Enemas can help relieve constipation and cleanse the colon. Water or saline-based versions are generally the safest options. However, enemas carry real risks—including disrupting gut bacteria and electrolyte imbalances—especially when used improperly or too frequently.1
Enemas are rectal injections of fluid designed to stimulate bowel emptying or cleanse the colon. They’ve been used for centuries to treat constipation and prepare patients for medical procedures and surgeries.
You can get an enema from a healthcare provider or administer one at home. This article covers the different types, potential benefits, and the risks you should know about.
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What are enemas?
Constipation happens when stool movement slows down, leaving you with hard, dry feces that are difficult to pass. It’s a common issue, and severe cases may require interventions like laxatives or enemas.
Enemas are also used to clear the bowel before diagnostic tests or surgeries. A clean colon reduces infection risk and ensures feces don’t interfere with procedures.
Some alternative health proponents believe that waste buildup in the colon causes symptoms like fatigue, headaches, and irritability. They claim enemas can relieve these issues—but there’s no solid evidence supporting these connections.
Enemas fall into two main categories: cleansing and retention.
Cleansing enemas
Cleansing enemas are water-based and held briefly before being expelled along with loosened stool and waste.
Common types include:
- Water or saline. The gentlest option. Saline mimics your body’s sodium concentration and works by expanding the colon to promote defecation.
- Epsom salt. Similar to saline but contains magnesium, which may help relax bowel muscles.
- Sodium phosphate. A common over-the-counter enema that irritates the rectum, causing it to contract and release waste.
- Lemon juice. Mixed with warm water, though evidence for its effectiveness is lacking.
- Apple cider vinegar. Some claim it helps clear the bowel, but scientific support is minimal.
- Soap suds. Mild soap (like castile) added to water creates irritation that encourages stool movement.
Retention enemas
Retention enemas are held in the bowel for at least 15 minutes before release. They’re often oil-based, which softens stool for easier passage.
Common types include:
- Coffee. Popularized by the Gerson therapy for cancer treatment, though scientific evidence for benefits is limited.
- Mineral oil. Lubricates and seals waste to promote removal.
- Probiotic. Some studies suggest probiotic enemas may help with conditions like ulcerative colitis in children.
- Herbal. Various herbs mixed with water, though safety data is lacking.
Potential benefits of enemas
The primary evidence-based use for enemas is treating severe constipation and bowel preparation for medical procedures.
Some proponents claim enemas help with weight loss, toxin removal, and improved energy—but these claims aren’t supported by scientific evidence. Most of what we know about enema benefits comes from anecdotal reports rather than rigorous studies.
When used appropriately in medical settings, enemas can effectively clear the bowel. Self-administration at home carries more risks.
Suggested read: The 17 Best Foods to Relieve Constipation Naturally
Potential side effects and dangers of enemas
Enemas aren’t without risk. Understanding these dangers is essential before considering one.
Electrolyte and gut bacteria disruption
Enemas can disturb your gut microbiome and throw off electrolyte balance.1
Research shows that enemas used before medical procedures temporarily disrupt gut bacteria. And various enema types have been linked to dangerous electrolyte disturbances—particularly sodium phosphate enemas.
A systematic review found that 68% of patients experiencing adverse effects from sodium phosphate enemas had underlying conditions, most commonly GI motility disorders, heart problems, or kidney issues. Virtually all side effects stemmed from water and electrolyte imbalances.1
There are documented cases of Epsom salt enemas causing death from magnesium toxicity. Severe electrolyte disruption from sodium phosphate enemas has also proven fatal.1
Overuse of enemas to flush the colon can lead to severe dehydration—another potentially life-threatening complication.
Acidic solutions can damage the bowel
Lemon juice, apple cider vinegar, and coffee enemas are highly acidic. Scientific evidence supporting their safety or effectiveness is lacking.
The acidity can cause rectal burns, inflammation, and infections. There are reports of hydrogen peroxide enemas given to children causing inflamed colons, bloody diarrhea, vomiting, and long-term complications.
Herbal enemas have caused internal bleeding serious enough to require blood transfusions and colon removal in some cases.
Perforation is a real risk
Improperly administered enemas can physically damage your rectum, anus, or colon. Studies show that bowel perforation is not a rare complication of frequent enema use.2
One study found that perforation after cleansing enemas for acute constipation, along with complications like severe electrolyte disturbances and sepsis, can cause death in up to 4% of cases.2
If you self-administer at home, sterile equipment is essential. Dirty tools increase infection risk. Sterile enema kits (bucket, tubing, solution) are available online and at pharmacies—follow cleaning and usage instructions carefully.
Alternatives to enemas
If your goal is to relieve constipation and promote regular bowel movements, less invasive options exist:
- Caffeinated coffee (drinking it) naturally stimulates defecation
- Adequate hydration—drink enough water throughout the day
- Regular exercise—walking, running, biking, or any aerobic activity
- Over-the-counter oral laxatives like magnesium
- High-fiber foods—fruits, vegetables, whole grains, nuts, and seeds
- Probiotics may help with chronic constipation
Suggested read: 19 Natural Laxatives for Constipation Relief
For severe or chronic constipation, consult a healthcare provider to determine whether an enema is appropriate and safe for your situation.
Bottom line
Enemas work by introducing water or oil-based solutions into the bowel through the rectum to remove accumulated waste. Mild options like water or saline enemas are safest.
However, enemas carry meaningful risks—electrolyte disturbances, gut bacteria disruption, bowel perforation, and chemical damage from acidic solutions. These risks increase with improper use, frequent use, and certain underlying health conditions.
For most people dealing with constipation, safer alternatives exist: hydration, fiber-rich foods, exercise, and oral laxatives. Reserve enemas for situations where your healthcare provider specifically recommends them.
Mendoza J, Legido J, Rubio S, Gisbert JP. Systematic review: the adverse effects of sodium phosphate enema. Aliment Pharmacol Ther. 2007;26(1):9-20. PubMed ↩︎ ↩︎ ↩︎ ↩︎
Niv G, Grinberg T, Dickman R, Wasserberg N, Niv Y. Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable. Int J Gen Med. 2013;6:323-328. PubMed ↩︎ ↩︎
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