An enema (plural enemata or enemas) is the procedure of introducing liquids into the rectum and colon via the anus. Enemas can be carried out for medical reasons (as a treatment for constipation) as a remedy for encopresis, as part of alternative health therapies, and also for erotic purposes, particularly as part of BDSM activities. In earlier times, they were often known as clysters, and were probably used more frequently than at present.
The patient was placed in an appropriate position (kneeling, with the buttocks raised, or lying on the side); some servant or apothecary would then insert the nozzle into the anus and depress the plunger, resulting in the liquid remedy (generally, water, but also some preparations) being injected into the colon.
Because of the embarrassment a woman might feel when showing her buttocks (and possibly her genitals, depending on the position) to a male apothecary, some contraptions were invented that blocked all from the apothecary's view except for the anal area. Another invention was syringes equipped with a special bent nozzle, which enabled self-administration, thereby eliminating the embarrassment.
Clysters were administered for symptoms of constipation and, with more questionable effectiveness, stomach aches and other illnesses. In his early-modern treatise, The Diseases of Women with Child, Francis Mauriceau records that both midwives and man-midwives commonly administered clysters to labouring mothers just prior to their delivery.
In Roper's biography of his father-in-law Sir Thomas More, he tells of Thomas More's eldest daughter falling sick of the sweating sickness and could not be awakened by doctors. After praying, it came to Thomas More "There straightway it came into his mind that a clyster would be the one way to help her, which when he told the physicians, they at once confessed that if there were any hope of health, it was the very best help indeed, much marveling among themselves that they had not afore remembered it." -- Utopia, Thomas More.
Clysters were a very favorite medical treatment in the bourgeoisie and nobility of the Western world up to the 19th century. As medical knowledge was fairly limited in those days, purgative clysters were used for a wide variety of ailments, the foremost of which were stomach aches and constipation.
Molière, in several of his plays, introduces characters of incompetent physicians and apothecaries fond of prescribing this remedy, also discussed by Argan, the hypochondriac patient of Le Malade Imaginaire. More generally, clysters were a theme in the burlesque comedies of that time.
Clysters are famously referred to in the conclusion of John Donne's Elegy XVIII, where the male persona warns against taking a 'wrong turn' when engaging in sexual activity, lest the unfortunate male penetrate the 'clyster' oriface.
According to Claude de Rouvroy, duc de Saint-Simon, clysters were so popular at the court of King Louis XIV of France that the duchess of Burgundy had her servant give her a clyster in front of the King (her modesty being preserved by an adequate posture) before going to the comedy.
Clysters also appear in sado-masochistic literature set during this period, where they are administered for disciplinary purposes. Girls especially were punished by being made to retain a large clyster for a specified time. An example is found in P.N. Dedeaux's The Prussian Girls. Castigation and embarrassment would follow failure to retain the solution.
William Laighton of Portsmouth, New Hampshire, obtained a patent for an enema chair on August 8, 1846. Upon receiving the patent, Laighton told his assembled colleagues that if the world were to receive an enema, Gloversville, New York would be the insertion point.
In certain countries such as the United States, customary enema usage went well into the 20th century; it was thought a good idea to cleanse the bowel in case of fever; also, pregnant women were given enemas prior to labor, supposedly to reduce the risk of feces being passed during contractions. Under some controversial discussion, pre-delivery enemas were also given to women to speed delivery by inducing contractions. This latter usage has since been largely abandoned, because obstetricians now commonly give oxytocin to induce labor and because women generally found the procedure unpleasant.
Patients who want easier, more gently-accepted enemas often purchase Combination Enema Syringes which are commonly referred to as "closed top" syringes, and which can also be used as old-fashioned hot water bottles, so as to relieve aches and pains via gentle heat administrations to parts of the body. Cost for each enema can be as little as the cost of baking soda added to ordinary tap water.
In medical or hospital environments, reusable enema equipment is now rare because of the expense of disinfecting a water-based solution. For a single-patient stay of short duration, an inexpensive disposable enema bag can be used for several days or weeks, using a simple rinse out procedure after each enema administration. The difficulty comes in from the longer time period (and expense) required of nursing aides to give a gentle, water-based enema to a patient, as compared to the very few minutes it takes the same nursing aide to give the more irritating, cold, pre-packaged sodium phosphate unit.
For home use, disposable enema bottle units are common, but reusable rubber or vinyl bags or enema bulbs may also be used. In former times, enemas were infrequently administered using clyster syringes. If such commercially-available items are not at hand, ordinary water bottles are sometimes used.
The same term is also used in alternative medicine where it may involve the use of substances mixed with water in order to detoxify the body. Practitioners believe the accumulation of fecal matter in the large intestine leads to ill health. This resurrects the old medical concept of autointoxication which was orthodox doctrine up to the end of the 19th century but which has now been discredited.
Enemas have also been used for ritual rectal drug administration such as balché, alcohol, tobacco, peyote, and other hallucinogenic drugs and entheogens, most notably by the Mayans and also some other American Indian tribes. Some tribes continue the practice in the present day.
People who wish to become intoxicated faster have also been known to use enemas as a method to instill alcohol into the bloodstream, absorbed through the membranes of the colon. However, great care must be taken as to the amount of alcohol used. Only a small amount is needed as the intestine absorbs the alcohol more quickly than the stomach. Deaths have resulted due to alcohol poisoning via enema.
Enemas may be used as part of BDSM activities, or as a regular sexual activity for an individual or between partners. In many cities, enemas are available as a service from practitioners in the sex industry to cater to human sexual desires. Enemas can be pleasurable to either sex, and in males, enemas can stimulate the prostate gland. Unexpected erections are common in medical settings, even if the person would otherwise consider it an unpleasant procedure.
An enema may also be used prior to anal sex or anilingus in order to enhance the sensation of intercourse, or to remove feces prior to sex, possibly reducing bacterial transmission and risk of infection, or just to reduce the possibility of fecal material adhering to the genitals or sex toys used during the subsequent activity.
The enema tube and solution may stimulate the vagus nerve, which triggers an arrhythmia such as bradycardia. Enemas should not be used if there is an undiagnosed abdominal pain since the peristalsis of the bowel can cause an inflamed appendix to rupture.
Colonic irrigation should not be used in people with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids or tumors in the rectum or colon. It also should not be used soon after bowel surgery (unless directed by one's health care provider). Regular treatments should be avoided by people with heart disease or renal failure. Colonics are inappropriate for people with bowel, rectal or anal pathologies where the pathology contributes to the risk of bowel perforation.