Enema (medicine)

The introduction of a liquid through the anus into the intestine is called an enema (enema, enema, anal irrigation, intestinal irrigation) . Enemas are used to relieve constipation and to cleanse the colon .

Word origin

The words enema, English clyster , French clistère , Italian clistere , can be derived from the ancient Greek words κλυστήρ klystér , German 'the rinser' and κλυστήριον klystérion , German 'cleaning' . As a synonym, the Greeks used the term ἔνεμα énema , from ἐνίημι eníēmi , German 'inject' , which found its way into the English language and is now more commonly used as clyster . In addition to the treatment, the instrument used for this is also called an enema.

application

Different types of enemas are used in medicine, depending on the requirements for defecation. The most common form is the simple enema , which results in rapid defecation in the event of acute constipation or prior to diagnostic interventions in the rectal area . Orthograde colon irrigation or cleansing enemas are used for colonoscopy or abdominal surgery to clean the colon. Irrigations or high enemas , lifting or swiveling enemas and rectal colonic irrigation are variants.

In alternative medicine , intestinal irrigation is one of the draining procedures (see also subaquale intestinal bath ). For example, they are used to accompany fasting.

A special form of enema, namely irrigation , is used for enterostomy and fecal incontinence . This technique is comparable to rectal colonic irrigation. Further applications are the lactulose enema for decompensated liver cirrhosis , the resonium enema for hyperkalaemia , and medicated enemas, e.g. B. in inflammatory ulcerative colitis . Rectal instillation of saline solution is a therapeutic measure used in intussusception (intussusception) in paediatrics. The amount of liquid varies from 120 to 2000 ml (correspondingly less in children). Micro enemas only contain approx. 5 ml; they are used to administer drugs to children.

Enemas and enemas can also be a method of consuming alcohol . Sometimes enemas and enemas are also sexual practices of Klinikerotik , Klysmaphilie , in preparation for anal intercourse and "corporal punishment" in the context of BDSM used.

equipment

Different devices are used depending on the type of inlet. Medical single-use enemas contain 100 to 200 ml, micro-enemas (see above) 5–10 ml.

If, on the other hand, larger amounts of irrigation fluid are to be administered, an enema syringe or an irrigator is used. For people without sphincter weakness, simple, flexible intestinal tubes are used, for patients with sphincter weakness ( fecal incontinence ) there are those with a sealing balloon ( balloon intestinal tubes ). For self-use there are hand-operated enema pumps that suck in liquid from a container (e.g. from the sink). Irrigator enema systems are containers or collapsible bags that are hung up.

So-called pear syringes made of rubber-rubber press about 200–400 ml of water into the intestine by squeezing the pressure ball, depending on which device is used.

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  Irrigator set

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  Klysopump with separate liquid container

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  Pear syringe 200 ml

history

Funnel or enema enemas are among the oldest intestinal enema methods. The enema takes place from a container ( irrigator ), which is held elevated or hung up. In ancient times, enemas were often carried out using bottle gourds or carved wooden vessels. This method is still used today by indigenous peoples.

In Babylonian , Indian and Ancient Egyptian medicine , the use of enema to perform bowel evacuations was common. It was believed that stool collections had to be removed from the body on a regular basis to protect and promote health. There are even said to have been specialists for enema applications. In the Chester Beatty VI papyrus , various recipes are mentioned that were used through an enema.

Pressure enema from an animal bladder (African wood sculpture, 19th century)

Portable self-enema device according to Giovanni Alessandro Brambilla (18th century; Medical History Museum of the University of Zurich)

Enema syringe (18th century; Medical History Museum of the University of Zurich)

In Greek medicine, too, the enema was regarded as a therapeutically important instrument. According to the idea of Hippocrates of Kos (460–377 BC), health was based on the balance of body fluids . Constipation means that the body fluids are out of balance. Intestinal enemas were mainly used for constipation and gastrointestinal diseases and were intended to cleanse the intestines of spoiled, pathogenic and excess juices. The enema application is also found in the writings of Galenus .

In Indian Ayurveda and yoga , the enema is important for both physical and mental health. The enema called Basti here is performed by sucking in water by means of muscle contractions of the pelvic floor and the anus, or pressure enemas are used, which were formerly made from urinary bladders from animals.

Another old enema device is the pressure enema. It consists of a compressible container to which a rectal cannula is attached. Indians from the Amazon region were the first to make rubber balls out of rubber and use them for enema. In the Middle Ages, animal bladders (urinary bladders), leather or parchment, which were sewn together to form a sack, were mostly used to produce pressure enema. An attachment tube, which usually consisted of precious metal, horn or bone and had one or more outflow openings at the end or on the side, was tied to the container. By applying pressure to the container, liquids could be squeezed into the rectum or other body cavities by hand .

Mechanical enema syringes made of metal with threads, plungers, plungers and cannulas have been around since the 15th century. In the times of Molière and the Sun King , the gift of an enema was a matter of course and was prescribed by personal physicians as a panacea.

Devices for self-enema, which are also based on the piston principle, have been around since the 17th century. The development arose from the wish of many patients not to have to bare their genital area in front of a stranger.

A special form was the tobacco enema, recommended by Thomas Sydenham , for example , to be used for colic, intestinal entanglements, intestinal worms and intestinal hernias. The tobacco enema was also used to resuscitate "apparent dead", especially in Holland in the 18th century. In Vienna Josephinum a tobacco enemas from 1769 today is still preserved. The rectal use of the tobacco enema required strong, black tobacco which was continuously blown into the patient for one hour. It was administered to the patient either standing, sitting on a birthing chair, or lying on his side. During the “resuscitation” the smoke was blown in orally. The smoke was generated in a kettle in which there were glowing coals and tobacco. Using a bellows, the smoke was directed through a hose and the openings in the end piece into the corresponding body region.

literature

• A. von Degenhard: The enema. Flensburg 1985.
• Julius Friedenwald, Samuel Morrison: The history of the enema with some notes on related procedure. In: Bulletin of the History of Medicine 8, 1940, pp. 68-114 and 239-276.
• Huldrych Koelbing: The medical therapy. Outlines of their history . Darmstadt 1985.
• Karl-Heinz Leven : Ancient medicine. Dictionary. Munich 2005.
• W. Liebermann: Enema: Some historical notes. In: Review of Gastroenterology. Volume 13, 1946, pp. 215-229.
• Karl Sudhoff : A bronze syringe from ancient times. In: Sudhoff's archive. Volume 1, 1908, pp. 75-78.
• M. Widmann, C. Mörgeli: Bader and surgeon. Medical craft in days gone by. Medical History Institute and Museum of the University of Zurich, 1998.
• F. v. Zglinicki : Kallipygos and Aesculapius. The enema in the history of medicine, art and literature. Baden-Baden 1972.

Web links

Commons : enemas  - collection of images, videos and audio files

• Johann Werfring: Healing tobacco smoke as an aid to drowning people. In: Wiener Zeitung. November 24, 2011, supplement “ProgrammPunkte”, p. 7.

Individual evidence

1. ↑ AWMF register number 006-027- Guideline Invagination . In: AWMF online
2. ↑ Martha Haussperger : Did empirical medicine exist in the Near East before Hippocrates? In: Würzburg medical history reports. Volume 17, 1998, pp. 113-128; here p. 124.
3. ^ Charles John Samuel Thompson: The dawn of medicine. A chapter in the history of pharmacy from the earliest times to the tenth century. In: Janus. 28, 1924, pp. 425-450; here p. 419 f. and 438.
4. ↑ Leon Elaut: Le traité Galénique of clystères et de la colique, traduit en Latin par François de Revelenghien. In: Janus 51, 1964, pp. 136-151.
5. ^ Alfred Martin: Representation of an enema in knee-elbow position. In: Sudhoff's archive. Volume 11, 1919, p. 330 f.
6. ^ Sabine Fellner, Georg Thiel: Nicotiana. European Smoking Culture. Verlag Sonderzahl, Vienna 2009, p. 56.
7. ↑ Axel W. Bauer : Therapeutics, Therapy Methods. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 1388-1393; here: p. 1389.
8. ^ Johann Werfring: Healing tobacco smoke as an aid for drowning people. In: Wiener Zeitung. November 24, 2011, supplement “ProgrammPunkte”, p. 7.
9. ↑ Manuel Frey: The clean citizen. Origin and spread of bourgeois virtues in Germany, 1760–1860 (= Critical Studies in History . Volume 119). Vandenhoeck and Ruprecht, Göttingen 1997, p. 68.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !