The Cold Water Enema

A cold application to the interior of the bowel is one of the most powerful means of stimulation which can be safely employed. Half a pint of water at a temperature of 50° will usually set up a very strong and painful contraction of the lower bowel. It is on this account necessary to begin with a moderate temperature. The first enema should have a temperature of 80° to 85° F. The temperature may be lowered on each application five to ten degrees, or until sufficient powerful contractions are produced to expel quickly the water introduced. By gradually reducing the temperature in this way, one as low as 40° may finally be used without causing excessive pain. Such low temperatures are very seldom required except in dysentery, in which they often render great service.

The cold enema is of special use in cases in which the colon has become gradually dilated and has become atonic, and contracts with insufficient force to expel its contents. In such cases a warm or hot enema is usually retained. By following the warm enema with half a pint or a pint of water at 60° to 70° F., prompt contraction of the bowel almost invariably follows, with expulsion of the bowel contents. This is a very important practical use of the cold enema, as the retention of the water in cases in which the bowel is filled with putrefying fecal matters is very often followed by very unpleasant and even serious effects, through the absorption of enormous quantities of toxic substances, which are dissolved by the water and brought into contact with the absorbing surface of the bowel. In such cases the hot enema should be immediately followed by a small cold enema, and the cold enema should be repeated several times, if necessary.

The Oil Enema

The amount of oil required is four to sixteen ounces. Either pure olive oil or any sweet oil may be employed. The latter is just as good as the former, and is less likely to produce nausea and vomiting, which sometimes follows the use of olive oil of an inferior grade. The temperature of the oil should be 104°. As a means of softening hardened feces, oil is no better than water; in fact, according to the writer's experience, it is less efficient. It is useful, however, as a means of lubricating the lower bowel, and when introduced at night prevents hardening and drying of the feces. For this purpose 4 to 6 ounces should be introduced at night When used for the purpose of lubrication only, a good plan is to administer the oil before breakfast. This is an excellent means of securing a thorough evacuation of the colon.

Sugar And Water Enema

Sugar is a powerful stimulant of the colon. A very old-fashioned remedy is the introduction of molasses into the colon. To half a pint or pint of molasses an equal quantity of hot water is added. A prompt action of the colon usually follows the introduction of this mixture. The writer has for years used malt sugar for this purpose, and with most satisfactory results. The malt sugar not only acts as a stimulant to the bowel, but at the same time furnishes valuable nourishment. Four ounces of malt sugar should be added to a pint of water.

Paraffin Oil Enema

Liquid paraffin, or paraffin oil, may be used as an enema in place of olive oil and other oils, and has the advantage that it does not produce nausea or other unpleasant symptoms. Paraffin oil is better than any animal or vegetable oil, for the reason that it is not a fat, and is not absorbed, neither will it undergo fermentation. The oil enema often causes nausea, loss of appetite, and coating of the tongue. This may be avoided by the use of paraffin oil. Only the specially purified refined white Russian oil should be used.

The Alum Enema

In cases in which the bowels cannot be made to move promptly by other means, alum has been found to be effective. A teaspoonful of powdered alum is used in a quart of water. By using cool water 70° to 80° the effect may be increased.

The Glycerine Enema

Pure glycerine introduced into the rectum in a quantity of one to four ounces is a useful means of stimulating bowel movements, by bringing about the defecating reflex. When pure glycerine is found to lead to too much irritation, as is sometimes the case, it should be used with an equal quantity of water.

The Cold Rectal Douche

By introducing cold water into the rectum with considerable force, a most powerful stimulation may be produced. The temperature of the water should be 70° to 80° F. If the stream furnished by the ordinary fountain douche has not sufficient force for this, a bulb syringe is necessary.

In administering the rectal douche a return tube should always be used, so that the rectum will not be over-distended. A small tube should be connected with the syringe, and a large one should be introduced alongside it, to counteract over-distension of the rectum. When the powerful stimulation of the rectal douche is required, it is not desired to secure the stimulation which results from distention of the rectum, for in these cases the rectum is always relaxed, and has to a certain degree lost its contractile power. It is desired only to obtain the stimulating effects produced by a low temperature and the impact of a stream of water introduced with considerable force, the effect of such an application is to produce almost immediately a very strong defecating reflex, with contraction of the pelvic colon and forcible expulsive efforts.

It is well that the enema tube should be introduced its full length and should be directed somewhat backward, so that the stream of water may be received upon the upper part of the rectum and, if possible, reach the pelvi-rectal fold.

In cases in which the sensibility of the rectum is largely lost, this measure affords a very excellent means of restoring normal sensibility. In extreme cases the alternating rectal douche may be employed, using first water at a temperature of 115°, then water at a temperature of 60° to 70°. In some extreme cases the temperature of the water is as low as 40° or 50°. The application should be made every ten seconds.