Constipation: Risks of Enema and Water Irrigation

Bowel issues

Hello doctor, I have been suffering from constipation for a long time.
I used to have a bowel movement every 3 to 7 days.
After visiting several doctors, I was prescribed laxatives and stool softeners for about six months.
Eventually, I felt that relying on medication was not a good solution, so I stopped taking them.
However, I still couldn't have regular bowel movements, so I started using enemas a few times.
I heard that enemas can lead to bowel paralysis, so I switched to using saline enemas.
This worked well initially, and I became accustomed to using saline enemas.
I continued this for about six months.
At first, everything was fine, and I was able to expel a lot.
Recently, however, when I use saline enemas, the water comes out, but only a small amount of stool is expelled.
I thought I should increase the water volume, but it feels like my colon is filled with water, and only water is being expelled with very little stool.
My diet hasn't decreased significantly; I feel like I'm eating a lot but having very little output.
After having a bowel movement, my stomach feels bloated, and I have little appetite.
In the past, I felt completely clean after a bowel movement and had a strong appetite afterward.
Now, with the enemas, I am expelling very little.
What could be the reason for this? Is it possible that the enemas are pushing stool back into the small intestine, causing a blockage there? During this time, I have also been making a special effort to stay hydrated and eat fruits and enzymes daily, but the amount expelled is still very small...

Shunshun, 20~29 year old female. Ask Date: 2016/02/14

Dr. Ke Fangxu reply Surgery

Please do not perform enemas with plain water on your own, as even a slight mistake could lead to intestinal perforation, which can be life-threatening.
Chronic refractory constipation does not have many effective treatment options; besides the use of stool softeners and fiber supplements, maintaining a good lifestyle and exercise habits can also be beneficial.
If these methods do not yield satisfactory results, partial colectomy may be considered as a final treatment option.

Reply Date: 2016/02/14

More Info

Constipation is a common issue that can significantly affect one's quality of life. It can be particularly frustrating when traditional treatments, such as laxatives, fail to provide relief. In your case, you have transitioned from using oral laxatives to enemas and then to water irrigation, which has provided temporary relief but has now led to new concerns. Let's explore the risks associated with the prolonged use of enemas and water irrigation, as well as the potential underlying issues that may be contributing to your current symptoms.

Risks of Prolonged Enema and Water Irrigation Use
1. Electrolyte Imbalance: Frequent use of enemas, especially if they contain solutions other than plain water, can lead to electrolyte imbalances. This is particularly concerning if you are using saline or other solutions that can alter your body's natural electrolyte levels, potentially leading to complications such as dehydration or kidney issues.

2. Dependence: One of the most significant risks of using enemas or water irrigation regularly is the potential for developing a dependence on these methods for bowel movements. Over time, your bowel may become less responsive to natural stimuli, leading to a cycle where you feel unable to have a bowel movement without assistance.

3. Bowel Perforation: Although rare, there is a risk of bowel perforation with the use of enemas, especially if done improperly. This can lead to serious complications requiring surgical intervention.

4. Rectal Irritation or Damage: Frequent insertion of devices or solutions into the rectum can cause irritation, inflammation, or even damage to the rectal lining, leading to pain and further complications.

5. Altered Gut Flora: Regular use of enemas can disrupt the natural balance of gut bacteria, which may contribute to digestive issues and affect overall gut health.

Understanding Your Current Symptoms
You mentioned that after using water irrigation for an extended period, you are now experiencing a decrease in the amount of stool being expelled, despite feeling as though your bowel is full. This could be due to several factors:
1. Fecal Impaction: It is possible that you may have developed fecal impaction, where hard stool becomes lodged in the colon. This can prevent normal bowel movements and may require medical intervention to resolve.

2. Altered Bowel Motility: Prolonged use of enemas may have altered your bowel motility, leading to less effective contractions of the bowel muscles. This could explain why you feel full but are unable to pass a significant amount of stool.

3. Dietary Factors: While you mentioned that your diet includes fruits and enzymes, it’s essential to ensure that you are consuming adequate fiber and hydration. A diet low in fiber can contribute to constipation, even if you are eating fruits.

4. Underlying Conditions: Conditions such as irritable bowel syndrome (IBS), hypothyroidism, or other gastrointestinal disorders could be contributing to your symptoms. It may be worthwhile to discuss these possibilities with your healthcare provider.

Recommendations
1. Consult a Healthcare Provider: Given your history and current symptoms, it is crucial to consult a healthcare provider. They can perform a thorough evaluation, including physical examinations and possibly imaging studies, to determine the underlying cause of your constipation.

2. Gradual Reduction of Enema Use: If you have been using enemas regularly, consider gradually reducing their use. This can help your bowel regain its natural function. Your healthcare provider can guide you on how to do this safely.

3. Dietary Adjustments: Focus on a high-fiber diet, including whole grains, fruits, vegetables, and legumes. Additionally, ensure you are drinking plenty of water throughout the day.

4. Physical Activity: Regular physical activity can stimulate bowel function and help alleviate constipation.

5. Alternative Treatments: Discuss with your healthcare provider about other treatment options for constipation, such as fiber supplements, probiotics, or medications that promote bowel motility.

In summary, while enemas and water irrigation can provide temporary relief from constipation, their prolonged use carries risks that may lead to further complications. It is essential to work closely with a healthcare provider to develop a comprehensive and safe approach to managing your constipation.

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