The Merck Manual

Excerpted from The Merck Manual - Tenth Edition

The Merck Manual has long been considered the Bible for Physicians

Few are aware that from 1899-1977 coffee enemas were included in the Merck Manual, a compendium of orthodox research techniques. Coffee enemas were not removed from the Manual because of their ineffectiveness, but rather to make room for newer material.

ENEMAS

Cleansing enemas are used to promote bowel evacuation by softening the feces and stimulating peristalsis. Carminative enemas serve to relieve distention. Retention enemas act to soothe or lubricate the rectal mucosa, to apply absorbable or local medicaments, and to soften feces. Other types are nutrient enemas (see Proctoclysis) and colonic irrigations (q.v.).

The patient should lie, preferably on his side, with the upper thigh flexed (Sim's position). The solution should always be administered at or above body temperature. With the irrigating can held or suspended 12 to 18 in. above the anus, the air and any cooled solution in the tubing are expelled and the lubricated catheter or rectal tip then is gently inserted into the rectum for about 2 to 4 in. The solution is administered slowly, over a period to 5 to 10 min. if necessary, to prevent acute discomfort. Should cramps occur due to overstimulation of the bowel, the flow must be temporarily stopped by pinching the tube. Gentle pressure against the anus with a folded towel may prevent the expulsion of solution and tube. The enema tube should be clamped during its withdrawal, to prevent spillage. A toilet stool or warmed bedpan must be readily accessible.

Cleansing enemas: The principal solutions used are tap water, weak soapsuds (with any mild soap), and saline (1 tsp. salt to 1 pt. water). Quantities are 1 pt. for children, 1 qt. for adults. If possible, cleansing enemas should be retained for 5 to 10 min.

For colostomy irrigation, the procedure is the same as for a cleansing enema except that a lubricated catheter is inserted through the colostomy opening. The proximal loop of the colostomy is irrigated first and then the distal portion.

Carminative enemas: (NOTE: Abdominal distention often may be relieved by the insertion of a rectal tube, or by the application of a flaxseed poultice or hot stupes containing water or 1:3 turpentine in oil, to the abdomen.) Carminative enemas are used with less frequency that formerly because of the somewhat irritating nature of certain of the ingredients, e.g., turpentine and oil, milk and molasses, turpentine and soap suds.

Retention enemas: The patient must first be told that the solution is not to be expelled but retained within the rectum until the next bowel movement takes place. Administration should be extremely slow to avoid stimulating peristalsis. The principal types of retention enema are:

Emollient: Mix 1 to 2 tsp. starch with sufficient cold water to make a thin paste; add 5 oz. boiling water, and boil for 5 min.
Lubricant: 3 to 6 oz of olive, cottonseed, or mineral oil.
Medicated: 6 to 8 oz. coffee, or 1 oz. whiskey added to 6 oz. isotonic saline, may be given for their stimulating effect. Other medicines should be diluted with 2 to 4 oz. of water or olive oil.

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