. It is shaped somewhat like a question mark, hence its name. The loop occurs at about a depth of ten inches, as can be felt if you push a firm object into the rectum, and up through the inner sphincter. The sigmoid comes in two sizes in humans. There is the long sigmoid and the short sigmoid, and few are born with one in between the two distributions of sizes. Those who have the big sigmoid can probably take about a full quart of water more than those with the short one.

The descending colon is in the left side of the lower abdomen, and can be easily felt any time the abdominal muscles are fully relaxed. It hugs the left wall of the pelvis, and reaches up to the splenic flexure, which is just under the left rib cage.

The transverse colon extends from the splenic flexure to the hepatic flexure, right across the abdomen on the right. It follows a sagging course across, and in many people sags about ¾ of the way down in the middle.

The ascending colon is on the right side of the pelvis, and the lowest part of it is called the cecum, the part of the colon where the small intestine expels its contents into the colon in a liquid form. It is the part of the colon with the largest diameter, and is most effective in absorbing water.

After taking a large enema, stand in front of a mirror, with the light from a ceiling lamp falling across the abdomen, and the shadows will make many of these structures readily apparent. The transverse should show up as a shadow about 2-3 inches below the belly button. When lying face down on a bed, the cecum will expand to an enormous size, then lift the body a few inches with the hands and knees and the right side of the belly will clearly show the shape and position of this part of the colon. The colon narrows gradually from the cecum (about 2-1/2 to 3 inches when distended) to the sigmoid, about 1 to 1-1/4 inches diameter.

Positions

There are many positions in which an enema can be taken. Two of the most widely known are the "Sims" position and the "Knee-Chest" position. The Sims position has the recipient lying on the left side, with the right knee brought up near the chest. The Knee-chest position has the enemee supported by the knees and the shoulders, with the chest sagging down, so that the chest almost touches the floor. This places the abdomen nearly upside down, so that the water can flow down from the rectum to the transverse colon by gravity. In cases of deep-seated constipation, this position will help the water reach way up into the colon for a good cleaning out. It is also useful in a technique for floating air or gas in the colon above the water so that the air can be expelled.

Standing upright requires you to hold the tube in the anus unless you use a nozzle that can be held in, but it allows me to accept more water than any other position.

Lying on the back is a favourite position, especially for the first enema of a session. You can watch the bag slowly deflate, and you can also watch the abdomen expand as the water enters the colon. You should lie down so that you can prop your head against a wall, like a pillow. You will probably be most comfortable if the knees are raised. You will first see the belly swell very low, just above the crotch, as the sigmoid expands. Then you will see the left side start to bulge as the water enters the descending colon. You will be in a position to massage the bowel as well as feel the shape and position of your colon.

Lying face down can be used, but pressing the belly on the floor restricts the abdomen's need to expand.

Lying face down and arching the back by raising the upper body on the elbows is a very stimulating position, and lifts the belly up from the floor. This presses the genital area against the floor, and leaves the hands free to massage the breasts, etc. Lying on the right side is the opposite of the Sims position, and causes the water to flow down into the cecum. When you do this, feel the ballooning out of the cecum, the part of the colon with the largest diameter. Sitting on the floor allows you to tense certain skeletal muscles, and can lead to a powerful orgasm. The floor helps hold the nozzle in. This may not be the greatest position for filling and cleaning the bowel, however.

Reclining is similar to sitting, but you lean back against something.

Standing on the head uses gravity to force the water down into the transverse colon, which usually needs a good cleaning out anyway, but especially if you are quite constipated.

Reclining in the bathtub is quite comfortable, except that the tub may be cold. You don't have to worry about leakage here.

Leaning over the edge of the bathtub is similar to getting on your hands and knees, but it leaves your hands and arms free, and is a little easier to stay in that position for a while.

Sitting on the edge of the bathtub is comfortable, and is the way to do a faucet enema, described in equipment.

Capacity

Every individual has his or her own capacity, and it will change from each enema to the next. The cleanliness of the colon and the amount of gas present will have a great effect on the volume of water that can be taken. Medical researchers have determined that the average adult human colon has a capacity of 7 quarts. This measurement may have been made using colons removed from cadavers, who wouldn't complain about the pressure. It may be that the average colon has this capacity, but that no one except a woman who has just delivered a baby has that much room in the abdomen to allow the colon to expand to its fullest. You may want to experiment with this by taking the largest enema that is comfortable, and then rolling from side to side very slowly and seeing if the water runs downhill to distend the lower side more. You probably will find that the lower part of the colon will be noticeably more swollen, indicating that it is your abdomen that is unable to expand to allow the colon to accept any more fluid.

Fifty or so years ago, most adult patients receiving barium enemas were given 4 quarts of the barium solution and made to hold it during the X-ray procedure. At the same time, the enema bags sold in drugstores held 3 or 4 quarts, and many people felt that they could not be properly cleaned out unless they took the full bag. Today's drugstore fountain syringes do not hold over 2 quarts, which many feel is a real shame.

Retention

Most people will find it difficult to retain an enema for more than five minutes. If the bowel is not clean, then the peristaltic action of the colon will push against the fecal masses and produce intense pressure. This will frequently happen with your first enema in a series. Not much to do but expel and try again. If you get a strong cramp and an urge to expel, getting up is the worst thing you can do. Making the descending colon vertical adds gravity to the force pushing out. This is how to have an accident. If you can, wait while lying down. The pressure will pass in 10-15 seconds as the wave of peristalsis passes the sigmoid colon and reaches the end. Then you can get up and expel without straining to hold it in. If you must go to the toilet, and the pressure is intense, you can hold the buttocks together with both hands. This helps the anal muscles keep it in.

One trick is to lie face down on the bed, and wait for three waves of cramps to pass down. After the third cramp, some people can walk leisurely to the toilet to expel, and get a good expulsion of all that stuff. If the cramps are extreme, however, don't wait. Another aid in retaining the water is to get into the knee-chest position when the pressure builds. This causes gravity to help hold the water in.

Another method is to lie on your back, and massage the colon with both hands. Whenever you feel pressure building, or can feel a big bulge with your hands, massage around that area until the pressure relaxes.

Some people recommend rolling from one side to the other every minute or so. The idea is that the water will flow repeatedly downhill, alternately filling the descending and sigmoid colon and then running down to the cecum. This is supposed to break up any masses in the transverse.

Some people use a butt plug to hold the water in.

Expulsion

Obviously, most people expel their enemas while seated on the toilet. This is probably not the best position for expelling water from the colon because of the need for the wide caecum to push the water up hill to the transverse, and then for the transverse to pump it back up its sag to get it to the descending. A large volume in the descending will cause the descending colon to slide down the left side and kink where it meets the sigmoid. This can get you stuck! If you can feel lots of water bulging on the left side, but can't get it out, you need to change positions. Get up and lie down for a moment, or get into the knee-chest position, or just turn around as if you are looking over your right shoulder. These techniques can un-kink the descending, and get the water passing out again.

Some people prefer to expel in the bathtub, which is much easier, because the colon does not need to lift water to get it out. This is extremely messy, however, so don't do it unless you don't mind cleaning up. If the colon becomes severely blocked while holding an enema, you may prefer to do this rather than call the paramedics. In the hospital, patients are frequently given a bedpan when expelling enemas, to get the same benefit of the position.

If there is substantial gas in the colon, it may be very difficult for the colon to lift water when large air bubbles are present. These like to collect at the hepatic flexure, high on the right side, and can be detected by a rumbling sound when you press there. If you want to get the gas out, you can sit on the floor and make sure the gas is at the hepatic. Roll slowly onto the right side, then massage the transverse, following its course with your hands. You will know that you are moving that gas by the rumbling. When you have the gas moved to the splenic flexure, move quickly to the knee-chest position. Now massage the descending colon upward, from the ribs to the groin on the left side (you're upside down, remember) until the gas has moved to the sigmoid. Use heavy massage in the groin area, to move water out of the sigmoid, and move the gas in. When this is done, get on the toilet quickly, and you should be able to expel a prodigious gas blast. You may have to repeat this procedure several times, but when all the gas is out of the colon you should be able to expel the water quickly.

Don't sit on the toilet for more that a few minutes if there is no water coming out. Sitting too long and straining are the chief causes of haemorrhoids. Those will certainly ruin your enema pleasure. If nothing is coming out, lie down either face down or up, or lie on your left side, or get into the knee-chest position. These will help the water move, and soon you can go back to the pot.

See also


This page uses content from SM-201; the original article can be viewed here.
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