Enemas are aqueous or oily solutions or suspension that are employed to evacuate the bowel

Enemas are aqueous or oily solutions or suspension that are employed to evacuate the bowel, to influence the general system by absorption or to affect locally the seat of disease or introduced into the rectum for cleansing, therapeutic or diagnostic purpose. Cleansing preparations are used to evacuate faeces in constipation before an operation.

Enemas are usually given at body temperature in quantities of 1 to 2 pt injected slowly with a syringe. If they have to be retained in the intestine they should not be used in larger quantities than 6 fl. ounces for an adult.

Sodium chloride, sodium bicarbonate, sodium monohydrogen phosphate and sodium dihydrogen phosphate are used in enemas.

The enemas act in following ways:

1. Large volume enemas (about 0.5 to 1.0 liter) e.g., water, soap and turpentine enemas or other type of enemas stimulate peristalsis.

2. Small volume enemas (about 100 to 500 ml) like olive and arachis oil enemas act by lubricating impacted feces.

Therapeutic Enemas may be used as:

1. Anthelmintic: Quassia enema for thread worms

2. Sedatives: Chloral hydrate, paraldehyde enemas.

3. Anti-inflammatory agent: Corticosteroids for ulcerative colitis

4. Stimulating enemas

5. Nutritive: When absorption by mouth is impaired, enemas are useful.

6. X-ray examination: Barium sulphate suspension is used for X-ray examination of the lower bowel.

Containers

Large volume enemas are administered from a douche can and should be warmed to body temperature before use. Some commercially available small volume enemas are in disposable polyethylene or polyvinyl chloride bags sealed with a rectal nozzle.

Labelling:

Special labeling requirements for enemas are 1. To be warmed to body temperature before use, 2. ‘Not to be taken orally’, 3. ‘For rectal use only’

Storage:

The enema should be stored in a cool place in complete darkness and an expiry date of only two days after issue is advisable.

Example: Prepare and dispense Chloral Hydrate Enema

Chloral hydrate 2.0 g

Mucilage of starch, sufficient to produce 100.0 ml

Method of Dispensing:

Dissolve weighed quantity of chloral hydrate in mucilage of starch and add sufficient to produce 100 ml.

Example: Prepare and dispense Magnesium Sulphate Enema

Magnesium sulphate 50.0 g

Purified water, sufficient to produce i 00.0 ml

Method of Dispensing:

Dissolve magnesium sulphate in purified water and shake, if required, and filter.

Example: Prepare and dispense Paraldehyde Enema

Paraldehyde 8.0 ml

Sodium chloride 0.9 g

Purified water, sufficient to produce 100.0 ml

Method of Dispensing:

Dissolve sodium chloride in purified water, filter, add paraldehyde and dissolve. Add sufficient purified water to produce 100 ml.

Example: Prepare and dispense Phosphate Enema

Sodium acid phosphate 160 g

Sodium phosphate 60.0 g

Purified water, sufficient to produce 100.0 ml

Method of Dispensing:

Mix sodium acid phosphate and sodium phosphate and powder in a pestle and mortar. Dissolve this mixture in purified water and make up volume to produce 100 ml.

Example: Prepare and dispense Soap Enema

Purified water (lukewarm), sufficient to produce 100.0 ml

Method of Dispensing:

Dissolve weighed amount of soft soap in warm purified water and add sufficient warm purified water to produce 100 ml.