Low Rectal Cancer
How to do the Enema
To be successful, the daily enema must be fit into a normal lifestyle by being effective and efficient. The usual concept of an enema is in "Sims Position". In this position you lie on your left side on a waterproof sheet and insert the rigid enema nozzle into the anus. You lie there until the bag empties. There is often cramping as water flows around solid stool that is blocking the colon. This may be an acceptable procedure for occasional constipation but it does not fit into a normal daily routine. Most people take a daily shower. If the daily enema can be taken at the same time as your shower, you can accomplish two tasks at the same time. Here is the procedure that I have developed after taking the daily enema for over a decade.
1. Place equipment into the shower and let the water warm up.
2. Start showering as normal. Based on experience, you can determine how much of your shower you want to do before starting the enema. The goal is to learn by experience when to start the enema in order for the bag to empty just as you have finished your shower, have dried off and are ready to get out.
3. Fill the enema bag from the shower head to about 2 quarts. Because you want the temperature of the enema to be about body temperature, the shower temperature is just about the correct temperature.
4. Hang the bag from a hook in the ceiling of the shower so that the bag is about head height. Let water start to run out of the nozzle to make sure that all air has been expelled from the tubing. Look carefully at the bottom of the bag at the one way valve to make sure that there is no air at that point. Close the clamp once there is no air at the beginning of the tubing.
5. Inflate the nozzle so that there are no ribs. Lubricate the entire surface of the nozzle with the Gel. Open the valve on the nozzle and let it collapse. Put a glob of Gel on your finger and lubricate the outside and inside of your anus. Use quite a bit of lubricant to make sure the nozzle will easily slide in.
6. Insert the deflated nozzle into the anus. From experience you will find the right depth that it is comfortable. Inflate the nozzle with a couple of squeezes of the inflator. Lightly pull the lubricated nozzle toward your anus to seal the nozzle to prevent water from leaking between the nozzle and the anal rings. Open the clamp to begin the enema. If you choose you can relax the anal muscles and allow any water trapped between the inflated nozzle and the anus to escape.
7. Continue to shower in the normal manner. If you do a daily enema, the colon is always nearly empty. You should not feel any cramping or discomfort. In fact, you cannot even feel the water filling our colon. Dry off and check the level of water left in the bag. If the bag has not yet emptied, you can elevate the bag to speed the flow
8. Once the bag is empty and you can see air in the top of the tubing, close the clamp.
9. Step out of the shower with the nozzle still in place and sit on the toilet. Open the air inflator valve to allow the nozzle to deflate. Gently pull the nozzle to expel it from the anus to allow water to begin to release.
10. If there is a little stool between the collapsed ribs, you can inflate the nozzle and swirl it into the toilet to clean off the nozzle.
11. Place the nozzle and bag in the sink or bath tub for later cleaning.
12. Relax the anal muscles and allow the water to drain from the colon. At first it feels strange like you have the worst diarrhea in your life. It is not an unpleasant experience. The amount of time needed to fully drain your colon will vary. It takes longer if you are reading a good book or doing a Sudoku puzzle. You will know if you are about empty when you feel gas escaping because gas is normally pushed upwards by the water as it enters the colon so it is the last to come out. If you do the enema daily, your colon will empty in about 10 to 20 minutes.
13. Wipe yourself and flush the toilet. Hold up the enema bag and open the clamp. Allow all of the water to drain from the tubing. Inflate the nozzle and clean it with soap and water. Dry the tubing and bag and put it away.
14. Begin to shave or put on makeup (depending on your sex). If needed, sit back on the toilet to finish emptying the last bit of water in your colon. Sometime standing and moving around will move the last bit of water to the end of the colon.
15. Use a cheap wet washcloth that you can buy from the discount store to wipe around your anus in case there was any splashing while you were emptying. Use the same washcloth to wipe the inside of the toilet seat of splatter. Put the washcloth in the dirty clothes basket. You are done until tomorrow.
Enema equipment has the potential for bacterial contamination. Never share your equipment with anyone else and never use another’s equipment. There is potential for bacterial or mould growth in the enema bag or tubing. If at all possible use transparent tubing and enema bag. If you see any discolouring that may indicate bacterial growth, you need to sanitize the bag. Fill the bag with about 1/2 of its volume with water and then put in a little beach. Allow a little water to flow through the tubing. Close the tubing with the clamp. Swish the bag about several times to distribute the water around all corners of the bag. Lay the bag into the sink and let the full bag remain for an hour or so. Place the bag into the shower and open the clamp to allow the bleach water to flow through the tubing until the bag is empty. Fill the bag with clean water and swish the water around. Connect the tubing and drain the clean water through the tubing until the bag is empty. Repeat the process again with clean water.
The enema is a technique that can be successfully used to avoid the bowel problems associated with the treatment for lower rectal cancer. The goal is to make the process fit into a "normal" daily routine. I have developed the technique listed above by trial and error. Everyone has a different lifestyle, body and bowel problems. The daily enema is a truly "do it yourself" process. It is up to you to try to fine tune the enema to make it your own. I do an enema on a daily basis because for my body the colon transit time is a little longer than 24 hours but less than 48 hours. I have tried the program on an every other day basis but found that I was uncomfortable at the end of the second day. In addition, the water enters and empties the colon faster when it is nearly empty rather than being packed with semi hard stool.