Well... both. My mother believed an enema should be hot, 115F, have enough Ivory or Castile Soap that the solution was milky cloudy, and should be given with the bag as high as she could hold it, but dropped to hip or chest level as soon as there were any cramps, with a rest period of no backflow, but little further filling, til the cramps subsided, several minutes, at least. From an early age, my mother put a great emphasis on "breathing through your enema", like Lamaze for childbirth, and let me tell you, when my mother gave enemas, there were similarities! The breathing instructions were initiated as soon as she warned me, or my sister, and popped the clamp...
"Do you feel it yet? (The heat... -- she had the bag low near her waist)
"N... N... No... not yet."
"How about now?" (The Bag went up to her shoulder height)
"Ohh... oh... yes, mom, I feel it, it's hot!"
"Ok, lets get this enema in you where it can do you some good! Now take slow deep breaths, in and out... " (she would have raised the bag high above her head, and she was 5'9", and typically I was sitting/leaning forward, almost standing, or lifting myself off the toilet, under the flow.)
"Owwwww... mom, I'm cramping... it hurts, it hurts! I can't take any more!"
"Yes, you can. Deep breaths, I'm lowering the bag, deep breaths, in and out, slow deep breaths! Let the enema flow higher in you. If you can take more now, you might not need as many enemas now, or another series tonight or in the morning." Deep breaths!"
After I was older, she might say...
"Keep breathing slow, slow and deep... you are done with the first bag, so I'm adding another quart to the bag, because you're older now, and you need to take as much as you can!"
And later....after several cramps and bag downs and ups...
"OK! You're almost done.."
"Mom, MOM, I can't hold any more!"(I was usually tummy expanded right up to under my ribs)
"Just the last bit, now exhale, let all your air out, and make some room for the last little bit, (she would raise the bag and only an inch could be seen sloshing back and forth)... Pant, pant, exhale all the way out and make some room...
OK, it's all in, lean forward, and I'm taking the nozzle out (always the adult nozzle, as the douche tip was reserved for my mom and sisters feminine needs)
"Now you sit there and hold it for 5 minutes, and don't you release it early! If you have to pant and exhale, do it. Breathe through the pressure, relax. Keep your cheeks clenched tight. If you lose control early, I'll have to give you another Ivory soapsuds enema now, instead of your saline wash! I'll be back in 5 minutes. Don't flush."
So you see, it was slow deep breaths from beginning to end, but exhales and pants at the end to make the little bit of extra room she needed to finish the bag. She practiced both techniques, at different times, and for different reasons!!