15. Enema

Learning outcomes

By the end of this section, you should know how to:

▪ prepare the patient for this nursing practice

▪ have an understanding of criteria used to diagnose constipation

▪ collect and prepare the equipment

▪ administer an enema

▪ describe the various enema preparations and their modes of action.

Background knowledge required

Revision of the anatomy and physiology of the colon, rectum and anus

Revision of ‘Administration of medicines’, particularly checking the medicine against the prescription (seep. 13)

Understand common causes of constipation and know appropriate health education advice for the prevention of constipation.

Indications and rationale for administering an enema

An enema is the introduction of liquid into the rectum by means of a tube. It is used:

▪ to relieve severe constipation. Potential complications of unresolved constipation include abdominal pain and distension; confusion; nausea and vomiting; overflow diarrhoea; abdominal obstruction or perforation

▪ to evacuate the bowel prior to surgery or investigation

▪ to administer medication.

An appropriately trained nurse prescriber has the ability to assess, diagnose and prescribe an appropriate enema to rectify severe constipation. This is a specialised extended role, recognised by a registerable qualification with the Nursing and Midwifery Council. An awareness of the Rome II criteria for constipation (see Table 15.1) offers guidance to the practitioner when diagnosing constipation, as will a digital rectal examination (see Practice 35).

**TABLE 15.1** Rome II criteria for constipation (adults)
*From Drossman 2000, with permission of the Rome Foundation.*© 2000
A diagnosis of constipation requires two or more of the following symptoms to be present for at least three months (not necessarily consecutive) in the preceding twelve months:
1. Straining at defecation for at least a quarter of bowel movements
2. Lumpy and/or hard stools for at least a quarter of bowel movements
3. A sensation of incomplete evacuation for at least a quarter of bowel movements
4. Less than three bowel movements a week
5. Manual manoeuvres to facilitate a quarter of bowel movements (e.g. digital evacuation or support of the pelvic floor)
6. Loose stools not present and insufficient criteria met for irritable bowel syndrome