Having been used for thousands of years, enemas are one of the oldest methods of getting the bowels moving again if you’re suffering from constipation. Historically, the use of enemas makes sense, developing before the invention of oral and intravenous medication, notes the Canadian Society of Intestinal research.

In recent years, some celebrities have touted enemas as a way to “flush out” the digestive system and detoxify the body. However, this advice is a load of nonsense, and the regular use of enemas can actually be dangerous.

Today, better and safer treatment options, including laxatives, suppositories, and a high-fiber diet, mean enemas are typically recommended as a last resort for constipation because of possible side effects.

The Back Story: How Does an Enema Treat Constipation?

Treating constipation with an enema involves introducing fluid into the intestines via the rectum. This helps soften and break up the stool, says Bryan Curtin, MD, a gastroenterologist and director of the Center for Neurogastroenterology and GI Motility at the Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy in Baltimore.

There are several types of enemas, including tap water, sodium phosphate (such as Fleet enemas), saline, glycerin, soap suds, and mineral oils.

“While phosphorus-based enemas are traditionally considered the most potent, I find that any enema can be effective if done correctly,” Dr. Curtin says. “The oil-based enemas are fairly messy and I typically avoid those.”

How to Administer an Enema

To administer an enema, follow the instructions on the box or leaflet closely.

Bharat Pothuri, MD, a gastroenterologist at Memorial Hermann in Houston, offers the following tips for using an enema safely and effectively:

Drink 16 ounces of water (two glasses) prior to the enema, as an enema can cause you to become dehydrated.
Lie on your stomach with your knees pulled to your chest. If you are unable to, lie on your left side with both knees bent and your arms resting comfortably.
Lubricate the enema tube and gently insert it into your rectum, squeezing the enema so that the contents can enter your rectum.
Wait in that position until you feel the need to move your bowels. Try to hold the enema in for at least five minutes to achieve maximum benefit.

“It’s important to make sure you hold onto the enema until the urge to defecate is strong,” Curtin says.

Possible Side Effects of Enemas

While enemas can be a useful tool for treating severe constipation, they do come with some risks and are not meant for frequent use.

“Like any other medication, enemas can be abused,” Curtin says. “Too much enema use can lead to anorectal pain disorders. Generally, you should avoid using enemas regularly unless instructed to by your doctor.”

Enemas that are administered incorrectly can damage the tissue in the large intestine and cause bowel perforation, research such as a case report published in 2020 in SAGE Open, has shown. If an enema is not sterile, it can put you at risk of an infection, including sepsis, Dr. Pothuri notes.

One study notes that perforation, hyperphosphatemia (a condition characterized by too much phosphate in the blood), and sepsis following enema use may cause death in up to 4 percent of cases.

Long-term use of enemas can lead to electrolyte imbalances, which can cause uncomfortable symptoms like fatigue, headache, muscle cramping, nausea and vomiting, per the Cleveland Clinic.

People with colorectal cancer, an enlarged distended colon which may be more prone to perforation, and people who have active inflammatory bowel disease should avoid using enemas, Pothuri says.

If you have any questions about the safety of enemas, talk to your doctor. It’s best to consult your healthcare provider before using an enema and to exhaust all other ways of treating constipation first.

Safer Options for Constipation Relief

Because of the possible side effects of enemas, it’s usually only advised as a last-resort option to treat constipation.

Before considering an enema, make sure you’ve tried the following options:

High-Fiber Diet “Generally, your doctor will first start by recommending dietary changes,” Curtin says. Adding fiber to your diet increases the bulk of your stool, speeding up its passage through the digestive system. Curtin says patients who are constipated should aim for 20 to 30 grams of daily fiber. A good starting point is to add more fruits and vegetables into your diet, as well as whole grains. A sharp increase in fiber can cause bloating and gas, per the Mayo Clinic, so aim to gradually increase the amount over a few weeks. Over-the-counter supplemental fiber, such as Metamucil, is also available. Talk to your doctor to learn if this is a good option for you.

Stay hydrated. Drinking enough water is important for overall health, including digestion. “The main purpose of the colon is to reabsorb water from the stool, and if you are dehydrated more water will be taken in, leading to harder to pass stools,” Curtin says. The National Academies of Sciences, Engineering, and Medicine suggests that women get a total of about 2.7 liters (11 cups) of fluid per day and that men get about 3.7 liters (16 cups) per day. Note that not all of this fluid has to be water; it can also include nutrient-rich foods and beverages like fruit, vegetables, juice, and tea. Also, it’s important to spread out the fluids over the day. Alcohol and caffeinated drinks can cause dehydration, so you’ll want to avoid those if you’re constipated.

Laxatives Laxatives, or stool softeners, such as docusate or milk of magnesia, are available over the counter. Talk to your doctor or pharmacist if you have any questions about these medications. Overusing laxatives can lead to worsening symptoms, per the Cleveland Clinic, so you should not use the treatment for more than two weeks without talking to your healthcare provider.

Other lifestyle changes like exercise can help get things moving in your digestive tract. It’s also smart to keep a food journal so you can see which foods trigger your constipation. Certain medications and supplements may also cause constipation, so if that is a concern, talk to your doctor, who may adjust your dose or switch your prescription.

Some prescription drugs are also available to treat chronic constipation. Your healthcare provider will work with you to decide on which one is best for you. If there’s a structural problem in your colon that’s causing your constipation, your doctor might recommend surgery.

Call your doctor to talk through options if constipation is a new issue for you or you’ve been constipated for more than a few weeks.