The combination of milk and molasses can be used to prepare a homemade enema based on ingredients that used to be available in many homes in the United States.
Ingredients:
(1) milk (16 ounces, 0.5 L)
(2) blackstrap molasses (16 ounces, 0.5 L)
Cautions: The mixture must be heated to improve the solubility of the molasses. Once heated it must be cooled to around 102°F (38.9°C). This requires an accurate kitchen thermometer and complete mixing of the ingredients.
In children Wallaker et al reported dosing the enema at 5 to 6 mL per kg, with maximum dose 135 mL.
The complication rate when used in children in the Emergency Department is reported to be low (Vilke, et al). It has been compared with sodium phosphate enemas (Hansen et al).
Minor adverse effects:
(1) intestinal gas with flatulence
(2) gastrointestinal symptoms if lactose intolerant
(3) dizziness
More serious adverse effects:
(1) thermal injury if solution not cooled
(2) cardiopulmonary "compromise" (hypotension, cardiac arrhythmia, tachycardia, etc)
(3) rectal or abdominal pain
(4) electrolyte disturbances
(5) fever, very rarely sepsis
When evaluating the enema for complications, it is important to distinguish simple constipation in an otherwise healthy child from a child with a more serious underlying condition. The latter patient is more likely to have a significant finding after the enema.
