Enemas or suppositories

• Ensure a medication order is present.
• Gather the required equipment
• Non-sterile gloves
• Apron
• Water-based lubricant
• Protective pad (Bluey) if required
• Soap and water / wipes (for in bed)
• Plastic bag/bin available (for rubbish disposal)
• Ensure the individual’s dignity and privacy always is maintained
• Introduces self to the person. Checks person identification. Explains procedure and obtains verbal consent. (Demonstrating understanding of need to stop immediately if individual requests).

If unstable injury:

• Procedure needs to take place during formal “log roll” procedure.
• Ensure position of person such that spinal alignment is always maintained

If stable SCI:

• Procedure can take place in bed
• Place person in left lateral position (if possible), flexing the knees to promote stability and expose the anus

If procedure taking place in shower commode:

• Position for comfort and anal access
• Consider additional needs for safety such as positioning to ensure anal skin is not stretched during the procedure, using a chest strap insitu and/or using a tilt on the commode chair.
• Place protective pad, if required on the bed or floor of bathroom. Enemas can be given over the toilet if there is adequate access.
• Don plastic apron, wash hands and put on a pair of non-sterile gloves.
• Observe individual throughout procedure (especially those at risk of Autonomic Dysreflexia (AD))
• If known to suffer discomfort or signs/symptoms of AD- local anesthetic gel may be instilled into rectum 10 minutes prior to procedure
• Generously lubricate index finger with water-based lubricant.
• Inform person when beginning and insert single lubricated gloved finger slowly and gently into rectum (digital check for faeces).
• Remove faecal matter if required and dispose of gloves. Re-apply new pair of second gloves.
• If a suppository is being used, this is inserted with the person in a lying position on the bed. Some suppositories require time to melt and become effective. The person can be transferred to the toilet/commode when the suppository has had time to melt and prior to a bowel movement commencing. A protective bed pad may be required for the transfer for protection. Please see more information in the Right Time for selecting suppositories.
• If an enema is being used, this can be inserted with the person lying on the bed or sitting on the toilet or commode. The enema will have a shorter response. Please see the Right Time for selecting enemas.
• Generously lubricate the suppository.
• Gently insert tip of finger into rectum to insert suppository into rectum approximately 4cm (to the second finger joint) ensuring contact against the mucosal wall.
• If using enema remove the top and lubricate length of administration tube, and slide enema into rectum, ensuring it is administered close to mucosal wall. The full length of the administration tube is inserted. Move the enema in a circular motion to provide additional stimulation. When removing the enema, keep squeezing the tube until the nozzle is completely removed to avoid vacuuming the contents back into the tube.
• Dispose of faecal matter in appropriate receptacle.
• Remove gloves and apron, discard accordingly and performs hand hygiene.
• Apply non-sterile gloves to clean and dry person's buttocks and anal area.
• Reposition person and perform hand hygiene.
• Record outcome such as amount, consistency as per Bristol Stool Scale.
• Record any abnormalities to person, team leader or medical officer and documents accordingly.

Most of the enemas and suppositories in spinal cord injury (SCI) bowel management are not scheduled medications. This means that they can be bought over the counter without a script. The funding utilised following a SCI will influence the pathway options to access enemas and suppositories in the community.

These can be purchased from a pharmacy or a continence product company.

A person may be eligible for some reduction in price with a prescription from a doctor (see Information for GP scripting) when these items are purchased at a pharmacy.

Refer to the funding sources below for more information or contact the relevant funding co-ordinator.

Most of the types of enemas/suppositories used in spinal cord injury bowel management can be bought over the counter without a script as they are not scheduled medications.

However, to access enemas/suppositories at a cheaper price, the GP can provide a prescription subsidised by the Pharmaceutical Benefits Scheme (PBS) as a Restricted Benefit.

• If the person has a Pensioner Concession Card or Health Care Card, the prescription will reduce the price to standard PBS medication prices – (A significant saving).
• If the person does not hold a Pensioner Concession or Health Care Card, the prescription may not significantly reduce the price of the enemas/suppositories; but it will contribute towards the person’s PBS Safety Net.

To access key PBS-subsidised enemas or suppositories, please prescribe: