Enema Administration

Indications:
  1. To remove fecal material from the colon
    in preparation for endoscopy (particularly proctoscopy)
    or radiographic contrast studies of the colon
    or lower urinary tract
 
  1. To relieve constipation or obstipation
  1. To administer medications in specific medical
    conditions (lactulose enema in hepatic encephalopathy,
    colonic irrigation in certain types of poisoning)
 
Complications:
  1. Rectal trauma, from mild irritation (straining and /or hemorrhage result) to rupture of the colon
  2. Vomiting, primarily in cats, when too large a volume is administered rectally
Equipment Needed:
  1. Examination gloves
  2. Lubricant
  3. Enema administration bucket or bag with attached tubing (most dogs) or red rubber catheter, approximately 8 French, with 60 cc catheter tip syringe (cats and toy breed dogs)
  4. Warm water or warm soapy water (liquid Ivory) or commercial enema solution, 5-10 ml/kg body weight. In cases of obstipation, the addition of a water-soluble lubricant (K-Y Jelly or glycerin) may be helpful.
Notes:
  1. NEVER use phosphate enema solution in cats as they may cause acute collapse associated with hypocalcemia.
  2. In any severely obstipated patient, sedation or general anesthesia should be considered for easier and more humane manipulation of fecal material
  3. Patients undergoing enema administration for preparation for colonoscopy usually require multiple enemas, in addition to being held off food for 24-36 hours. An alternative to enemas for preparation for this procedure is the oral administration of a colon electrolyte lavage solution (cathartic), such as OCL or GoLYTELY (see GI lecture notes).
Procedure:
  1. Hang the enema bag or bucket in a convenient location for gravity flow.
  1. Restrain the patient in a standing position, usually in a wash basin, bathtub, or run area. Be prepared: enema results are often rapid!
  1. Put on examination gloves.
  1. Evaluate the animal for signs of abdominal pain
    or ulcerative colitis (hemorrhage).
  1. Lubricate the tip of the tubing.
  1. Insert the tip of the enema tubing into the rectum,
    approximately 2-3 cm in cats or small dogs and
    at least 5-6 cm in large dogs. Gently compress
    around the anus to prevent enema fluid from escaping.
    Elevating the hindquarters can also be helpful.
  1. Open the clasp on the enema tubing
    or attach the syringe and begin infusion.
    Part way through the infusion, it may be possible
    to insert more of the tubing into the rectum
    to give a "higher" enema.
  1. In most cases, move the animal to an area suitable for defecation after each enema before assessing the need for a subsequent enema. Steps 5-7 can be repeated as many times as needed to obtain satisfactory evacuation of the colon.
  2. Record the treatment and any results in the animal’s record.