How to make an enema at home: 5 medically approved and safe steps

Prolonged constipation can cause bloating, burning pain, and make bowel movements a daily "struggle." According to common medical standards, having fewer than 3 bowel movements per week is a common sign of constipation. In some cases, enemas can help soften stool and stimulate defecation; however, performing them incorrectly can easily lead to rectal damage, electrolyte imbalance, or infection.

In this article, Tiptory helps you understand how to prepare an enema solution, prepare the equipment, and perform a home enema more safely according to professional guidelines. Experts recommend using it only when absolutely necessary and after consultation with a healthcare professional.

How to prepare a safe enema solution

Only perform under medical guidance

• Home enemas are not the first choice for treating constipation and should only be used for a short time if deemed appropriate by a doctor or pharmacist.

• Incorrectly preparing the concentration or using too much solution can cause burning pain, rectal damage, dehydration, and electrolyte imbalance.

• Individuals experiencing severe abdominal pain, vomiting, bloating, bloody stools, or suspected bowel obstruction should not self-administer enemas.

Prepare ingredients as prescribed

The reference formula in the original content includes:

• 4 cups, equivalent to about 950 ml of water.

• 2 teaspoons of table salt, equivalent to about 11 g.

• 2–6 teaspoons of glycerin, equivalent to about 10–30 ml, but only add if instructed by a healthcare professional.

• Prescription medication, if specifically indicated by a doctor.

The above ingredients yield approximately 950 ml of solution. However, this entire amount should not be automatically used for a single enema.

Note on saline solution formula

• The ratio of 11 g of salt in 950 ml of water is not entirely equivalent to 0.9% physiological saline.

• Therefore, users should ask a doctor or pharmacist about the appropriate concentration instead of adjusting it subjectively.

• A safer option is to use pre-packaged enema solutions or saline solutions of the correct concentration recommended by a medical facility.

Properly prepare the solution

1. Wash hands and clean the preparation area.

2. Use clean, intact utensils specifically for preparing the solution.

3. Precisely measure the amount of water and salt according to healthcare professional's instructions.

4. Put the ingredients into a clean, airtight bottle, then shake until the salt is completely dissolved.

5. Do not self-add glycerin, soap, herbs, coffee, essential oils, or medication to the solution.

6. Pour only the amount of solution specified by the doctor into the enema bag.

Do not consider homemade solution sterile

• A clean bottle does not mean a sterile bottle; a homemade solution is also not sterile.

• Do not use water with signs of contamination or equipment that is moldy, cracked, or difficult to clean.

• Do not prepare in advance for long-term storage or reuse any solution that has come into contact with the equipment.

Stop immediately if any abnormalities occur

• Stop if you experience severe cramping, bleeding, dizziness, rapidly increasing discomfort, or if you cannot gently insert the tip of the tube.

• Do not force the tip of the tube or inject the solution with strong pressure.

• If constipation is prolonged, you frequently need enemas to defecate, or you cannot have a bowel movement accompanied by abdominal pain and vomiting, seek medical attention to find the cause instead of continuing to self-treat.

Part 1: How to prepare saline enema solution with correct ratio

Step 1: Prepare water and bottle correctly

Prepare a clean container bottle

• Choose a bottle with a tight-fitting lid, a capacity greater than 950 ml, and no cracks, deformities, or residue.

• Wash the bottle thoroughly before use. You can boil heat-resistant bottles for about 5 minutes or use the high-temperature setting of a dishwasher.

• Allow the bottle to cool and dry naturally on a clean surface. Do not touch the inside of the bottle or lid.

• Note that a bottle cleaned at home is not equivalent to sterile medical equipment.

Prepare about 950 ml of warm water

• Measure 4 cups of water, equivalent to about 950 ml, and pour it into the prepared bottle.

• Prioritize the type of water recommended by a doctor or medical facility. Do not use water with signs of contamination or that is not of guaranteed quality.

• If using distilled water, choose a product that is within its expiration date and stored correctly.

• Do not assume tap water is suitable for preparing an enema solution, as water quality can vary between regions.

Check the temperature before mixing

• Keep the water warm, close to body temperature, about 37–40°C.

• It is recommended to check with a clean thermometer to avoid inaccurate estimation by hand.

• Do not use water hotter than 40°C as it can cause burns and damage to the rectal lining.

• Water that is too cold can also increase discomfort or cause spasms during an enema.

Ensure safety before use

• Only mix and use the solution according to the ratio and volume instructed by a healthcare professional.

• Do not self-add salt, glycerin, soap, herbs, or medication to the water.

• If the bottle or water becomes contaminated during preparation, discard the solution and start over with clean equipment.

• Individuals with severe abdominal pain, vomiting, bloating, rectal bleeding, or suspected bowel obstruction should not self-administer a home enema.

Step 2: Measure salt correctly when preparing the solution

Accurately measure the amount of salt

1. Only perform this step if the formula has been confirmed appropriate by a doctor or healthcare professional.

2. Use a standard measuring spoon or electronic scale to precisely measure 2 teaspoons of table salt, equivalent to about 11 g.

3. Add the salt directly to the bottle containing about 950 ml of prepared warm water.

4. Do not estimate by eye or use a regular eating spoon, as spoon sizes can vary, leading to incorrect solution concentration.

Do not arbitrarily change the ratio

• Adding too much salt can create a hypertonic solution, causing mucosal irritation, drawing water into the intestines, and increasing the risk of dehydration or electrolyte imbalance.

• Adding too little salt will also prevent the solution from reaching the intended concentration.

• The formula of 11 g of salt in 950 ml of water is not entirely equivalent to 0.9% physiological saline. Therefore, this formula should not be used for home enemas without consulting a doctor.

• Do not use the entire solution simply because you have prepared 950 ml; the volume for each enema must comply with professional instructions.

Absolutely do not use Epsom salt

• Epsom salt contains magnesium sulfate, which is completely different from table salt (sodium chloride).

• Do not use Epsom salt to replace table salt in an enema solution.

• Magnesium can be absorbed through the rectum and cause severe hypermagnesemia, especially in people with kidney failure, the elderly, or those who are dehydrated.

• This condition can lead to muscle weakness, low blood pressure, shortness of breath, arrhythmia, coma, and be life-threatening.

Prioritize safer options

• It is recommended to use standard pre-packaged enema solutions or products instructed by a doctor or pharmacist instead of self-preparing them.

• Do not self-add glycerin, soap, herbs, coffee, essential oils, or medication to the solution.

• If severe abdominal pain, bleeding, dizziness, shortness of breath, unusual weakness, or irregular heartbeat occurs after an enema, stop use and seek immediate medical attention.

Step 3: Dissolve salt before use

Seal the bottle before shaking

1. Check that the bottle cap is clean, unbroken, and can be completely sealed.

2. Tighten the cap to prevent the solution from leaking or coming into contact with external contaminants.

3. Wipe the outside of the bottle dry to prevent slipping during the procedure.

Shake until the salt is completely dissolved

• Shake the bottle well for about 30 seconds or until no salt particles are visible at the bottom.

• Observe the solution under light: after dissolving, the solution should be clear, without sediment or suspended particles.

• If the salt is not completely dissolved, continue to shake gently; do not heat the bottle directly or use a solution with sediment for an enema.

Check the solution before use

• Clear saline solution does not mean the concentration is accurate, sterile, or absolutely safe.

• Do not use if the solution is cloudy, discolored, has an unusual odor, or shows abnormal sediment.

• Recheck the temperature, ensuring the solution is only warm, close to body temperature, and does not cause burning.

• If the bottle is dropped, opened, or the solution is at risk of contamination, discard it and prepare a new one according to medical instructions.

Do not store for multiple uses

• Homemade solutions do not meet the sterility conditions of packaged medical products.

• Only prepare the amount instructed by your doctor and do not save any leftover for the next enema.

• Do not share bottles, enema bags, or tips with others as this can transmit bacteria and pathogens.

Step 4: Use the correct amount of enema solution

Use only the specified volume

1. Ask your doctor or pharmacist about the appropriate type and volume of solution before performing an enema.

2. Close the clamp on the enema bag tubing and pour in the instructed amount of solution.

3. Do not automatically assume 470 ml is the standard dose for all adults. The volume needed depends on the type of solution, age, underlying conditions, and treatment purpose.

4. Do not fill the bag completely or try to use all the prepared solution.

Check temperature and equipment

• The solution should only be warm, close to body temperature, not hot or icy cold.

• Inspect the bag, tubing, and tip; do not use if the equipment is cracked, dirty, or has been shared with others.

• Hang the bag at the height instructed by the equipment's manual. Hanging it too high can create excessive flow pressure, causing pain or rectal damage.

• Flush a small amount of solution through the tube to remove air, then clamp the tube before use.

Do not self-administer enemas to children

• Do not mechanically apply 350 ml for children aged 6–12 or 180 ml for children aged 2–6.

• Children have smaller bodies and are more prone to dehydration, electrolyte imbalance, or rectal damage than adults.

• Parents should only use products, dosages, and methods specifically prescribed by a pediatrician based on age and weight.

• Do not self-administer an enema to children under 2 years old. If a child has abdominal pain, vomiting, bloating, fever, bloody stools, or prolonged constipation, seek medical attention.

Do not substitute with mineral oil

• Mineral oil can help lubricate and soften stool in some cases, but it is not a suitable substitute for everyone.

• Do not pour 130 ml of pure mineral oil into an enema bag or halve the dose for young children.

• Only use rectal mineral oil preparations at the dose stated on the label or as instructed by a healthcare professional.

• Do not use industrial mineral oil, cosmetic oil, or products not clearly labeled for rectal use.

Stop if any abnormal signs occur

• Stop administering the solution if sharp pain, severe cramping, bleeding, dizziness, or unusual resistance occurs.

• Do not squeeze the bag, increase its height, or force the solution to flow faster.

• Individuals with kidney disease, heart disease, dehydration, inflammatory bowel disease, recent gastrointestinal surgery, or suspected bowel obstruction should consult a doctor before using any type of enema solution.

Step 5: Only add medication when indicated

Do not arbitrarily add glycerin or medication

• Only add glycerin or prescription medication to the enema bag when a doctor has clearly specified the drug name, strength, dosage, and usage instructions.

• Do not self-add 2–6 teaspoons of glycerin just to increase the laxative effect. The appropriate dose depends on the formulation, age, underlying conditions, and severity of constipation.

• Using too much glycerin can cause burning in the anus, cramping, diarrhea, dehydration, or electrolyte imbalance.

Do not mix medication into homemade solution

• Medications for inflammatory bowel disease, such as rectal medications for ulcerative colitis, are often manufactured as enemas, foams, or suppositories with a specific concentration.

• Do not mix prescription medications with homemade saline solution unless specifically instructed by the prescription or doctor.

• Arbitrarily changing the solvent, concentration, or volume can reduce treatment effectiveness, increase irritation, and lead to inaccurate drug distribution.

• Do not crush oral tablets, open capsules, or use oral medications for an enema.

Follow the prescription correctly

1. Check the drug name, dose, expiration date, and route of administration listed on the label.

2. Use the accompanying equipment or equipment instructed by a medical facility.

3. Administer the medication at the prescribed time; some rectal enemas are often used before bedtime for easier retention.

4. Retain the medication in the rectum for the duration requested by the doctor, but do not force yourself if there is severe pain or unusual discomfort.

5. Do not self-increase the dose, frequency of use, or extend the treatment period without consulting a doctor.

Monitor reactions after use

• A feeling of urgency to defecate or mild discomfort may occur initially, but it should not be prolonged or worsen.

• Stop use and contact a healthcare professional if you experience severe abdominal pain, rectal bleeding, prolonged diarrhea, dizziness, or signs of dehydration.

• Seek emergency care if you experience shortness of breath, swelling of the lips or tongue, widespread rash, fainting, or severe abdominal pain.

• If you are being treated for inflammatory bowel disease or ulcerative colitis, do not stop medication immediately when symptoms improve; complete the course of treatment as prescribed.

Part 2: Guide to safe and painless self-enema

Step 1: Consult a doctor before performing an enema

Determine if an enema is truly necessary

• Enemas may be considered by a doctor in some cases of constipation or to prepare for a medical procedure.

• This is not the first-line treatment for constipation and is not suitable for everyone.

• Enemas only help to cleanse the end of the bowel; this method does not address the underlying cause of chronic constipation.

• Improper self-administration can cause pain, bleeding, rectal injury, infection, or electrolyte imbalance.

Communicate fully with your doctor

Before performing an enema, provide your doctor with the following information:

• Duration of constipation, frequency of bowel movements, and stool characteristics.

• Accompanying symptoms such as abdominal pain, vomiting, bloating, fever, or bloody stools.

• History of kidney disease, heart disease, inflammatory bowel disease, bowel obstruction, gastrointestinal surgery, or anorectal conditions.

• Pregnancy status, elderly age, or risk of dehydration.

• Medications, supplements, and laxatives currently being used.

Do not self-administer enemas if you have dangerous signs

• Do not perform an enema if you have severe unexplained abdominal pain, persistent vomiting, abdominal distension, or inability to pass gas.

• Do not self-administer an enema if you have rectal bleeding, black stools, high fever, or severe dizziness.

• These symptoms may be related to bowel obstruction, gastrointestinal bleeding, or conditions requiring early examination and treatment.

Follow pre-surgical instructions

• If a pre-surgical bowel cleanse is needed, use the correct type of solution, dosage, and timing provided by the hospital.

• Do not assume that an enema is required approximately 2 hours before every surgery. Preparation time depends on the type of surgery, anesthesia method, and protocol of each medical facility.

• Do not switch to self-prepared solutions or use additional laxatives outside the prescribed regimen.

• If performed at the wrong time, with insufficient solution, or unable to complete, immediately notify medical staff instead of repeating it yourself.

Do not overuse enemas to treat constipation

• Do not use rectal enema solutions frequently or continuously without medical supervision.

• If constipation lasts for more than 2-3 weeks, recurs frequently, or requires reliance on enemas for bowel movements, consult a gastroenterologist.

• Long-term treatment often requires considering diet, fluid intake, exercise, bowel habits, current medications, and underlying medical conditions.

Step 2: Adhere to the dosage and frequency of enema administration

Request specific instructions from your doctor

• If your doctor permits home enema administration, you must inquire about the specific product name or solution type to be used.

• Confirm the exact volume for each administration, the time of day, and the maximum number of times per day or week.

• Ask your doctor how long it should be used and what to do if a bowel movement does not occur after the enema.

• Do not apply dosages from others or online formulas, as the appropriate volume depends on age, underlying conditions, and the cause of constipation.

Follow the prescribed dosage strictly

1. Carefully read the prescription and product label instructions.

2. Measure the exact amount of solution; do not estimate visually.

3. Do not increase the dose yourself if the first attempt was ineffective.

4. Do not combine multiple types of laxatives or enema solutions without consulting your doctor.

5. Record the time of use, type of solution, and body's reaction to provide information during follow-up appointments.

Do not administer enemas too frequently

• Overuse of colon cleansing enemas can cause irritation, inflammation, or damage to the rectal lining.

• Repeated enemas also increase the risk of dehydration and electrolyte imbalance, especially in children, the elderly, and individuals with kidney or heart disease.

• Prolonged use can lead to dependence on rectal stimulation for bowel movements, while the cause of constipation remains untreated.

• Do not use daily or for longer than the doctor's recommended duration.

Monitor effectiveness after use

• Observe bowel movement ability, severity of abdominal pain, stool consistency, and signs of dehydration.

• Contact your doctor if the rectal enema solution is ineffective, constipation quickly recurs, or you need to use it increasingly frequently.

• Do not immediately administer another enema after a failed attempt, as the solution or medication may still be absorbing.

Seek medical attention immediately for any abnormal signs

• Discontinue use and seek medical help if severe abdominal pain, vomiting, abdominal distension, rectal bleeding, dizziness, muscle weakness, or abnormal heart rate occurs.

• Constipation accompanied by inability to pass gas, unexplained weight loss, black stools, or fever requires prompt medical evaluation instead of continuing self-enema at home.

Step 3: Choose a safe enema kit

Prioritize sterile kits

• Use a rectal enema kit that is individually packaged, sealed, and manufactured for medical purposes.

• A kit typically includes a bag or container for the solution, tubing, a flow clamp, and a rectal tip.

• Some products include lubricant; if not, choose a water-based lubricant approved for medical use.

• Do not use homemade bottles, tubes, or devices as it is difficult to control cleanliness, pressure, and there is a risk of injury.

Inspect the product before opening

1. Read the product name, instructions for use, and manufacturer's warnings.

2. Check the expiration date and packaging condition.

3. Do not use if the bag is torn, unsealed, damp, moldy, or shows signs of being opened.

4. Ensure the tip is smooth, free of cracks, sharp edges, or deformities.

5. Make sure connections are secure and the flow clamp functions properly.

Keep equipment clean during handling

• Wash hands with soap and dry them before opening the kit.

• Place components on a clean, dry surface; avoid letting the tip touch sinks, floors, or toilets.

• Do not directly touch the tip that will be inserted into the rectum.

• If the tip falls or becomes contaminated, do not continue to use it.

Do not share or arbitrarily reuse

• Prioritize single-use kits and dispose of them after home enema administration.

• Do not share enema bags, tubing, or tips with others due to the risk of transmitting bacteria and pathogens.

• If the manufacturer states the product can be reused, clean and store it according to instructions; however, reuse still makes it difficult to ensure complete sterility at home.

• Do not attempt to sterilize plastic instruments with boiling water or chemicals if not permitted by the manufacturer, as the material may deform or leave irritating residues.

Purchase from a trusted source

• You can purchase a colon cleansing kit at pharmacies, medical supply stores, or reputable online retailers.

• Prioritize products with Vietnamese labels, manufacturer information, instructions for use, and clear origin.

• Do not choose products based solely on low price or "colon detox" advertisements; appropriate instruments should be selected according to medical purpose and doctor's instructions.

Step 4: Administer the enema safely

Preparation before administration

• Only administer a home enema after a doctor has confirmed its suitability and provided clear instructions on the type of solution, volume, and frequency of use.

• Choose a private location, close to a toilet, and lay a clean towel underneath.

• Wash your hands, check that the tube clamp is closed, and ensure the solution is only slightly warmer than body temperature.

• It is preferable to use a pre-packaged enema kit with a depth limit on the tip and clear manufacturer's instructions.

Position the enema bag at an appropriate height

1. Hang the bag at the height specified in the kit's instructions; a reference level is typically about 30–46 cm above the rectum.

2. Do not hang the bag higher to make the solution flow faster, as high pressure can cause pain, spasms, or injury.

3. Gently release some solution through the tube to expel air, then close the clamp.

4. If assisted, ensure they understand how to adjust the flow and respect the privacy of the person performing the enema.

Lubricate the tip correctly

• Apply a sufficient amount of water-based lubricant gel to the anus and the tip.

• Only use petroleum jelly if the manufacturer's instructions allow, as oil-based products may not be compatible with certain materials.

• Do not use soap, medicated oil, lotion, or scented lubricants as they can easily irritate the mucous membranes.

Choose a comfortable position

• Lie on your left side, with both knees slightly bent towards your chest to facilitate the flow of the solution.

• Relax your abdominal muscles and breathe slowly.

• Do not pull your knees too close to your chest if this position causes pain or difficulty breathing.

Insert the tip slowly

1. Gently insert the tip towards the navel, up to the marked limit or the depth indicated by the manufacturer.

2. Do not assume a depth of 7.6 cm in all cases; the appropriate depth depends on the type of tip, age, and body structure.

3. Do not force the tube in. You can exhale slowly to relax the anal sphincter.

4. Stop immediately if you encounter resistance, sharp pain, or bleeding; absolutely do not twist, push, or force the tip deeper.

Allow the solution to flow slowly

• Slowly open the clamp to allow the solution to enter the rectum at a gentle rate.

• If fullness or mild spasms occur, temporarily close the clamp, breathe evenly, and only continue when the sensation subsides.

• If severe pain, dizziness, nausea, difficulty breathing, or bleeding occurs, stop the colon cleansing enema and contact a medical facility.

• Do not forcefully squeeze the bag or force the entire solution in if your body cannot tolerate it.

Do not perform when there are dangerous signs

• Do not self-administer an enema if you have severe unexplained abdominal pain, vomiting, fever, abdominal distension, inability to pass gas, or bloody stools.

• Individuals with kidney disease, heart disease, inflammatory bowel disease, anorectal disease, or recent gastrointestinal surgery should consult a doctor before performing an enema.

• Children should not follow adult procedures and depths; enemas for children must be specifically indicated by a pediatrician.

Step 5: Retain the solution for the correct duration

Adhere to the instructed time

• After introducing the solution, lie still in a comfortable position and retain the solution for the time specified on the product label or instructed by your doctor.

• With some types of rectal enema solutions, the urge to defecate may appear after about 5 minutes; however, the onset of action varies depending on the product and individual body.

• Do not assume you must retain it for a full 15 minutes if you are experiencing significant pain or cannot control the urge to defecate.

• Do not extend the retention time solely to increase effectiveness, as this can cause discomfort and rectal irritation.

Reduce mild spasmodic sensations

• Relax your shoulders and abdomen, inhale slowly through your nose, then exhale slowly.

• Maintain the side-lying position if you feel comfortable; do not stand up abruptly.

• Mild spasms or a feeling of fullness may occur as the solution begins to stimulate bowel peristalsis.

• If discomfort increases, go to the toilet instead of trying to hold it in.

Do not try to retain when there are abnormal signs

• Expel the solution and stop if severe abdominal pain, sharp anal pain, nausea, dizziness, or bleeding occurs.

• Seek medical help if symptoms do not subside, the abdomen remains distended, or you cannot have a bowel movement or pass gas.

• Do not perform another colon cleansing enema immediately after a failed attempt, unless instructed by a doctor.

Do not arbitrarily extend retention time if glycerin is present

• Do not assume that glycerin-containing solutions must be retained for 60 minutes.

• Retention time depends on concentration, formulation, and treatment purpose; retaining it for too long can increase irritation, cramping, or diarrhea.

• If glycerin or prescription medication is used, follow the exact time instructed by the doctor or manufacturer.

• Do not add glycerin to saline solution for home enema administration yourself.

Go to the toilet when needed

• When the urge to defecate becomes strong, slowly move to the toilet.

• Avoid straining heavily or sitting on the toilet for too long.

• After defecating, monitor for pain, unusual bleeding, and signs of dehydration.

• Drink water as needed if there are no fluid restrictions due to heart, kidney, or other medical conditions.

Step 6: Go to the toilet after the enema

Safely move to the toilet

• When the urge to defecate becomes clear, slowly stand up and go to the toilet.

• Do not try to retain the rectal enema solution longer than the time instructed by your doctor or the manufacturer.

• If you feel dizzy or weak in your legs, sit or lie down and ask for assistance to prevent falling.

• For the elderly or those with limited mobility, prepare a commode or toilet chair next to the place where the enema is being performed.

Allow the solution and stool to pass naturally

1. Sit firmly on the toilet, placing your feet on the floor or a low stool.

2. Lean slightly forward and relax your abdominal muscles.

3. Breathe evenly, do not hold your breath or strain hard.

4. Wait for the solution and stool to be expelled by the natural peristalsis of the bowel.

5. You can continue to sit for a short time if you still feel the urge to defecate.

Do not sit on the toilet for too long

• The process of defecation may not occur immediately, but do not sit and strain continuously.

• If you have not had a bowel movement after about 10–15 minutes, gently stand up, walk around near the toilet, and wait for the urge to return.

• Sitting for too long or straining hard increases pressure on the anal area, which can worsen hemorrhoids, anal fissures, or dizziness.

• Do not attempt to manually remove stool or insert additional instruments into the rectum.

Post-defecation care

• Only leave the toilet when the urge to defecate has significantly decreased.

• Gently wash the anal area with warm water and pat dry; avoid harsh rubbing.

• Drink water as needed unless your doctor has restricted fluid intake.

• Loose stools or a few additional bowel movements may occur after an enema, so it is advisable to stay near a toilet for some time.

What to do if there is no result

• Do not self-administer another enema immediately if you have not had a bowel movement.

• Contact a doctor or pharmacist for guidance if the solution does not pass, constipation does not improve, or abdominal distension worsens.

• Seek immediate medical attention if you experience severe abdominal pain, vomiting, fever, rectal bleeding, dizziness, or inability to pass gas.

Step 7: Recognize the risks of enemas

Understand common side effects

• Home enemas can cause nausea, abdominal cramping, bloating, diarrhea, or a burning sensation in the rectum.

• Frequent bowel movements can lead to dehydration, fatigue, and dizziness.

• Mild symptoms usually subside after the solution has been expelled; if discomfort persists or worsens, contact a healthcare professional.

• Do not self-administer additional laxatives or enemas to "speed up" the effect.

Recognize serious complications

• Inserting the nozzle too deeply, using excessive force, or creating high flow pressure can tear or perforate the rectum or colon.

• Bowel perforation is a rare but dangerous complication, which can cause peritonitis and requires emergency medical attention.

• Using the wrong type of solution, incorrect concentration, or administering enemas too frequently can cause electrolyte imbalances (sodium, potassium, phosphate, or magnesium).

• The risk of electrolyte imbalance is higher in children, the elderly, dehydrated individuals, and those with heart or kidney disease.

Stop immediately if warning signs appear

Stop the procedure and seek immediate medical attention if you experience:

• Sudden, severe abdominal or rectal pain.

• Heavy or prolonged rectal bleeding.

• Hard, increasingly distended abdomen, inability to defecate or pass gas.

• Persistent vomiting, fever, fainting, or confusion.

• Muscle weakness, seizures, difficulty breathing, or irregular heartbeat.

• Solution not expelling, accompanied by increasing pain and tension.

Do not self-administer enemas if you are in a high-risk group

• Individuals suspected of intestinal obstruction, bowel perforation, acute enteritis, or active gastrointestinal bleeding should not self-administer an enema.

• Individuals who have recently undergone gastrointestinal surgery, have kidney disease, heart failure, electrolyte disorders, or are dehydrated need to be evaluated by a doctor beforehand.

• Pregnant women and children should only undergo enemas when specifically indicated and with detailed guidance from healthcare professionals.

• Do not use solutions containing sodium phosphate, magnesium, or prescription medications unless confirmed suitable by a doctor or pharmacist.

Choose medical facility support

• If you are unsure about the procedure, concerned about complications, or unable to perform it safely, consult with a doctor.

• The doctor may suggest performing the procedure at a hospital or clinic, or recommend an alternative, more suitable treatment plan for constipation.

• Do not let embarrassment become a barrier to safety: seeking assistance from a healthcare professional is a cautious choice, not a sign of failure.

Step 8: Do not use unfamiliar ingredients for enemas

Completely avoid traditional remedies

• Do not use coffee, milk, vinegar, or "detox" mixtures for home enemas.

• These ingredients do not have appropriate concentrations, pH levels, or cleanliness for the rectal lining.

• They can cause chemical burns, colitis, infections, severe diarrhea, dehydration, and electrolyte imbalances.

• "Natural" does not mean safe; the rectum can absorb many substances directly into the body.

Do not put the following substances into an enema bag

• Lemon juice or other acidic fruit juices.

• Alcohol, beer, and any alcohol-containing solutions.

• Garlic, aloe vera, thistle, or wild herbs.

• Turpentine and solvents.

• Mineral water or water not specifically indicated for rectal use.

• Coffee, milk, vinegar, essential oils, or "colon detox" preparations.

These substances can cause serious damage even when diluted. If used and burning pain, bleeding, vomiting, dizziness, or confusion occurs, seek immediate medical attention.

Do not use homemade soap solutions

• Soap solutions can be highly irritating, causing inflammation or damage to the rectosigmoid mucosa.

• Only use under professional guidance and direct supervision by healthcare personnel in an appropriate medical environment.

• Do not use hand soap, shower gel, dish soap, or any household soap to prepare an enema solution.

Distinguish between mineral water and mineral oil

• Mineral water is not a saline solution and should not be used to prepare an enema solution.

• Mineral oil is a different product; only use preparations specifically manufactured for rectal use and follow the instructions on the label or prescription.

• Do not use cosmetic mineral oil, industrial oil, or pour oil into the enema bag yourself.

Use packaged products according to instructions

1. Check the seal, expiration date, and route of administration on the packaging.

2. Wash hands and lubricate the nozzle with water-based gel if the product is not pre-lubricated.

3. Lie on your side as indicated in the instructions for use; do not choose a position that causes you to lose balance.

4. Gently insert the nozzle in the correct direction and to the limit indicated on the product.

5. Do not use your finger to probe, do not push deeply, and do not try to overcome resistance.

6. Stop immediately if you experience sharp pain, bleeding, or cannot insert the nozzle easily.

Retain the medication for the prescribed time

• After administration, retain the solution or medication for the time indicated on the label; do not assume all products need to be retained for 15 minutes.

• Do not try to hold it in if you experience strong cramping or an urgent need to defecate.

• Do not repeat the dose yourself if there is no result, unless instructed by a doctor or pharmacist.

Only use products with a clear medical purpose

• Prioritize pre-packaged enema solutions with clear origin, ingredients, and comprehensive instructions for use.

• Do not purchase products advertised as "detoxing," "fast weight loss," or "total colon cleansing."

• If you are unsure whether a product can be used rectally, ask a pharmacist before use.

Choose the right type of enema solution

Prioritize pre-mixed, standardized products

• If an enema is needed, it is advisable to choose a pre-packaged product from a pharmacy as directed by a doctor or pharmacist, rather than mixing it yourself.

• Check the ingredients, route of administration, expiry date, and seal status before purchasing.

• Use the correct dose as indicated on the label or prescription; do not self-divide doses, dilute, or combine multiple types of solutions.

• Over-the-counter products can still cause side effects and are not inherently suitable for everyone.

Caution with phosphate solutions

• It should not be assumed that enema solutions containing sodium phosphate are safe for all children simply by using the correct dose on the label.

• Young children are susceptible to dehydration and electrolyte imbalances; only use phosphate products when confirmed suitable by a pediatrician.

• Elderly individuals, dehydrated individuals, or those with kidney disease, heart failure, intestinal obstruction, or colitis should also consult a doctor before use.

• Overdosing or repeating sodium phosphate can cause hyperphosphatemia, hypocalcemia, cardiac arrhythmias, kidney damage, and life-threatening complications.

• Do not administer an additional dose if the first dose was ineffective, unless instructed by a healthcare professional.

Do not use food or folk remedies

• Do not use milk, lemon juice, herbal tea, coffee, vinegar, or kitchen ingredients to prepare an enema solution.

• These substances can introduce bacteria into the intestines, alter pH, cause mucosal burns, colitis, or electrolyte imbalances.

• Do not use any product rectally if the label does not explicitly state this purpose.

Do not self-administer enemas with pure water

• Enemas with undiluted water can alter water and sodium balance, especially when large volumes are used or repeated frequently.

• The mechanism of an enema is not simply "salt drawing water into the intestines"; the effect also depends on the composition, concentration, and volume of each product.

• Only use the type of solution and amount of water instructed by a doctor, pharmacist, or manufacturer.

• Do not add salt yourself to "make it stronger," as an overly salty solution can also cause dehydration and mucosal damage.

Seek medical attention if constipation does not improve

• Do not continue to self-administer enemas if constipation is accompanied by severe abdominal pain, vomiting, bloating, inability to pass gas, fever, or rectal bleeding.

• If you frequently rely on enemas to defecate, consult a doctor to identify the cause and develop a long-term treatment plan.

• Foundational measures such as adjusting fiber intake, drinking enough water, exercising, and establishing regular bowel habits are usually prioritized depending on health status.

References

1. Chang, L., Chey, W. D., Imdad, A., Almario, C. V., Bharucha, A. E., Diem, S., Greer, K. B., Hanson, B., Harris, L. A., Ko, C. W., Murad, M. H., Patel, A., Shah, E. D., Lembo, A. J., & Sultan, S. (2023). American Gastroenterological Association–American College of Gastroenterology clinical practice guideline: Pharmacological management of chronic idiopathic constipation. Gastroenterology, 164(7), 1086–1106. DOI: 10.1053/j.gastro.2023.03.214.
2. Harish, K., Tony, J., Sunilkumar, R., & Varghese, T. (2006). Severe colitis induced by soap enemas. Indian Journal of Gastroenterology, 25(2), 99–100.
3. Niv, G., Grinberg, T., Dickman, R., Wasserberg, N., & Niv, Y. (2013). Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable. International Journal of General Medicine, 6, 323–328. DOI: 10.2147/IJGM.S44417.
4. Smith, R. H., & Ekins, B. R. (2022). Toxicity of phosphate enemas: An updated review. Clinical Toxicology, 60.
5. Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Nurko, S., Langendam, M. W., Chumpitazi, B. P., Faure, C., Southwell, B. R., Vandenplas, Y., & Benninga, M. A. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258–274. DOI: 10.1097/MPG.0000000000000266.
6. United States Food and Drug Administration. (2014). FDA drug safety communication: Possible harm from exceeding recommended dose of over-the-counter sodium phosphate products to treat constipation. U.S. Department of Health and Human Services.
7. National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Treatment for constipation. National Institutes of Health, U.S. Department of Health and Human Services.
8. National Library of Medicine. (2024). Sodium phosphate rectal: Drug information. MedlinePlus, National Institutes of Health.
9. Sheibani, S., & Gerson, L. B. (2008). Chemical colitis. Journal of Clinical Gastroenterology, 42(2), 115–121. DOI: 10.1097/MCG.0b013e31814c681e.
10. Son, H., Song, H. J., Seo, H. J., Lee, H., Choi, S. M., & Lee, S. (2020). The safety and effectiveness of self-administered coffee enema: A systematic review of case reports. Medicine, 99(36), e21998. DOI: 10.1097/MD.0000000000021998.

Content edited by: Leigh Kennedy Ly.

Information reviewed and verified by expert: Amelia Wilson.