What Does Soapsuds Enema (SSE) Mean?

A soapsuds enema (SSE) is a widely recognized method for inducing bowel movements by stimulating the colon. This simple but effective procedure is often used in medical settings for bowel cleansing before surgeries or diagnostic procedures, and it can also relieve constipation. The treatment involves creating a solution by dissolving 1 ounce of soft soap in 2 pints of hot water (at around 100°F or 38°C), which is then administered into the colon to provoke a bowel movement.

How Does a Soapsuds Enema Work?

The soapsuds enema works by causing irritation in the colon lining, which stimulates the muscles of the intestinal wall (the smooth muscles) to contract and initiate peristalsis—the wave-like movements that propel fecal matter through the digestive tract. The presence of soap in the solution enhances this reaction, making it a more aggressive form of enema compared to simple water or saline enemas.

1. Irritation of the Colon: The soap’s alkaline nature irritates the mucosal lining of the colon, leading to increased bowel movements.
2. Stimulated Peristalsis: As the colon reacts to the irritation, it stimulates peristalsis, which helps in evacuating the fecal matter.
3. Softening of Stool: The water used in the enema can soften hardened stool, making it easier to pass during the process.

Indications for a Soapsuds Enema

A soapsuds enema is usually indicated in the following situations:

• Constipation Relief: When regular laxatives or dietary changes fail to relieve constipation, an SSE may be employed as an effective treatment.
• Preoperative Preparation: It is often administered before surgeries or procedures like colonoscopy to clear the bowel.
• Bowel Cleansing: SSE may also be used in cases of fecal impaction or to prepare the intestines for diagnostic imaging tests like a barium enema.

How to Perform a Soapsuds Enema

Administering a soapsuds enema requires careful preparation to ensure effectiveness and patient comfort:

1. Solution Preparation: Dissolve 1 ounce of soft soap in 2 pints of warm water at a temperature of approximately 100°F (38°C). Ensure the soap is thoroughly mixed with the water.
2. Patient Positioning: Have the patient lie on their left side with their knees drawn toward their chest (also known as the Sims position), as this facilitates easier flow of the solution into the colon.
3. Enema Administration: Gently insert the enema tube or nozzle into the rectum. Slowly allow the solution to enter the colon, stopping if the patient experiences discomfort or cramping.
4. Retention Time: Encourage the patient to retain the enema for as long as possible (ideally 5 to 15 minutes) to allow the solution to work effectively.
5. Evacuation: After retaining the solution, the patient should sit on the toilet to evacuate the contents of their bowel.

Risks and Precautions

While a soapsuds enema is generally safe, there are some risks and precautions to consider:

1. Mucosal Irritation: The soap in the enema can cause irritation or inflammation in the colon lining if used too frequently or with too strong a solution.
2. Dehydration: Enemas, in general, can lead to dehydration if used repeatedly without adequate water intake.
3. Electrolyte Imbalance: Prolonged use can lead to an imbalance in electrolytes, particularly in patients with underlying medical conditions.
4. Perforation: In rare cases, improper technique or excessive pressure can cause perforation of the colon, which is a medical emergency.

It’s essential to consult a healthcare provider before using a soapsuds enema, especially for patients with gastrointestinal disorders such as ulcerative colitis or Crohn’s disease, where irritation of the colon should be avoided.

Alternatives to Soapsuds Enema

Other types of enemas may be used depending on the medical indication:

• Saline Enema: A gentle solution of salt and water that causes minimal irritation, making it a better option for people with sensitive colons.
• Mineral Oil Enema: Used to soften stool and lubricate the colon, often prescribed for constipation.
• Phosphate Enema: A hypertonic solution that draws water into the colon to stimulate bowel movements.

Conclusion

A soapsuds enema (SSE) is a traditional and effective method of bowel cleansing, widely used in both medical and home settings. When properly administered, it can relieve constipation and prepare the colon for medical procedures. However, caution should be exercised to avoid potential complications, and it is always best to consult with a healthcare professional before using an SSE.