Why No Enemas?

Published:

Dear Dr. Myrtle,

On the subject of enemas: You said something to the effect that it’s not good to have/use/administer to oneself an enema before anal sex, but I found a hundred websites of the opinion that there’s nothing harmful about enema-ing and that it just may be beneficial...such as Columbia University’s Go Ask Alice!


Yes, but where’s her data on exactly how safe it is?

Before I bore you (I’ll do that in just a sec), notice that the Ask Alice question only references occasional use as safe--for example giving a warm water enema before labor to induce the nervous system to expel everything, baby included. This is not done over and over again, it is done once in an attempt to help labor along.

Short answer:

Yes, having an enema once in a while to address constipation is probably safe (6 months... 1/yr). Tepid warm tap water is the suggested solution ONLY for a situation of constipation that occurs occasionally. Ask your health professional whether there are specific health reasons why you should or should not use enemas.

And now for the boring reality.

Enemas are certainly not rare behaviors given the extraordinary number of websites out there dedicated to "colon health". People suggest almost *everything*: cola, coffee, tea, brandy, water, vinegar....but that doesn't make it safe to use these products. (It’s a really bad idea to use any type of alcohol in an enema, because not only can you die from alcohol intoxication, it destroys sensitive colon cells.) 

The question I ask, is why are you using an enema prior to sex. 

  • Are you worried that the genitals are too dirty to touch?
  • Are you specifically thinking that you will clean out the rectum prior to anal sex, and that by using an enema, everything will be safer?
  • Are you responding to neurological reinforcement that evacuating the bowels feels good?

How the colon works.

The colon’s main function is to absorb water out of the liquid stool moving from the small intestine. All of the muscular contractions that happen are both to move stool along, as well as maximize the contact of the surface absorption of the colon (little soft fingers of absorption cells) with the liquid stool. By the time stool gets to the colon on the left side of a healthy body, the stool is moist and formed into loose clumps. Movement into the rectum triggers a neurologic awareness of the need to evacuate the bowels, so normally the rectum does not have stool waiting inside.

Reasons to use enemas.

Indications for using an enema are: constipation (usually normal transit constipation), or for diagnostic bowel prep for further tests, surgery or medical procedures. However there are known problems with enemas. Having an enema can:

  • increase the risk for bowel infection
  • cause pressure related trauma that can break a hold in the side of the rectum
  • remove protective colon mucus and absorptive cells
  • increase inflammation of the colon
  • increase the risk of blood infections (from the bowel)
  • increase the risk of infection transmission (from a sexual partner into the weakened colon)
  • make it harder for a person to evacuate their bowels (poop) naturally

Look on line for pathology slides to see the changes from just one bowel prep: moderate to severe loss of surface protective mucus, moderate to severe loss of surface protective/absorptive cells, and moderate infiltration in acute inflammation cells (lymphocytes and polymorphonuclear cells). The colon should have long fronds of delicate finger-like projections with a protective coating of mucus. Instead, post enema, you see a barren lawn, cut down to 1/4 inch, dry as a bone without any mucus.

Your colon may also forget how to function because chronic enemas play tricks with the brain. When we feel stretch of the rectum, the neurologic response is supposed to be to expel stool. But with chronic enema use, our nerve cells have been retrained to hold it in instead of expelling it. Since expelling is what the colon is supposed to do in response to stretch, people lose their ability to poop.

How enemas can negatively impact anal penetration.

Beyond those concerns, the increased permeability is really a problem. Someone is planning to have anal sex... so they give themselves an enema. The delicate cells rip off the cells on the lining of the colon, and increase the permeability. So if you are hoping to clean yourself out and make anal play safer, you are instead increasing your risk for sexually transmitted infections by harming your body. 

Do No Harm.

The data just isn’t there to support enema use as a benefit. Do No Harm should be the first bit of advise that any sexual health specialists give, and I don’t see where the benefit can be advocated for. Just because somebody from some other college or university decided it was ok and posted it on their website doesn’t make it safe, does it? If someone is so *psychically* disturbed with the idea that anal penetration is gross, so the anus/rectum/colon needs this kind of treatment, perhaps anal penetration isn’t for them, eh?

(But but but... the website said...)

Some feel that colonic irrigation can even be addictive physically because it *feels so good* to wash stool out. The enthusiasm for this practice is mentally reinforcing, since evacuation is a neurologically reinforced event. However, the balance of health information suggests that it isn't healthy for the person being penetrated, and doesn't remove 100% of the bacteria present in the rectum. Humans function best when their microbiome (the bacteria that live with and inside of us) are healthy, and enemas do not improve bacterial health.

Bottom line:

Barriers, lube, lots of lube, time, patience and high arousal is the key to successful, enjoyable, pleasurable anal play. Enemas don't improve anal play.

Dr. Myrtle