External Applications in Anthroposophic Nursing

Enema for Adults

Kind of substance

Chamomile

Guiding principle

Extended bed rest, drug treatments (morphine) and tumor-induced chronic obstructions to intestinal passage (e.g., pre-ileus and chronic ileus in the context of peritoneal carcinomatosis) can lead to constipation. Intestinal enemas are a tried and tested means of softening the stool.
When milk and honey are used, this lubricates and has a stimulating effect on peristalsis (more on milk-honey enemas here).
Enemas are not indicated in cases of an acute ileus (e.g., during the initial manifestation of a locally advanced gastrointestinal tumor).

Administering an enema is particularly important for people with high fever and poor drinking habits. Infusion therapy can often be avoided.
If the enema is administered as a fluid substitute, the aim is “rapid intake of fluid, through which the patient’s circulation and drinking behavior can be stabilized and feelings of weakness and nausea can be counteracted. A resulting emptying of the lower sections of the colon has a relieving effect on the immune system. Toxins accumulated in the colon can be flushed out. In addition, the downward excretion gesture of the organism brings relief to the upper body.

(Source of quote: G Soldner, HM Stellmann, 2018, 5th edition, p. 265)

Indications

  • Febrile states
  • Vomiting and diarrhea
  • Exsiccosis
  • Dehydration
  • Infectious diseases, viral and bacterial
  • Constipation
  • Constipation, habitual
  • Constipation, due to medication (e.g., morphine)
  • Constipation, postoperative

Instructions

Particularities:
Every enema is an intimate nursing procedure. Very sensitive handling of this application is required. An enema can be perceived as unpleasant and as an invasion of the genital area, since with older children and adults, for instance, a feeling of shame may be involved.

Materials:

  • Gloves
  • Bedpan or preferably a commode chair, if a visit to the toilet is not possible
  • Intestinal tube
  • Irrigator with a tube system
  • Way to hang it up (e.g., infusion stand)
  • Liquid, 250–1000 ml: warm water or thin warm chamomile tea, freshly prepared
  • The liquid is diluted to 1 liter 9 g, = 2 level teaspoons of pure table salt (roughly equivalent to a physiological saline solution)
  • Temperature: body temperature
  • To reduce fever: 2°C (3.6°F) below body temperature
  • Alternatively, a ready-to-use single enema solution, 100–500 ml depending on the supplier
  • Vaseline, to make the attachment easily slidable
  • Bed protection and cellulose and/or kitchen paper
  • Incontinence pad
  • Hand towel to protect privacy
  • Blanket to cover the patient


Instructions
  • Provide a commode chair next to the bed (preferred by the patient) and also a bedpan (depending on the patient’s condition, when mobilization is not possible)
  • Put on the gloves
  • Fill the irrigator (disconnected) with liquid, hang it on the infusion stand at the desired height
  • Let the liquid run to the base of the catheter, clamp the tube, the tube is empty of air
  • Lubricate the end of the intestinal tube
  • Prepare bed protection and incontinence material, the patient lies on his or her left side, with legs bent
  • Gently insert the end of the tube into the anus
  • Let the liquid slowly into the intestine, in portions if necessary (regulate the intake speed by altering the height of the irrigator)
  • Clamp and withdraw the tube, and grasp the end with the paper towel
  • If necessary, put the incontinence material on the patient
  • Cover him or her comfortably and warmly
  • When a bowel movement seems imminent, help the patient onto the bedpan or toilet chair.
  • Stay with the patient during elimination for safety reasons
  • A repetition of the enema is possible after 1–2 hours

Evidence
Well-proven in many patients
Dosage
Situational, must be decided depending on the indication
Onset of effect
Foreseeable
Other recommended therapies
For constipation: Chamomile steam hip bath
Warning
  • Be aware when administering to people with hemorrhoids or after rectal surgery
  • Be aware of allergies (Chamomile)

Case example

A 74-year-old patient, living alone, was referred by her family doctor at 11:00 pm and admitted to the acute ward as an emergency case. She suffered from fecal impaction with signs of ileus, and malnutrition under opiate therapy for chronic pain.
She suffered from severe nausea and had colicky abdominal pain, her abdomen was ballooned, hard and very sensitive to pressure. The patient was stabilized with an intravenous infusion.

After abdominal examinations (stool congestion in the small intestine), the patient was given a suppository twice, with a 30-minute interval, to soften the rock-hard stool in her rectum. Subsequently, she was given an enema with 250 ml chamomile tea. She was able to excrete a first large amount of feces under strong pain, sitting on the toilet chair. Nausea tortured her but she did not vomit. The irritation intensified after she was given an orally administered laxative. After 2 hours a second enema was administered and the patient was monitored on a monitor. She recovered slowly. The painful bowel movements became less.
During the following 3 days she was treated with an enema, with an intestinal tube and irrigator and increasing amounts of liquid, up to 500 ml chamomile tea.
Her bowel movements (quantity, consistency and color) and vital signs were strictly monitored.
The excreted amount of feces was 7 kg within 5 days.
The patient was fed a warm, liquid diet and on the 6th day she was switched to a light diet. She was discharged on the 9th day.

“I never want to go through a procedure like that again,” she said. The patient explained that she had not felt like drinking more than 2 cups of coffee with milk per day before entering the hospital. She was assigned to ambulant care to accompany her further.
YB

Author

YB

Substances