Nowadays, there seems to be a great emphasis in magazine and television advertising about the need to do some sort of detoxification or cleanse of the colon to stay healthy. Most of time, the products being promoted are expensive herbs, powders or liquids, taken orally, to produce a clean colon; however, there's an old fashioned way that those of us that grew up in the 50's already know about - enemas! Even though most of the "experts" in the medical community say enemas are useless and even dangerous, many of us still believe having a periodic high enema series (i.e., three separate enemas given over a two to three hour period, once every 4 to 6 months) to cleanse the colon is a good thing to do. The problem is many who have had bad childhood experiences and memories with enemas are dead set against submitting to taking, or being given an enema. They will say "why choose a method that has a reputation of being humiliating, uncomfortable, and truly unpleasant over something that is less invasive?" My mother's answer to that was to ask why disturb the entire digestive system when it's only the last 5 feet that needs attention?
Having grown up in an environment where enemas were given in a careful, loving, and non threatening way, I have always looked forward to having a high enema series periodically; but that was because my mother knew how give large volume enemas were effective and felt good. Because so many people don’t know, I thought it might be useful to discuss how to give an enema that “feels good” to someone who has never had one, or who has had a bad experience with one during childhood. The object is to show how having an enema can be an exciting, pleasant, even enjoyable experience, and that the feeling afterwards of being really, really clean inside is delightful! The example I’ve chosen to discuss is how to give someone the second of the three enemas that are given in what I define as a “high enema series”.
Because the intent of the second and third enema is to cleanse as much of the entire colon as possible, we call them "high enemas". This is not the kind of enema one would use to relieve constipation; instead, for constipation, a smaller, cleansing enema is used. In an enema series, the same, smaller volume enema is given first to rid the colon of any gas and clear the descending colon of any obstructions.
The discussion that follows assumes the patient has just been given that first cleansing enema. Also, as I continue this narrative, I will refer to the recipient as the "patient", and the gender as female, even though the procedure is the virtually the same if the patient is male. The one giving the enema can be either male or female.
Best approach to use for anyone that you're giving a high enema series to is to first explain the procedure in detail beforehand, in private, perhaps several days, or even a week, ahead of time. You'll want to talk about the procedure itself. Discuss the importance of trusting the person giving the enema because the patient will at times be unable to control bowel movements. Mention that the very nature of the procedure requires the patient be completely undressed, and at times, exposed and vulnerable. It is important to talk about trust again because there may be sexual concerns; repeat that the purpose is to do a complete cleansing of the colon, nothing else. When she's ready to move forward, schedule a time and pick a quiet, private place. The patient's home or apartment has the advantage of being familiar territory for the patient, as long as it's certain there won't be any interruptions. Regardless of what location is chosen, on the chosen day make sure the doors are secure, phone and answering machines are turned off, and maybe have some easy, soft music playing in the background.
The right place to give someone an enema is in a bedroom, on a bed, because it's the easiest place for the patient to relax. Be sure the room temperature warm, no lower than 76 degrees. There should be toilet nearby. While the patient releasing the first enema, begin preparing the bedroom for the second enema. Ask the patient to wait somewhere other than the room you're in while preparations are made.
First step is to strip to bed down to the bottom sheet and cover with a vinyl or rubber sheet. Place a large, soft towel on the rubber/vinyl sheet and have several more towels and pillows close by. You will want to use a large, 4 quart top fountain syringe, even though the patient probably won’t be able to handle that large a quantity at first. A clear, silicone bag is ideal because the amount of water remaining in the bag can be clearly seen. In addition, it is helpful if the hose has a "spinning wheel" type flow monitor and a "ramp clamp" so the speed and direction of the flow can be seen and adjusted as necessary.
Regarding the delivery devices, you will want to use three different ones for the three enemas. A standard douche nozzle is best for the first cleansing enema, because the water flows out of the nozzle slowly through small holes in the sides, not out of one larger hole at the end. It is less likely to get plugged up during insertion if the patient has feces in the rectum. In addition, the shape makes it less likely to slip out. Some male patients may resist being given an enema with something that is labeled as being "feminine", but once they've had an enema using this device, they will like the way it feels when it's inserted, enjoy the warm water spraying against the prostate while having an enema, and forget that it’s used for feminine hygiene.
For the last enema, a 30" French 42 silicone colon tube is my favorite, because the device can deliver the enema directly into the transverse colon, and it slips in more easily after the patient has already had two enemas.
For the enema we're discussing here, best delivery device is some sort of inflatable balloon type retention nozzle. During a high enema, you can keep the patient most comfortable if you move her body into different positions from time to time. The retention type device allows you to do this without having the nozzle slip out and causing an embarrassing "accident". Some retention nozzles are made of hard plastic and are uncomfortable to insert if the patient is tight. Inflatable nozzles are easier to insert because they are actually small diameter tubes before they're inflated. The best balloon type retention nozzle is the double balloon made of silicone. It looks like a rectal tube with holes in the side, not the end, with two deflated balloons. Attached are two bulbs that are used to inflate the balloons. The soft silicone end is inserted far enough so that one balloon is in the rectum and the other is outside. Once in place, give the bulbs one or two gentle squeezes. Inflate the inside balloon first, the outside one last. This nozzle creates a seal that relieves the patient of any concern about being able to hold her enema. Some actually enjoy the sensations as the balloons are being inflated.
Continuing on with preparation, fill the 4 quart open top enema bag with a solution of very hot soapy water, keeping in mind that the solution will cool down while you're finishing the prep. A bar a plain ivory soap is best; move the bar around until the water becomes milky and there are some soapsuds on top. Hang the bag next to the bed being sure the bottom of the bag is no higher than 12 to 15 inches above where the patient's bottom will be. It’s a good idea after hanging the bag to add a little extra water so the soap suds overflow onto the outside of the bag. It will add to her excitement when she enters the room and sees how much water is awaiting her bottom. Have one or two rubber gloves, a tube of KY, some baby oil, a roll of toilet paper, and a paper cup nearby so when you're sitting next to the bed, everything is within easy reach.
When you're finished with the preparations, invite the patient in. When she enters the room, she will see everything laid out all at once - the huge enema bag, the bed with towels and pillows spread out, and the double balloon you plan to use. She will also catch the aroma of the ivory soap and rubber (or vinyl) sheet. Hopefully, she will have no more than a look of nervous anticipation on her face. Take her by the hand, lead her to the bed and help her undress, but leave the bra and panties on. Have her lie face down on her tummy, and offer her a pillow or two. She will probably glance back and see the 4 quarts of hot soapy water hanging right where she is lying, which can be intimidating, so it's important to help her release any tension about that. If she asks, tell her you're not going to make her take all four quarts at once if it gets too uncomfortable for her. Touch, eye contact and conversation are very important - a hand on the shoulder, stroking the back of the head, all these give positive vibes. Eye contact allows you to see her reaction and adjust your technique as needed to keep her comfortable. Tell her how nice her insides are going to feel when that warm, soapy solution starts to flow into her. Then tell her you're going to give her a nice back rub so she can get really relaxed. Take some baby oil and start to massage the neck, shoulders and back, then the calves and back of the thighs. Be slow and through. If the patient is wearing a bra, unsnap it and slide it off, being careful not to expose the breasts. Don't rush this step! Keep asking if she's feeling more relaxed. Having the patient relaxed will make the experience less stressful for her. Check the temperature of the enema and if it's in the 102-104 degree range, ask if she's ready, then slip her panties off completely and focus on slowly, but firmly massaging the buttocks. Using both hands, move slowly from her lower back, along the left side, down to the top of her thigh, then do the same thing on the right side. Repeat this several times. Next, tell her you're about to start a more intimate part of the massage and to just relax and enjoy, then quickly drip some warm baby oil on your hands and between her buttocks and place the thumb of each hand on the bottom of each buttock; push firmly until you feel her hip bone, then move each hand simultaneously up toward the back, spreading her cheeks and exposing her anus as you go. Repeat several more times working the baby oil into her and applying thumb pressure closer and closer to the anus each time without actually touching it (keep in mind the recipient may begin to experience sexual side effects; the male may have an erection and the female may sense vaginal moisture leaking between her legs. It's best to ignore this unless the patient becomes anxious, concerned or embarrassed. Give her a reassuring word that these kinds of side effects are normal, and she shouldn't be concerned). Softly ask her how massaging the buttocks feels, then explain you will be giving her the first part of the enema in the knee-chest position. Tell her the knee-chest position is the best position for taking high enemas because gravity helps pull the enema deep into the transverse colon. While she remains lying on her tummy, show her how the ramp clamp and flow monitor work by releasing some enema solution into a paper cup. She'll see the flow can be made faster or slower quite easily; it also helps gets all the air out of the hose. Next, slip on a rubber glove and apply some KY to your fingers. Give you fingers time to warm the KY, then tell her to rise to her knees, spread them about 6 inches apart, lower her head onto the pillow and turn to the side so she can make eye contact with you and so she can also glance back at the bag and monitor. Try to maintain eye contact as you place just your lubed index finger gently on her anus. Have her take several deep breaths and you will feel the anus relax, which will allow you to slowly slip your index finger deep into her rectum. Don't rush this step; wait for her anus to relax before trying to penetrate. Once inside, stop and let her get used to the feeling. After several seconds, ask if she's feeling OK. If she is, explore her thoroughly because this step will show you the path the balloon needs to take. Have her push your finger out as if she were having a bowel movement, then lube the balloon and gently slip it into her rectum. Inflate the balloons, then give her a minute or two to get used to that sensation. Slowly begin giving her the enema using the ramp clamp. Rule of thumb is to let about 8 to 12 ounces in, then pause for a minute. Slow and gentle is of the utmost importance! Together, you can both watch the flow meter spinning as the enema goes in. If the meter starts to slow down, her colon is probably contracting, which could cause discomfort. Using the ramp clamp, slow the flow down until monitor stops spinning; it may even start spinning the other way. What's happening is the pressure inside her is being relieved as her colon is contracting. The trick here is to find a balance that allows the pressure to be relieved but prevents the enema from being going back into the bag. After a couple of times, she will be amazed at how the spinning wheel tells you how she's feeling inside, and that you know how to control a comfortable flow without her having to tell you. This also lets her to relax more, enabling her to take a larger enema comfortably. Once she's taken about a third of the enema, stop the flow and reposition her on her right side. Be sure to lower the height of the back so that it's no higher 12 to 15 inches above her bottom. Give her time to get comfortable, and then restart the flow. This part of the enema will deliver water to the ascending colon. She will be getting very full, but as long as the height of the bag is low, the pressure will be safe. If you notice the flow meter is reversing more and more, she may be at capacity. Stop the flow and have her roll onto her back with knees bent. Regardless how much water is left in the bag, if you notice her tummy is very swollen, her colon is probably full. If she's not too uncomfortable, gently massage the abdomen. This helps loosen old mucous and fecal matter that may have been trapped in her for weeks, if not longer. Once she feel the urge to release is too great, deflate the balloons, slip the balloon out, hold some toilet paper on the anus, and walk her to the toilet. Have her sit on the toilet seat backward, place her hands behind her head and twist back and forth while you reach around her waist and massage her abdomen in a clockwise, circular direction. This can be very embarrassing having someone watch as they have a huge, watery bowel movement; consequently, your patient may wish to release her enema in private. If she is adamant, you should respect that request, but suggest she will get a better result if you stay and help by massaging the abdomen while she is twisting her body back in forth. I have found that this combination causes large amounts of the enema to literally explode into the toilet. After such a release, she will feel empty and clean and anxious to have you give her the third enema.
Oftentimes after a high enema, water can remain for several hours, resulting in soiled panties. To avoid that, I insert a "super plus" tampon into the rectum after the last enema. With a generous amount of KY, the tampons with plastic applicators slide in easily and are very comfortable. As is the case with the douche nozzle, some male patients don't like being given something designed for feminine hygiene, but it does help if later in the day water decides to escape at an inopportune time!
While all this might sound bazaar, this is exactly how my mother introduced me to enemas. After my first high enema series, the choice was always mine as to whether my mother would give me another enema or not. I could always say no, but I never did. As I got older, she said I had the option of self administering, but I preferred having her help me right up until I left home for college. She taught me that having enemas was not as bad as many of my friends believed, and that the experience could actually be pleasant!