At a glance
Enema questions come up in three situations:
- During a bad bout of constipation, when nothing else has worked
- Before a test such as a sigmoidoscopy
- Before fissure surgery, when the hospital sends instructions
People’s accounts are mixed. Some describe real relief. Others describe sharp pain, fresh bleeding and a setback. The fissure sits exactly where the nozzle has to go, so this is an area where many clinicians are careful.
This guide describes what people report and why clinicians are cautious. It does not explain how to use an enema. If you are thinking about one, speak to your GP, pharmacist or colorectal team first.
What people report
Relief for some. A group of people describe using an enema during severe constipation, when they were afraid a large, hard stool would tear the fissure open. They report it cleared things without the strain they feared. A few describe using enemas repeatedly over months and feeling it helped. This is a minority view and not a pattern to copy: clinicians generally advise against regular enema use without supervision, whatever the type, because it can hide the cause of constipation, can injure the lining, and with repeated use can upset the body’s salt and water balance.
Pain and bleeding for others. Many people describe the opposite. The nozzle hit the fissure, the sphincter clamped down, and they had sharp pain and bleeding afterwards. Some describe being unable to insert it at all because the muscle was so tight.
Stinging. Pharmacy enemas that contain salts are often described as stinging broken skin. People compare it to salt on a cut.
Unclear cause and effect. A few people describe a fissure that appeared after an enema, and a surgeon who thought that might be the cause. Others say an enema had nothing to do with it. There is no way to know from accounts alone.
Why clinicians tend to be cautious
From what people say they were told, and from general medical guidance, the cautions fall into a few groups.
- The tip and the tear. A fissure usually sits just inside the anal canal. Anything passed through that area can catch the tear, particularly when the sphincter is in spasm.
- The type of enema. Phosphate enemas have specific warnings about salt and fluid balance. These matter more for people with kidney or heart conditions, people who are dehydrated, older adults, and anyone using them repeatedly.
- The habit. Regular enemas can stand in for dealing with the cause of constipation. Clinicians usually want to understand why stools are hard and treat that instead.
- Masking a problem. Constipation that needs an enema to shift can sometimes point to something else that needs checking.
The pre-surgery enema question
Some hospitals ask people to have an enema before fissure surgery, such as lateral internal sphincterotomy, or before an examination under anaesthetic. This is one of the most anxious moments people describe.
Common worries:
- Being unable to get the nozzle in because of spasm
- A partner or relative struggling to help
- Fear that the enema will tear the fissure the day before surgery
- Not being able to hold the fluid, or let it out, because the muscle is so tight
What people found when they rang the team:
- Some were told a nurse could give it on the ward
- Some were offered a drinkable prep instead
- Some were told to try, and that the surgery would go ahead if they could not manage it
- Some were told no prep was needed after all
The pattern is clear. People who called ahead felt calmer and got a clear answer. Ringing the pre-assessment nurse or surgical team is a normal thing to do.
Enemas before tests
A sigmoidoscopy often uses an enema rather than drinkable prep. People with a sore fissure describe the enema as harder than the test itself. Some asked whether a different prep or sedation was possible. See the guide on sigmoidoscopy for more on this.
If a clinic asks for an enema before a first appointment and you are in a lot of pain, people suggest calling the clinic to say so. Several describe the examination being changed, for example looking only at the outside, once the clinician knew.
Where it fits with other options
Most fissure care focuses on keeping stools soft and regular so nothing hard passes. People typically discuss these options with a clinician or pharmacist first:
- Fluids, fibre and food changes
- Osmotic laxatives and stool softeners
- Glycerin suppositories, which some people with fissures also find difficult to use
- Prescribed treatments that relax the sphincter
If constipation has built up to the point where an enema feels like the only option, that is worth a same-day conversation with a pharmacist or GP.
When to seek care
Call 999 or go to A&E if bleeding is heavy, if you feel faint or confused, if you have severe tummy pain or a swollen hard tummy after an enema, if you are vomiting and cannot pass stool or wind, or if you have passed very little urine after a phosphate enema.
Get urgent help (NHS 111, your GP, or your local urgent care line) if you have:
- Bleeding after an enema that does not stop
- Sharp anal pain after an enema that keeps getting worse
- Fever, swelling or discharge near the anus
- Dizziness after using a phosphate enema
See your GP or clinician if constipation keeps coming back, if you find yourself needing enemas regularly, or if you have been asked to have one before a procedure and do not think you can.