Imagine you’re in the hospital, your kidneys are not functioning well, and for the past three to four days you’ve been eating well but your bowels haven’t moved even once. That was the situation for my husband last year after a scary episode of atrial fibrillation, and we were both getting concerned. I tried digital stimulation with him sitting on the toilet, but nothing happened. Finally, on the morning of the fourth day we brought it up at rounds. They started with Miralax. A few hours later the plan turned to Dulcolax suppositories. He had never had a suppository, and he was very apprehensive. I comforted him and assured him it was a safe, effective, painless process, and if it worked he’d feel better. Over an hour later nothing had happened. The medical staff ordered a second suppository, and this time I convinced them to let me insert it. I pushed the suppository as far as my finger would reach, signaled to the nurse that the suppository was in, and then curled up next to him on the bed waiting for some kind of result. But it never came.
I had never really thought much about the chemistry or method of action that makes an enema effective. I knew that some solutions were oil based, others contained a salt intended to draw fluid into the bowel. Every enema I had ever given myself was only water from the tap. As it turns out, though, enemas are a real problem for someone in late stage kidney disease. Some OTC enemas will actually contribute to kidney failure which can be catastrophic. Enter the S.M.O.G. enema. Developed at Duke University Medical Center in Durham, NC, the idea is use smaller quantities of four solutions in a mixture, so that no one component is potent enough to cause damage. It is the last resort for kidney patients with severe constipation before turning to mechanical means of removing the blockage. The S.M.O.G. enema is one equal part sorbitol 70% solution, one part milk of magnesia, one part mineral oil, and one part glycerin. See the material data safety sheet for the preparation here: https://www.safety.duke.edu/sites/default/files/SMOG.pdf
My husband had never had an enema, either, and I could see fear on his face. He asked repeatedly if there were some other way. He was still trying to negotiate even as the nurse emptied the 2L pitcher into an enema bag and hung it next to the bed. It was about 9 PM and he was growing tired. I promised to stay beside him and hold his hand. Finally, he accepted that this was going to happen. I watched as the nurse turned him on his left side, opened his gown, parted his buttocks and slid the lubricated nozzle into his anus. He frowned. The the nurse opened the line and the mixture began to flow. Several times he started to feel cramps and the nurse pinched the line to slow down the flow. Finally, the nurse looked at me and said, “He’s full,” and indicated that a small amount of fluid had started seeping from his rectum onto the protector pad underneath him. She removed the nozzle and replaced his gown and the bedcovers. As she started cleaning up she told me to expect action within an hour. I waited while my husband drifted in and out of an uncomfortable sleep. 10:30 PM, nothing. 11 PM, still nothing. Midnight, and still no result. I started to get scared, but the nurse said that she would keep checking. I rolled over in the uncomfortable chair next to him and tried to get a little sleep. Around 3:30 AM I was roused from sleep by someone calling my name. My husband was awake and pulling at the blanket draped over me. “I think I messed myself,” he said. Sure enough, turning on a light and lifting the covers I found watery poop everywhere. And the last thing I learned in the hospital that night: If you call a nurse at 3:30 AM to clean up a poop spill, if it’s bad enough, they simply throw everything in the trash - sheets, pillow cases, blankets, gowns, protector pads, etc.
After we returned home, I was curious about the renowned S.M.O.G. enema solution and exactly how it might affect a patient like my husband. I set out on a mission to mix my own and try it out. Sorbitol is available by prescription only in my state, but I found a seller on Amazon willing to ship me a bottle. Everything else was available at my local pharmacy. One fateful Saturday morning when nothing particularly important was scheduled for the next day or so, I lie in bed on my left side, and using an enema bottle filled with S.M.O.G., I instilled 240 ml into my rectum. The sensation started the instant the liquid reached my mucosa and it was so intense. It took all of my willpower to squeeze in the rest of the mixture. Within seconds I was standing up, on my tiptoes clenching my glutes to fight the reaction. Waves of discomfort washed over me. I couldn’t prevent myself from crying out, it was so intense. I was only able to retain it for about twelve minutes. I craved the relief I was sure waited for me at the toilet, but not so fast. This monster was going to keep on giving. For the rest of the weekend I was on the toilet with breaks of maybe an hour between trips. Have you ever had that sensation that you have to go so bad, your sphincters are wide open, the cramps keep coming, but there just isn’t anything else left to pass? Similar to dry heaves when you’ve vomited everything you have to regurgitate. I even wondered if I had injured myself with this test. It was certainly the wildest experience I’ve ever put myself through.
So, about two weeks ago I tried it again, using only 120 ml. It did not disappoint. I am so glad I had nothing else important to do for the next few days.