How to administer an enema

Rationale and key points

This How to module aims to help nurses to undertake the administration of rectal enemas in a safe, effective and patient-centred manner, ensuring privacy and dignity. The administration of an enema is a common healthcare procedure, which can be used to deliver medication or aid bowel evacuation.

• The administration of an enema should be undertaken by a competent nurse.
• An enema is a liquid preparation inserted into the rectum.
• The nurse must explain the procedure to the patient and should assist the individual before, during and after the procedure.
• The nurse should document all care given.

Keywords

clinical procedures, clinical skills, dignity, drug therapy, enema, medication, medicines, patient experience, privacy

Pre-test questionnaire

Before starting this module, test your knowledge on this subject by answering five multiple choice questions.

1. Before starting the procedure, health practitioners should:a) Gather equipment and check the medicationb) Check that the enema has been prescribedc) Ask the patient to empty their bladderd) All of the above

2. Which position should the patient adopt?a) The left lateral positionb) The right lateral positionc) The supine positiond) The prone position

3. For how long should an enema be retained to enable it to work effectively?a) 1-5 minutesb) 5-10 minutesc) 10-15 minutesd) At least 30 minutes

4. How far into the rectum is the enema usually inserted?a) About 3cmb) About 5cmc) About 7cmd) About 8cm

5. What can you use to describe any stool passed?a) The Oxford Stool Toolb) The York testc) The Bristol Stool Chartd) The Birmingham Stool Chart

Useful Resources

• Loveday H, Wilson JA, Pratt RJ et al (2014) epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection. 86, Suppl 1, S1-S70.
• Multidisciplinary Association of Spinal Cord Injured Professionals (2012) Guidelines for Management of Neurogenic Bowel Dysfunction in Individuals with Central Neurological Conditions. tinyurl.com/oekvcrp (Last accessed: October 22 2015.)
• Peate I, Wild K, Nair M (Eds) (2014) Nursing Practice: Knowledge and Care. John Wiley and Sons, Oxford.

• References

  Boyd C (2013) Clinical Skills for Nurses. John Wiley and Sons, Oxford.
  British National Formulary (2016) British National Formulary No. 71. BMJ Group and the Royal Pharmaceutical Society of Great Britain, London.
  Crisford M (2011) Elimination. In Dougherty L, Lister SE (Eds) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Eighth edition. John Wiley and Sons, Oxford, 195-278.
  Davies C (2004) The use of phosphate enemas in the treatment of constipation. Nursing Times. 100, 18, 32-35. MEDLINE
  Higgins D (2006) How to administer an enema. Nursing Times. 102, 20, 24-25. MEDLINE
  Kyle G (2007) Bowel care. Part 4 – administering an enema. Nursing Times. 103, 45, 26-27. MEDLINE
  Mendoza J, Legido J, Rubio S, Gisbert JP (2007) Systematic review: the adverse effects of sodium phosphate enema. Alimentary Pharmacology and Therapeutics. 26, 1, 9-20. MEDLINE •CROSSREF
  NHS Commissioning Board, Chief Nursing Officer, Department of Health Chief Nursing Advisor (2012) Compassion in Practice. Nursing, Midwifery and Care Staff: Our Vision and Strategy. The Stationery Office, London.
  Nursing and Midwifery Council (2010) Standards for Medicines Management. tinyurl.com/ck8fk4z (Last accessed: October 22 2015.)
  Nursing and Midwifery Council (2015) The Code. Professional Standards of Practice and Behaviour for Nurses and Midwives. NMC, London.
  Royal College of Nursing (2012) Management of Lower Bowel Dysfunction, including DRE and DRF. RCN Guidance for Nurses. Third edition. RCN, London.