An enema may be associated with a number of complications, especially if it is performed by someone who has not been properly trained.


Potential complications include:

(1) laceration or perforation during the anal insertion of the enema tip, especially along the anterior rectal wall

(2) perforation secondary to instilling too much fluid or using too high a pressure

(3) acute colitis secondary to additives in the enema fluid

(4) allergic reaction to additives in the enema fluid

(5) water intoxication with electrolyte disturbances

(6) burn injury if hot water is infused

(7) chemical injury from instilling the wrong fluid


Excessive pressure may occur if:

(1) the enema hose is attached directly to a faucet

(2) the enema bag is elevated too high

(3) excessive pressure is applied to the enema bag


Rectal laceration is more likely if:

(1) a hard enema nozzle is used

(2) the inserter in inexperienced and forces the nozzle against resistance

(3) the person is sitting up


Types of perforations that may occur:

(1) anal perforation

(2) submucosal perforation

(3) extraperitoneal perforation

(4) intraperitoneal perforation

(5) perforation into an adjacent organ


Lacerations and perforations may be associated with hemorrhage or abscess formation.


The differential diagnosis includes inserting some other foreign bodies into the rectum, with the claim of enema injury to mask a potentially embarrassing situation.


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