Enemas: A Natural Health Tool or Cause for Concern?

by Steven Wright

enemas

After seeing private 1-on-1 clients for a few years, I was consistently shocked at how many constipated clients reported things like, “I use 1 or 2 enemas a week because the constipation is so bad.”

Everytime I heard this it made me cringe. I knew that these people were doing their best to poop as often as they could, which in my opinion is better than being constipated. But they likely had no idea how dangerous enema usage for chronic constipation can be.

In the alternative health world enemas seem to get a free pass. But I doubt so many people would use them if they knew about the following concerns.

As you’ll soon learn, I’m not suggesting that very occasional (not monthly) usage of enemas is bad.

I think that when used as suggested by doctors for colonoscopy prep and to avoid further complications that can come from constipation, such as toxic megacolon, impacted stools or hemorrhoids, they can be a wonderful tool.

A Seemingly Harmless Tool for Constipation

Enemas are often a go-to for people experiencing chronic constipation.These seemingly harmless constipation fixes are available over-the-counter in different forms:

  • Sodium phosphate (referred to as saline)
  • Bisacodyl
  • Oil based

Each of these types of enemas achieve their laxative effects via different pathways.

The Interesting Ways Enemas Work

Interestingly enough, enemas don’t just flush water in there to help you get the poop out. They work in some very novel ways.

Fleet is a common over-the-counter enema sold as a “saline enema” that uses the active ingredient sodium phosphate to get you unstuck. It acts primarily by drawing water into the colon, which loosens stools and increases gut motility. These enemas are associated with some pretty big risks that we’ll dive into more in a bit.

Studies suggest Bisacodyl enemas work directly on the tissue of your colon. They aggravate the cells into increased secretion and motility of the muscles. They also appear to draw water into the colon.

Oil based enemas are often the go-to for hard stools.They act by softening stuck stools through lubrication from the oil and softening of the stool. However, they do have the undesirable side effect of possible anal leakage after use.

Each type primarily tries to soften and encourage the body to get rid of the stool. However, they can lead to things like leakage and “consta-rrhea” – an idea that Chris Kresser talks about where you have diarrhea but not full evacuation and still end up feeling constipated.

Enemas, Cause for Concern?

We’ve talked before about the problems that can arise from laxative use for chronic constipation. Turns out some of the same problems apply to the use of enemas. They can be broken down into the following three issues:

  • Electrolyte Disturbance
  • Dependency
  • Gut Flora Disruption

None of these issues are good to have on a regular basis. Enemas, used for short-term interventions, such as a colonoscopy prep, are not the big issue here. However, please read about the Fleet electrolyte issues below as these can be very dangerous.

  1.  Enemas Affect Your Electrolyte Balance

If you are dealing with any known electrolyte imbalances it’s a very bad idea to use a phosphate enema. These are typically sold as Fleet Saline Enemas. Diarrhea in general will deplete electrolytes, however phosphate enemas seem to be worse than normal.

A case report in a research article reported an elderly man who experienced kidney damage following administration of sodium phosphate enemas.The other bit that should be mentioned are some of the risks associated with phosphate enemas like Fleet. One study puts it this way:

“Phosphate enemas should be used with caution in patients with impaired renal dysfunction, pre-existing electrolyte imbalances, risk of electrolyte disturbance (hypocalcemia, hyperphosphatemia or hypernatremia) or a serious adverse event secondary to one of the above, dehydration, chronic inflammatory bowel disease, gastric bypass or stapling surgery (177).”

Though these cases are rare they are still worth mentioning and certainly worth considering if you are thinking of using a sodium phosphate enema.

  1. Enema Dependency is Real

Our bodies are amazing at adjusting to habits and routines. Think about travelling across time zones. It takes our brains and hormones a few days to adjust, but after about a week we are right on schedule.

The same thing can happen with using the bathroom. Our bodies like schedules and routines. If you use an enema every few months there’s not a new schedule. But using one weekly is something that your brain and intestines begin to count on. Your muscles will begin adapting to a new way of life and it’s not natural. Our bodies were designed to remove the waste by themselves.

I’ve talked to more than a few people who are unfortunately caught in this enema usage cycle.  And the whole time they are disrupting their gut flora and electrolytes.

Mental and physical dependence on enemas can and does happen. It’s something to be aware of. Certainly there are many other ways to get rid of the constipation.

  1. Your Gut Flora Doesn’t Want You to do Enemas

Your gut flora is extremely important for health. Diseases of the GI tract are almost always found with gut microbiota alterations known as gut dysbiosis. A study that used laxatives to induce diarrhea in healthy people found, “significant relative shifts in the phylas Bacteroidetes and Firmicutes and to a relative increase in the abundance of Proteobacteria on the mucosa, a phenomenon also noted in several inflammatory and diarrheal GI diseases.”

It goes on to summarize, “Changes in microbial community structure induced by osmotic diarrhea are profound and show similarities to changes observed in other GI diseases including IBD.”

What does this have to do with enemas? Well, many times enema usage leads to osmotic diarrhea, which is exactly what is happening in these studies. Furthermore, a study on colonoscopy preparation showed short-term changes in gut flora post procedure.

Another similar study concluded that there were definite changes in microbial gut flora after colonic procedures. These studies focused on the bowel preparation for colonoscopies which vary but often include the use of enemas and laxatives that flush your bowels.

This act of flushing the gut changed the gut flora short term. So, the infrequent usage of these laxatives isn’t something to get too freaked out by. However, regular usage seems to be a very bad idea.

Alternatives to Enemas for Constipation

So, let’s say you’re a bit concerned about enema usage like I am. What is a constipated person to do?

In my opinion, there are safer and natural alternatives to ease the pain and start going again.

I’ve developed a whole constipation protocol that those who own our Solving Leaky Gut program are using with amazing success. And now it’s time to give it to you in greater detail.

Check out our 2.5-Hour Constipation Event to learn safe short- and long-term strategies to beat constipation. In these materials, I’ll guide you through non-toxic, non-habit forming ways to start pooping on a daily basis. More importantly, we dove into the root causes of constipation that are typically the real reason behind the bloating and pain.

Learn more here: http://constipationhelp.scdlifestyle.com

I’ve struggled on and off with constipation throughout my life. And I know based on all my client experience, that regardless of mild to extreme constipation, the whole problem is much more complex than modern medicine wants to admit.

The great thing is, once you find the root cause of your constipation and rebuild your body it won’t ever be a problem again. I’ll show you how here.

-Steve

Is Your Body Secretly Suffering from a Leaky Gut?

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About the author

Steven Wright Steve Wright is a health engineer and author. In 2009, he reached a breaking point when IBS took over his life and the doctors didn't know how to help. Since then, he has transformed his health and started SCDLifestyle.com to help others naturally heal stomach problems. You can check out his story here and find him on Google+, Facebook or Twitter.

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{ 30 comments… read them below or add one }

Shiva September 25, 2014 at 7:46 pm

You talk about the use of medicated enemas but what about the use of just water enemas a few times a week?

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Steven Wright October 4, 2014 at 7:41 pm

You’ll be disrupting the gut flora with any enema and I think that’s a very bad idea. And you could be developing dependence issues with it which is also a source of concern for me.

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Mishel September 25, 2014 at 8:52 pm

I am going to have mercury removal soon, and my dentist wants me to detox. He has suggested chlorella, in which I told him is Illegal. He then said a coffee enema is a good idea. Then maybe micro silica and or clay. Are you thinking that even a detox enema here and there could be dangerous??

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Steven Wright October 4, 2014 at 7:43 pm

I think Chlorella is a great idea compared to a coffee enema. It may be “illegal” on SCD but that shouldn’t stop you from using it. It’s a very safe and great way to help with detoxing.

Any enema will disrupt gut flora, infrequent disruptions are probably not a horrible thing but still are likely to be a stressor on the body

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Mishel September 25, 2014 at 8:54 pm

PS: I forgot to mention I have a moderately tough case of Chron’s.

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Alexa September 25, 2014 at 10:45 pm

I have a quick question. The Ann Wigmore Institute promotes doing water enemas, colonic hydrotherapy, and wheatgrass implants for cleansing. Now, I know this is going way further than this post addresses, but the enemas and colonics are only done using water, and the wheatgrass is home grown and freshly juiced prior to the implant. Say a person were only to do this water enema followed by a wheatgrass implant every 1-2 months more as a cleansing protocol (not so much for constipation, patient has healthy stools on the Bristol chart), would that be safe? I understand the dangers of the enemas that use things besides just water as well as doing them constantly as a habit. I love the information on your site and truly value your opinion! Please let me know what you think.

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Steven Wright October 4, 2014 at 7:45 pm

I can’t really comment on whether or not it’s safe. My opinion is that every time you disrupt the colonic flora unless it’s for a FMT it’s probably not a great idea. Every 1-2 months is pretty frequent in my book.

I’d suggest gathering more info about the pros and cons and other schools of thought on detoxing. Then you’ll understand the possible risks/benefits even more

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Myron September 26, 2014 at 1:16 am

I have never heard of the three types of compounds you refer to in the article. I first learned of coffee enemas from an article by V.E.Irons in 1982, who was an ardent advocate of their use. I first used them then, and have done so many times with no observable ill effect. Irons used them as part of his ‘colonic cleansing’ program. Three years ago, after being diagnosed with stage 4 prostate cancer, I began using them again up to twice a day, as they were an integral part of the ‘Kelley Cancer Protocol’ and meant to detoxify the liver, not treat constipation. Two cups of warm, organic coffee are slowly introduced into the colon, either after a bowel movement or a quick plain water enema to help expel fecal material first. The coffee is retained for at least 10 minutes before expelling; longer is OK. I usually feel energetic and revitalized for two hours or so after doing them (the caffeine?), and have had no difficulty returning to normal BM frequency after stopping them. Currently, I have used them daily for a time as part of my own anti-cancer strategy. i cannot say if they have been beneficial or not; only that I have experienced no harm that I am aware of. Your concerns about electrolyte disturbance may be valid, however.

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Steven Wright October 4, 2014 at 7:47 pm

Thanks Myron! I have no experience using them to help with cancer and I’m aware there are several schools of thought who heavily promote them.

I think in general the rule of life applies most goals can be achieved in multiple ways. I’m in no position to say what to do about cancer so if it’s working don’t stop. Might want to test out some extra electrolyte supplements though.

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Billy Bob September 26, 2014 at 11:13 am

I dont disagree that enemas can be used incorrectly, but some lives have been saved from them too…check out Dr. Wilson’s site about coffee enemas…Im pretty sure there is a lot of proof about them reversing cancers etc. They are great detox tools….but i did notice they messed up my electrolytes some….so i couldnt handle them too much.

i think liver flushing and proper diet are easier for me to detox and keep things balanced.

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Steven Wright October 4, 2014 at 7:49 pm

Hey “billy bob” – With enough digging you’ll find a promoter of any therapy you’d like.

I made zero mention of coffee enemas on purpose, I don’t claim to understand how they may or may not work to help with cancer.

I am saying that ANY ENEMA at all will be disrupting the colonic flora and in my opinion unless it’s a medical emergency or an FMT it’s something to think twice about doing.

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Michelle September 28, 2014 at 6:57 am

Interesting article, thank you. I, too, am interested in your position on coffee enemas. I was diagnosed with H. Pylori, and part of my healing/detox protocol is to do coffee enema’s. As a nurse, I was skeptical about it’s usage as I’m aware of the dangers you mentioned in your article, but I’ve been doing one to two a week for the last month with no ill effect. I feel squeaky clean afterwards. I’d also like to site Dr Wilson’s work as being one of the research modalities I used to put my mind at ease. I would really love to hear your thoughts on coffee enemas as they are so widely used by the alternative health community. Thank you!

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Lori Jo Berg September 28, 2014 at 2:55 pm

Hi Michelle, thank you for reaching out. Jordan and Steve believe that chronic constipation must be approached with diet, lifestyle, and supplements and enemas should only be used under certain circumstances. Even Coffee enemas should not be the first go to solution for constipation.

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Marg May 5, 2015 at 10:26 am

How can I get enough fibre without any grains in my diet. My IBS is so bad I cannot have any raw vegetables or any legumes and only cooked fruit. I also follow a low fodmap diet. I suffer from extreme constipation as a result of this diet.
Any suggestions?

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Lori Jo Berg May 6, 2015 at 11:08 am

HI Marg, The SCD diet has helped many people not only with diarrhea, but with constipation as well. We suggest starting by addressing your diet with our free quick start guide here: http://scdlifestyle.com/scd-quick-start-guide/

Also, please read the following article on constipation, as it can be very helpful on your journey: http://scdlifestyle.com/2013/07/real-food-tips-constipation/
We also have an entire section of constipation related articles on our site, and these can be found here: http://scdlifestyle.com/category/constipation/

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Rachel August 20, 2015 at 10:14 pm

What about an enema with just warm filtered water and 1-3 probiotic capsules poured into it? Would this be a type of good enema for like once a month or something like that?

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Mariel Heiss August 21, 2015 at 8:16 pm

Hi Rachel – thanks for commenting 🙂

Steve and Jordan don’t recommend enemas as often as monthly – they really only recommend them in special circumstances like for impacted colons. If you’re struggling with constipation, we recommend you check out this article: http://scdlifestyle.com/2013/07/real-food-tips-constipation/ and the Constipation live-call linked in this article, too!

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Marilyn September 4, 2015 at 2:08 pm

I use just about daily bc i dont go anymore without help from enemas. What should i do in place to stop. Bc i know i rely on them. Now i know its bad at first i figured it was better then taking pills since i wasnt taking them. But now im scared im doing harm. Its been like a month or two almost daily or every few days i use.. Please help me.

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Mariel Heiss September 4, 2015 at 5:53 pm
Arnold September 20, 2015 at 2:17 pm

What about probiotic enemas??

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Mariel Heiss September 23, 2015 at 5:18 pm

Hi Arnold – thanks for asking.

Steve and Jordan don’t have much experience with probiotic enemas. We encourage you to do your own research on this topic, as it is an interesting possibility for treatment.

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Terry January 2, 2016 at 6:30 am

I have been taking weekly enemas for the past 30 years and am not sure what this guy is saying, but I would take a 2 quart goat soap enema from an enema bag in the sims or knee-chest position followed by 2 warm filtered water enemas of 3 quarts each in the same positions with no side effects at all. I take a daily probiotic. On the days that I do not take an enema I have normal bowel movements. A friend who was a friend of my mothers told her about this and my mother passed it along to me. Enemas generally are safe. I use KY or Vaseline as a lubricant and make it a rule to take the entire enema bag before holding the enema for 5 minutes at which time I sit on the toilet and expell it. I wait 15 minutes between enemas. The enemas do cause you to feel full, but not uncomfortable unless constipated. I recommend enemas wholeheartedly. The medical industry wouldvlike you to think that they alone have all the answers all the while doctors and pharmaceutical companies continue to treat symptoms and not the problem. Anyone who desires more information on weekly enemas just drop me a note at [email protected]

Terry

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Jay January 12, 2016 at 11:52 pm

I’m losing it. I cannot go poo my stomach is extremely hurting me. I don’t know what to do. I tried the whole home remedies bananas,yogurt, Gatorade, tea… I’m going crazy. I pray to have a regular stool but I can’t . help someone ughh ?

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Mariel Heiss January 13, 2016 at 2:41 pm

Jay – I’m so sorry to hear what you’re going through.

The SCD diet has helped many people not only with diarrhea, but with constipation as well. We suggest starting by addressing your diet with our free quick start guide here: http://scdlifestyle.com/scd-quick-start-guide/

Also, please read the following article on constipation, as it can be very helpful on your journey: http://scdlifestyle.com/2013/07/real-food-tips-constipation/

We also have an entire section of constipation related articles on our site, and these can be found here: http://scdlifestyle.com/category/constipation/

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Aneta April 19, 2016 at 9:20 pm

I havent been to the toilet for past 2 years…..I am fully dependent on water bucket enemas since then. I ahve been struggling with my gut problems past 10 yeasr but it came to the point when nothing is passing through. I have been to all kind of Natural Therapists out there, spend most of my money and time researching, keep on taking supplements, probiotics (critical care 200billions) prebiotics, herbs, diets….. and nothing. At the moment doing kombucha and fermented food what makes my life even worse. I go to the gym 5 days a week otherwise i feel like killing myself. Everyday of my life is a struggle, not mentioning intimate relationship which practically doesnt exist….
Anyone who went down that way and by miracle made it would you be please so kind and share??? Thank you X

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Jan May 30, 2016 at 12:30 am

Hi Aneta,
My story is the same as yours- have tried a cupboard full of natural remedies and a variety of diets(including GAPS and Ayurveda each for 2 years). Now I’m stable on a severely restricted diet and daily enemas. Wondering if it will pass when I’m out of perimenopause? Are you also female in your 40’s? Do you also have a gluten allergy? Lifelong constipation, food and chemical sensitivities, nasal allergies, skin rashes? Wondering what connection there may be as I’m also constantly looking for answers in this apparent medical mystery.
You’re not alone!

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Caroline October 20, 2016 at 11:28 am

My daughter has been using phosphate enema through her Ace(Stoma) followed by Saline 750 ml as advised (she has tethered spinal cord which disrupts bowel).Over the past year her health has declined and she has suffered vomiting most times she eats requiring ng tube to sustain weight.She says it feels like her stomach is contracting upwards when she eats.After being robbed offer were admitted to hospital 3 weeks ago and her blood shows increased phosphate-it’s being delivered straight into the colon and her washouts don’t always work so ive always feared it’s being absorbed.Shes also constantly tired.Please advise as I’ve been begging for someone to listen and lol at alternatives.Having now taken her off phosphate she kept her first small lunch down today.

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Mariel Heiss October 20, 2016 at 12:24 pm

Hi Caroline – I’m really sorry to hear what you and your daughter are going through. What you’re describing is beyond the scope of what we can help you with. We encourage you to seek out a functional medicine doctor in your area using this site: https://www.functionalmedicine.org/practitioner_search.

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James October 30, 2016 at 2:00 pm

I am really glad to have ran into this article. I have dreadful problems with my stomach between my GORD and IBS, including excessive belching and flatulence which is worse after eating, constipation, diarrhoea, nausea, vomiting, stomach cramps and pains, poor appetite, indigestion, heartburn, and regurgitation. The problem is, due to my medications and IBS, I get constipation regularly and am literally unable to go unless I take movicol and dulcolax, and I can be like that for days, weeks, and sometimes even months before I swing to the other way. My digestive system is literally ridiculous and really gets me down. Aswell as my GORD and IBS, I believe my fibromyalgia and adrenal insufficiency affect my digestive system aswell, as stomach pain, nausea, etc, can be symptoms of these conditions, too. Sometimes when my OCD is very bad or my anxiety is bad, the stress of that can also upset my stomach, so between it all it’s no wonder I have problems. Then there’s my medication, including my dopamine antagonists, antidepressants, anticonvulsants, anticholinergics, etc.

Also can I apologise for commenting on so many articles, as I am aware that I have commented on about 5 of them or more today. It’s just if I feel it’s necessary to comment, I will do so.

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Mariel Heiss October 31, 2016 at 3:46 pm

Hi James – the SCD diet may be able to help with all these issues (even constipation caused by medications).

Get stared here: http://scdlifestyle.com/scd-quick-start-guide/

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