Enema

What is an enema?

Enema (Dutch: klysma) is introducing fluid into the rectum through the anus. Medically it is done to clean out or to administer medication; within BDSM for the sensation, for the control, or as part of medical play. Taking pleasure in enemas is called klismaphilia.

How an enema works in practice

An enema comes down to three things: what goes in, how much, and how fast.

The common form is small and lukewarm. A bulb syringe or a bag with a few hundred milliliters of water at body temperature, introduced slowly with plenty of lubricant, and then held for a few minutes. The urge comes in waves and the pressing is exactly what this play is about. The encyclopedia lists the common fluids: plain water, saline, soap solution, glycerol, mineral oil and sodium phosphate.

The difference between the careful and the sloppy version is in the pressure. Fluid should flow, not spray. Anything that has a pump or a tap as its source is a different category of risk, and that is where most of the serious harm comes from.

Why people find enemas exciting

The pull is in the combination of being full and not being allowed. An urge arises that you cannot think away, and someone else decides when it is over. That is a form of control that needs no rope or cuff.

For the one on the receiving end, it delivers a feeling like nothing else and one that has a built-in time limit. For the one giving, the appeal is in the caring side: it is slow work, with gloves, lubricant and pace.

Going wrong here does not mean it gets uncomfortable. A doctor gets involved. That makes it a poor first introduction to anal play.

What the medical literature shows

Here comes the caveat that gets the most room on this page, because the risks have been studied and they are not theoretical.

Phosphate enemas. Smith, Eddleston and Bateman took stock in Clinical Toxicology of the side effects of enemas with phosphate, and they are not mild. Children usually came in with reduced consciousness and tetany, adults with low blood pressure and prolongation of the QT interval. Their conclusion: phosphate enemas are potentially toxic, especially in young children with Hirschsprung’s disease and in older people with other conditions, and in those age groups phosphate-free preparations belong considered.

Tap water. Plain water seems harmless and in large amounts is not. The bowel absorbs it, and it dilutes the sodium in your blood. Chertow and Brady described that in The Lancet back in 1994 under the title Hyponatraemia from tap-water enema. Steffer and Sandalow show in JACEP Open where that leads: confusion, vomiting and involuntary movements at a badly lowered sodium, after repeated tap-water enemas. So keep it to small amounts and use a saline solution.

Perforation. Cirocchi and colleagues gathered in Techniques in Coloproctology fifteen studies on enemas that led to a perforation. In more than four out of five cases the hole was in the rectum. That is rare. It is just not something you recover from with a day of rest, and it is the reason to work calmly, shallowly and with the right gear.

Phosphate enema or plain water?

They both have a limit, but a different one. A phosphate enema is small in volume and works chemically: it pulls fluid into the bowel, and the phosphate itself can end up in your blood. That is where the electrolyte disturbance sits. A water enema works mechanically, with volume, and that is where the dilution problem sits.

In practice: anyone who keeps it to small amounts of lukewarm water and does not repeat stays far from both problems. Anyone who uses liters, or does a second phosphate enema within a day, is close to them.

Misconceptions about enemas

“It is just cleaning, so it can do no harm.” The harm in the literature comes not from dirt, but from volume, pressure and chemistry.

“More water works better.” More water is exactly what dilutes the sodium in your blood.

“A phosphate enema is safer because it is a pharmacy product.” It is a medicine with a maximum dose, and that is exactly where it goes wrong.

What I see of it myself

This is one of the few things on this list that I do not do myself. Anything involving feces is on my list of hard limits, and that is no judgment about anyone who does enjoy it.

In conversations the preparation is underestimated and the amount overestimated. The question that always comes is how much water should go in. The answer is almost always: less than you think, and lukewarm.

And the second question that always comes is whether it hurts. No, it squeezes. That is something else, and it comes in waves.

What you can do yourself

• Use lukewarm water, not hot and not cold, and keep it to a few hundred milliliters rather than to liters.
• Do not repeat a phosphate enema within 24 hours. The serious cases in the literature turn on exceeding the dose.
• Let the fluid run on gravity. No pump, no hose on the tap, no pressure.
• Stop at sharp or one-sided pain and go to the doctor or the emergency room; that is not the ordinary urge.
• Do not do this with bowel conditions, kidney problems or in older people with other conditions without first consulting a doctor.
• Call for medical help right away with confusion, vomiting or involuntary movements after an enema. Those are the signs that in the case reports go with a sodium that is too low.

Read more about enemas

On this site, the page about anal sex covers why the anal lining is more vulnerable than people assume, and the article about consent as the backbone covers the conversation that belongs before play with a medical side.

Off this site, the review by Smith and colleagues is the most honest there is about what phosphate enemas can do and to whom.

Sources

• Toxicity of phosphate enemas: an updated review. Smith, Eddleston & Bateman, Clinical Toxicology 60(6), 672–680, 2022. Provides the finding that phosphate enemas are potentially toxic, the picture of reduced consciousness and tetany in children and low blood pressure and QT prolongation in adults, and the advice to consider phosphate-free preparations at extreme ages.
• The tip of the iceberg of colorectal perforation from enema: a systematic review and meta-analysis. Cirocchi et al., Techniques in Coloproctology 24(11), 1109–1119, 2020. Provides the pooling of fifteen studies on perforation from an enema, and the finding that the perforation was in the rectum in 80.9 percent of the cases.
• An Uncommon Cause of Choreoathetosis. Steffer & Sandalow, Journal of the American College of Emergency Physicians Open 4(1), 2023. Provides the picture of confusion, vomiting and involuntary movements at a badly lowered sodium after repeated self-administered tap-water enemas.
• Hyponatraemia from tap-water enema. Chertow & Brady, The Lancet 344(8924), 748, 1994. Provides the earliest description of a sodium that is too low after a tap-water enema.
• Enema. Wikipedia. Provides the description as introducing fluid into the bowel through the anus, the list of common fluids, and the term klismaphilia for the pleasure people take in it.

Related terms

• Anal sex. The broader territory, with the build-up and the precautions that apply here too.
• Butt plug. The tool people usually start anal play with.
• Dilator. The other way to get used to something anally, without fluid.
• Degradation. The motive for which an enema is used in some scenes.
• Duckbill speculum. The other object from the consulting room that ended up in medical play.
• Medical play. The umbrella the enema as a form falls under, with the risk and legislation side included.
• Nursing. The other close neighbor: the nursing role-play in which an enema belongs.