An enema, also known as colon flush, relieves and cleanses the intestines. It stimulates intestinal peristalsis, so enemas can be used to relieve acute constipation. Other conditions can often be alleviated with enemas as well. However, an enema is not suitable for everyone. We explain all the important details about the effects and how to perform enemas.

What is an enema?

The term enema or colonic enema refers to different variants of colon irrigation:

Normal enema

Typically, an enema refers to a small colon flush that can be performed at home using an irrigator. Usually, only the last part of the colon is rinsed with approximately 500 – 1500 ml of fluid. The effect usually occurs within 5 to 30 minutes.

This article is about this type of enema!

Enema

An even smaller rectal flush involves using only 50–200 ml of fluid, with the goal of achieving rapid and targeted bowel movement (within a few minutes) in cases of constipation. Often ready-made enema solutions are used, which are available commercially in small disposable applicators.

*Get your enema kit here

High Enema

There are also so-called high enemas, in which a larger portion of the colon is flushed (including the transverse colon) and more fluid is used (1-2 liters). For this type of enema, some enema sets include a longer, flexible piece of tubing (also called a colon tube).

In contrast to conventional enema cannulas, which are 5 to 10 cm long, the intestinal tube measures 30 to 40 cm. To ensure that the fluid can also rise up the intestine, the following procedure is used:

1. Start in the side position (left).
2. Carefully and slowly insert the intestinal tube 20–30 cm deep into the anus.
3. After insertion, slowly allow the fluid to flow in.
4. While the enema is running, a change in position (e.g. knee-elbow position or lying on your back) can help the fluid penetrate deeper.
5. Hold the liquid for at least 10-15 minutes to allow for deeper cleansing.
6. Then go to the toilet and empty your bowels.

Colon hydrotherapy

Colon hydrotherapy (CHT) is a deep colonic irrigation performed in a specialized alternative medical practice usually over several sessions.

In each session, the colon is flushed several times (with 10 to 30 liters of purified water). The water is drained away through a closed system, so it is neither visible nor smellable. Abdominal massages helps loosen deposits.

Each session lasts approximately 45 to 60 minutes. The cost is $100 to $200 per session. Health insurance companies do not cover the costs.

Reasons for CHT are generally digestive problems (constipation, flatulence), the desire for intestinal cleansing with detoxification (e.g. in conjunction with fasting) or as support for skin problems or immune deficiency.

After a CHT, you usually feel good and can continue your day normally.

This article focuses specifically on the normal enema, which can be performed at home.

Is an enema part of colon cleansing?

The most important thing to note first: Colon cleansing/colon rehabilitation CAN be accompanied by one or more enemas. However, it can always be performed successfully without an enema.

Only in cases of very stubborn constipation is a small enema a really good remedy, for which there is no comparable alternative that works so quickly, is so easy to perform and has so few side effects.

Naturopathy: Why an enema?

From a naturopathic perspective, an enema is an important component of a colon cleansing program. Enemas enhance the effects of the other components of a colon cleanse (mineral clay, fiber, herbal preparations).

In addition, an enema is often recommended in naturopathy completely independently of intestinal cleansing – for example in the short term, i.e. once only for headaches, flatulence or feverish colds.

However, for chronic conditions – e.g., pain disorders, skin rashes, allergies, chronic inflammatory diseases – enemas are not recommended just once.

Instead, they should be performed as a course of treatment or regularly at longer intervals, e.g., daily for one week, then every three days or once a week – depending on the symptoms and the recommendation of the naturopathic doctor.

But why should enemas, a procedure that affects the intestines, have a healing effect on the head, respiratory tract, or skin? Why should they be able to relieve pain or reduce the risk of allergies? And why should flushing the intestines inhibit chronic inflammation?

How the gut affects overall health

In naturopathy, a person is only as healthy as their gut. If the gut is blocked, bloated, cramped, or overgrown with fungi or harmful bacteria, then the intestinal flora is disrupted, the intestinal mucosa is irritated and becomes permeable, and the immune system is compromised.

All of this leads to both short- and long-term health problems that can occur anywhere in the body – whether on the skin, in the lungs, the bladder, or wherever the person’s weak point is located.

First and foremost – due to malnutrition, antibiotic therapy, environmental pollution or excessive stress – is the disturbance of the intestinal flora (also called dysbacteriosis or dysbiosis), which then leads to all other disorders:

1. If the intestinal flora is out of balance, digestion and thus the absorption of nutrients becomes sluggish.
2. Fermentation and rotting processes occur.
3. Short-chain fatty acids are used by the intestinal mucosal cells as a raw material for energy production. However, short-chain fatty acids can only be produced by healthy intestinal flora. If the intestinal flora is disturbed, only a few short-chain fatty acids are produced, and the intestinal mucosal cells suffer from an energy deficiency.
4. Intestinal peristalsis only works at half strength, so that the stool remains in the intestine longer than usual, thus leading to a gradual self-poisoning of the organism.
5. The vitamin supply – which is partly taken over by the intestinal flora – is no longer optimal.
6. The intestinal mucosa is now colonized by pathogenic microorganisms (harmful bacteria and fungi) and damaged by their metabolic toxins, which increases its permeability.
7. This permeability means that both the bacteria’s metabolic toxins and other metabolic end products, which should actually be excreted, can enter the bloodstream.
8. Incompletely digested proteins can now also pass through the intestinal mucosa and enter the bloodstream. However, these foreign substances do not belong in the blood and now cause the immune system to attack them, resulting in inflammation.
9. In addition, immune reactions of this kind can lead to allergies and autoimmune diseases .

An enema has a very positive effect on all of these factors.

How does an enema work?

An enema first flushes out older fecal matter from the intestines and relieves blockages. At the same time, harmful microorganisms are removed. Not only the harmful ones, of course, but if other measures are taken to heal the intestines, an environment is created where healthy intestinal flora can develop.

The removal of harmful substances and microorganisms promotes the regeneration of the intestinal mucosa.

Intestinal peristalsis is also activated. This shortens the stool’s residence time and (from a naturopathic perspective) reduces re-poisoning of the organism. Re-poisoning means that harmful substances from the intestine re-enter the bloodstream through the intestinal mucosa instead of being excreted in the stool in a timely manner.

Headaches, for example, could be the result of such re-poisoning. An enema interrupts the flow of toxins into the body, flushes the toxins out of the body with water, and relieves the headache.

(How and why an enema can cause headaches is explained below under “Side Effects”.)

Stopping re-poisoning could also be the reason why enemas often have a soothing effect on other acute problems, such as the onset of a cold.

As soon as the fermentation and putrefaction processes in the intestines are stopped by the enema and the existing toxins and pathogenic germs have been flushed out, the immune system is relieved, the fever subsides, and the cold viruses can be eliminated.

*Get your enema kit here

The enema practice

There are many reasons for an enema. Since anyone can easily perform an enema, they cost nothing, are painless (if small and performed carefully), and have a quick and, if used as a treatment, long-lasting effect, it’s worth trying.

What is an irrigator?

The irrigator is therefore the best option for beginners. This is a three-piece enema set consisting of a container for the fluid, a hose, and a tube with a tap for turning the water (or other fluid) on and off. The tube is inserted just a few centimeters into the anus.

Which liquid for colonic irrigation?

Some people experiment with coffee, oil, alkaline water (water with alkaline powder), or even vinegar. The general rule is that you should only flush your intestines with liquids that are considered healthy and that you would actually drink.

So if you don’t like coffee, are sensitive to it and therefore never drink coffee, you shouldn’t use it for colonic irrigation.

Water

If you choose water as your enema fluid, you should use filtered or bottled still water. Cold or even room-temperature water can make some people feel cold during the enema and cause cramping and ruffle the nervous system. Therefore, it’s best to warm the water to body temperature.

Bentonite water

Bentonite water is water into which two tablespoons of bentonite are stirred per liter. Bentonite adsorbs toxins from the intestines, improves the intestinal environment, and promotes the recovery of healthy intestinal flora.

Herbal tea

A suitable herbal tea is chamomile, for example, which soothes the intestines and also has a mild anti-inflammatory effect. It shouldn’t be too strong (at most, just as strong as you would normally drink it) and should be diluted with water if necessary.

Flaxseed tea

Flaxseed tea also relieves inflammation in the intestines. However, flaxseed tea isn’t a true “tea.” It’s more like the liquid used to soak flaxseeds. Soak 3 tablespoons of whole flaxseeds in plenty of water.

After an hour, add enough water to reach the desired volume and pour off the flaxseeds. This way, you only use the slimy liquid and NOT the actual seeds.

Coffee

Coffee enemas are praised by various sources as very effective. They are said to stimulate the liver in particular, enhance this organ’s detoxification capacity, and can relieve pain.

Coffee enemas are best performed in consultation with a therapist, as they can have extremely strong – even negative – effects.

They should also only be used with organically grown coffee, preferably green coffee (unroasted coffee), which is commercially available as soluble granules specifically for enemas. Coffee enemas are said to cleanse not only the intestines, but virtually the entire body via the liver.

Olive oil

A 2021 study on the efficacy of olive oil as an enema for children with severe chronic constipation was published. The children (118) received either an enema containing 1–2 ml/kg olive oil alone or the olive oil enema followed several hours later by a glycerin enema in the outpatient pediatric surgery department (Kobe Children’s Hospital, Japan).

Olive oil was effective in relieving constipation in 77.6% of patients (1).

Hydrogen peroxide

You sometimes read about enemas with hydrogen peroxide (5 ml of a 3 percent hydrogen peroxide solution per liter of water). These are said to cleanse the intestines of toxins, release oxygen to the intestinal mucosal cells, and kill harmful microorganisms.

We would advise against it, as these types of enemas carry significant risks, such as irritation of the mucous membranes and bloating. Especially if you use too much hydrogen peroxide, it can cause chemical burns to the intestinal mucosa.

In one case report, a woman who was constipated underwent an enema with 100 ml of undiluted 3% hydrogen peroxide solution on the advice of her grandmother. The result was severe rectal inflammation, intestinal bleeding, and severe pain that required morphine anesthesia (2).

Previously—until the 1960s and 1970s—diluted hydrogen peroxide enemas were used to promote bowel movements in newborns with meconium ileus (obstruction of the last segment of the small intestine). Due to serious incidents, some of which resulted in death, other fluids are now used.

How much liquid should you use?

The amount of fluid you inject depends on your bowel condition. A cramped or blocked bowel won’t initially absorb much fluid, so even 200 ml can cause uncomfortable pressure to build up.

This may be sufficient for some people. So never force yourself to take more than your intestines are willing or able to absorb. You can also do several rounds (e.g., 2-3) with a small amount and practice holding the liquid for longer and longer periods.

So it’s less about taking in as much water as possible, but rather about holding it in for as long as possible (e.g., 30 minutes, but not exactly hours). Initially, you might feel like you need to go to the toilet immediately after taking in the water.

Which position for an enema?

The “traditional” position involves lying on the floor. But kneeling on all fours on the floor is also a position that allows you to administer the enema, and the fluid can flow into your bowel very easily. For people with knee problems, back pain, or other physical limitations, lying on their side is more suitable. However, it should be noted that after administering the fluid, you often need to go to the toilet relatively quickly, so you should therefore position yourself in a place not too far away.

There should also be a way to raise the container where you plan to administer the enema. Only if the container is higher than you are kneeling or lying down can the fluid flow into the intestine.

This is how colonic irrigation is performed

The filled container is then hung in an elevated position (doorknob, towel hook, etc.). Then, the end of the intestinal tube (and ideally the anus as well) is greased with a lubricating cream or oil, such as natural coconut oil.

To release air from the hose, briefly open the small tap before inserting it and let enough water run into the sink until there are no more air bubbles in the hose. Close the tap and then assume your chosen enema position.

Now push the intestinal tube a few centimeters into the anus (so that the tap is still on the outside) and turn the small tap back on. Hold the tube firmly by the tap to prevent it from coming loose or disappearing into the intestine (it’s all happened before!).

Now let as much water flow in as feels comfortable. Close the tap and pull the tube out of your anus.

If you were kneeling, get up and go to a place where you can relax. You can lie down on the sofa or bed, cover yourself, and let the water (or appropriate liquid) work its magic.

While doing this, massage your stomach in a clockwise direction.

If you feel uncomfortable lying down, you can also sit down or pace around the room. Do whatever you feel like doing!

After about 5 to 20 or even 30 minutes, the water and the dissolved intestinal contents are excreted again in the toilet.

When the urge to defecate becomes too strong

During the first round of colonic irrigation, your bowel may absorb only a small amount of water, and you may quickly feel pressure. Remove the tube, go to the toilet, and empty yourself. Then start the next round.

The goal is less to be able to absorb more and more water, but rather to be able to retain the water you’ve let in for longer (even when massaging your stomach). This also allows the intestines to be cleansed.

Starting with the second attempt, try not to rush to the toilet immediately at the first urge to go. Instead, wait for about three peristaltic impulses before rushing to empty your bowels. A peristaltic impulse is noticeable by a strong urge to defecate. Breathe slowly and calmly. This will help you get through the urge without having to empty again immediately.

How many rounds should you do?

Two to three passes are recommended. However, more than three passes won’t noticeably improve the result. If you can hold the liquid for 20-30 minutes, one pass is sufficient.

Even if you do not want to perform a complete colon cleansing in parallel with your enemas, it would be advisable to at least take a high-quality probiotic to accelerate the development of a healthy intestinal flora and thus the elimination of dysbacteriosis.

How often can you do an enema?

Some people take an enema every day for their entire lives and feel great. Others get fed up after just one. Try it and see how you feel! The most important part is that you do not do this instead of your normal bowel motion, especially if you want to do it daily – always do it after your normal bowel motion.

As always with holistic measures, one should approach this very individually.

During a colon cleanse, for example, you can do one to three enemas per week, or just three in the first week and another three in the fourth week. But daily enemas during the first week are also fine if you feel comfortable with them.

Enemas are also recommended before and during a therapeutic fast, as fasting is usually carried out with an empty and cleansed bowel and one wants to accelerate the process of bowel emptying with enemas.

We would therefore recommend enemas especially for use in a cleanse, or just once or a few times when one is needed, but not for permanent use.

*Get your enema kit here

Can an enema have side effects?

Yes, enemas can have side effects, but these occur especially when

1. Enemas are done too often
2. Enemas are given with too much water
3. you can only go to the toilet with an enema because you have become so used to it with daily use (habituation effect)

Side effects with small amounts of water

However, the normal enemas with 200 – 500 ml of liquid described above – if performed occasionally – have very rare side effects and if so, only mild side effects:

1. Mild cramps or bloating due to the introduction of fluid
2. Mild dizziness or headache if the circulatory system is sensitive
3. Temporary irritation of the intestinal mucosa, especially with very frequent use
4. Electrolyte losses are hardly a problem with smaller amounts, but can occur with daily use
5. Detoxification reaction (“detox headache”): An enema can release toxins, metabolic waste, and old stool residues. These enter the bloodstream briefly before being excreted (“Herxheimer reaction,” re-poisoning). This can trigger headaches, fatigue, or a mild feeling of illness.

Side effects with larger amounts of water and frequent use

Those who frequently use enemas with large amounts of fluid may develop the following side effects:

Electrolyte and fluid loss

The enema can flush out salts (sodium, potassium) and fluids. A mild mineral deficiency can cause headaches or dizziness.
Tip: Take a mineral supplement afterwards or drink a high-quality vegetable broth.

Blood pressure fluctuations

An enema can temporarily lower blood pressure (through fluid loss and intestinal reaction). Low blood pressure can manifest itself in the form of headaches, dizziness, or weakness.

Tension or stress reactions

Unfamiliar postures (e.g., lying on your side or knee-elbow position) can trigger neck tension. Therefore, always stay consciously relaxed and choose only positions that you can practice comfortably.

Oxygen deficiency or circulatory reaction

If you lie flat during the enema or change your breathing due to tension, you may experience a temporary reduction in the amount of oxygen reaching your brain. Therefore, always breathe consciously and evenly.

Narrowed and spastic bowel due to wrongly performed enemas with pre-existing conditions.

A study of people who had been using enemas for years (due to intestinal diseases) showed that in these specific cases, long-term enema use appeared to have caused neuromuscular dysregulation.

This led to chronic spasticity and narrowing of the left (descending) colon. At the same time, the right colon (ascending colon) was severely dilated in the patients (3).

However, it should be noted that these were patients who used enemas because they already suffered from severe disabilities/pre-existing conditions in the intestinal area, e.g. congenital malformations of the rectum and anus, cloacal malformation or myelomeningocele (a form of spina bifida (open back) which is often associated with neurogenic intestinal dysfunction).

In addition, patients between the ages of 4 and 45 used enemas to empty their bowels. They rarely used just water, but rather glycerin, saline solution, a mixture of saline solution with glycerin and soap, or, in some cases, phosphate solutions or a molasses-milk mixture.

The observed side effect is therefore not to be expected with the enema application described here.

Who should not take an enema?

Enemas are not suitable for everyone. Certain groups of people should avoid enemas with large amounts of water or only use them under medical supervision:

1. In the case of intestinal diseases and inflammations such as Crohn’s disease, ulcerative colitis or irritable bowel syndrome with severe symptoms – however, in the case of ulcerative colitis, medically prescribed enemas can be helpful, with which certain medications (e.g. butyrate, budenoside) are administered locally (4).
2. In case of intestinal injuries or bleeding, for example due to hemorrhoids or anal fissures
3. After recent operations in the intestinal area
4. In case of cardiovascular diseases – these could be negatively affected by the sudden loss of fluid, especially in case of low blood pressure or serious heart problems
5. In case of kidney problems or electrolyte imbalances – enemas may flush out minerals and impair mineral balance
6. Caution is advised during pregnancy and breastfeeding, as enemas can induce contractions
7. In case of acute diarrhea or infections, consult your practitioner beforehand
8. Intestinal obstruction (ileus) is an absolute contraindication, as the fluid cannot drain away and the situation can become dangerous

Conclusion: An enema can often be very helpful

An enema is a simple and quick method of colon cleansing that gently relieves constipation and can improve well-being. It supports digestion, rids the body of toxins, and can even relieve headaches or cold symptoms.

Because it is easy to perform, has few side effects when performed correctly, and has an immediate effect, it is particularly valued in naturopathy as an effective support for intestinal and general health.