Types of Enema for Ulcerative Colitis

Enema aims at emptying the bowel to smoothly carry out the diagnostic examination of the gastrointestinal tract. Ulcerative colitis is a type of inflammatory bowel disease that leads to inflammation in the bowel including the rectum and colon.

Giving enema involves inserting gas or liquid into the lower part of the large intestine or rectum. A study showed that during the procedure people might experience some discomfort.⁽¹⁾ If pain is experienced the doctor may stop the enema and look for other alternative options.

There are different types of enemas suggested by doctors for ulcerative colitis:

1. Barium Enema

   It is a procedure in which the radiologist passes a white liquid called barium through the rectum into a person’s bowel. Then the assessment of inflammation is done using an x-ray.

   A barium enema can be helpful in some cases in finding the cause of a bowel problem.

   A person is given a barium enema either in the hospital or in any imaging center. A barium enema is not frequently recommended and the doctor often suggests alternatives such as CT scans or colonoscopies.

   Preparation: Before a barium enema, a person is ensured that the bowel is empty. He is advised to take lighter meals or a low-fiber diet. Laxative medication is advised a day before the enema is given. The person is also recommended to drink plenty of water.

   Procedure: The person is made to lie on his side, over an x-ray table. A soft tube is inserted by the radiologist into the rectum. This carries barium into the bowel. After the barium is injected, the person is asked to move around to help the barium spread. Air is pumped into the bowel to help expand barium around the space. Several x-rays are taken of the bowel to determine the extent of inflammation.

   Side Effects of Barium Enema:

   The side effects of barium enema include:

   • Bloating
   • Diarrhea
   • Headache
   • Nausea
   • Constipation

   Sometimes bowel perforation or an allergic reaction

2. Mesalamine Enema

   Mesalamine enema is an anti-inflammatory medication that is used in the treatment of ulcerative colitis. It may help in the healing process.

   Preparation: Mesalamine enema works best empty stomach, therefore, a person is advised to have a bowel movement before performing the enema.

   People can usually continue with the standard diet during the enemas at home.

   Mesalamine enema plays its role by stopping the body from producing a substance causing inflammation. It can be given as an anal suppository or enema. The dosage depends on the type and brand of mesalamine, the severity of the condition person’s weight and age, and the length of time the medication is taken by a person.

   Procedure: A person needs to perform enemas daily every night. During the procedure, he needs to lie down on the left side or kneel on the floor while resting the chest and one arm on the bed. A lubricant can be applied to the applicator if necessary. The bottle is tilted a bit so the nozzle aims at the back and it is squeezed gently to release the medication. A person should remain in the position for 30 minutes to allow the medication to spread. It is best to perform the procedure while going to bed. This helps the medicine stay in the system for at least 8 hours.

   Side Effects and Risk of Mesalamine Enemas

   The potential side effects of mesalamine enema include:

   • Gas
   • Acne
   • Hemorrhoids
   • Joint pain
   • Rectum pain
   • Heartburn

   A pregnant or breastfeeding female can safely use a mesalamine enema. There are certain drugs including aspirin Ibuprofen or naproxen that may interact with the medication.

3. Budesonide Rectal Foam Enema

   Budesonide rectal foam enema is a corticosteroid that may be helpful in reducing inflammation in the bowel.

   Preparation: Budesonide may not cure ulcerative colitis but can help relieve bowel inflammation. It works best when the bowel is empty. The dosage of the medication depends on the severity of the condition.

   Procedure: The person should lie on the side or stand with one leg on the chair. The applicator can be gently inserted into the rectum. Push the dome so that the applicator fills with the dose of foam. Wait up to 15 seconds and remove the applicator and dispose it off.

   Side Effects and Risks of Budesonide Rectal Foam Enema

   The potential side effects of budesonide rectal foam include:

   • Nausea
   • Diarrhea
   • Pain in the rectum
   • Gas

   Other risk includes the sign of infection such as fever, mouth sores, sinus pain, vomiting, change in vision, and chills.

   Budesonide may react with antifungal medications and medications containing steroids and therefore should be avoided by those using them.⁽²⁾

4. Alternative Enemas

   Sometimes alternative enemas are recommended by the doctors, which include:

   • Steroids: It helps in giving relief from itching, inflammation, and redness.
   • Cannabidiol (CBD): It helps in reducing inflammation due to ulcerative colitis
   • Coconut Oil: It can be used to improve symptoms of colitis.⁽³⁾
   • Apple Cider Vinegar: A mixture of apple cider vinegar and water may be helpful in healing the digestive system.

   A doctor may suggest different types of enemas to diagnose and treat ulcerative colitis. If a person has a problem performing enemas, medications can be given in the oral form.