ORIGINAL

Niger J Paed 2012; 39 (3): 115 - 117

Eyong K I

Ekanem E E

Inah G B

Enema abuse by mothers of children

presenting to the emergency room at

the University of Calabar Teaching

Hospital

Etuk I S

Inyang A W

Adams B E

Eyong M E

DOI:http://dx.doi.org/10.4314/njp.v39i3.5

Accepted: 2nd November 2011

and fever were the predominant

reasons why enema was given.

Types of enema given were herbal

concoctions in 13(59.1%) plain

water enema in 8(36.4%) and salt

water enema in one (4.5%) child.

Electrolytes derangements were the

commonest associated findings.

Others were convulsions/coma,

intestinal perforation, acute renal

failure and severe dehydration from

diarrhoea.

Conclusion: Enema abuse is a con-

tinuing cultural phenomenon in the

Calabar area. It is associated with

severe consequences including in-

testinal perforation. Enema abuse

should form part of history taking

in this environment and child care

practitioners should actively search

for possible complications. Most

importantly, health education to

stem this widespread practice

Abstract Enema is largely used

and widely abused in our commu-

nity for various ailments including

fever, constipation; abdominal

pains vomiting and even diarrhoea.

Objectives: To describe the abuse of

enema at home in the Calabar area,

and the associated findings among

children who received enema.

Method: Children admitted to the

Children Emergency Unit of the

University of Calabar Teaching

Hospital with history of enema use

at home were recruited into the

study. The presenting symptoms,

type of enema used and associated

findings were documented. Rele-

vant investigations were carried out

where necessary. Tables and simple

proportions were used to analyze

the data.

(

)

Ekanem E E

Eyong K I, Etuk I S, Adams B E,

Eyong M E

Department of Paediatrics,

Inah G B

Department of Radiology

P M B 1115

University of Calabar , Calabar.

Email:dreeell@yahoo.co.uk

Inyang A W

Department of Surgery ,

University of Calabar Teaching

Hospital, Calabar

Results: Twenty two children were

seen with enema abuse over a six

months period. Diarrhoea diseases

9

Introduction

have been used as enemas.

Enemas are used in many settings and for many

Enema is largely used and widely abused in our com-

munity for various ailments including fever, cons₁t₀ipa-

tion, abdominal pains vomiting and even diarrhoea.

This prospective work was designed to describe the

abuse of enema at home in the Calabar area, and the

associated problems that may arise from such abuse.

It is hoped that the work will draw attention to this prob-

lem and increase the acumen of child health practitio-

ners in preventing, recognizing and managing the prob-

lem.

purposes. These purposes include bowel cleansing

before radiologic procedures, aiding in the administra-

tion of food and medic₁ine, and treating constipation and

encopresis in children. Enema preparations often used

in paediatrics, such as barium, soapsuds, and saline,

have been associated with infrequent but important com-

plications. Multiple reports describe metabolic derange-

ments in serum phosphate, magnesium, sodium, calcium

and potassium with the use₁_-₄of sodium phosphate, mag-

nesium phosphate, enemas

Transient bacteraemia has been no_,₆ted with the use of

5

barium, air, and coffee enemas. Colonic perforation

Subjects and Methods

7

,8

has been reported with over-the-counter enemas.

Allergic and anaphylactoid reactions have also been

observed when saline, barium, and herbal preparations

Subjects were children seen in the Children Emergency

Unit (CHU) of the University of Calabar Teaching Hos-

1

16

pital from May to October 2010 with history of enema

use at home. The socio-demographic data of the parents

and children were recorded. The symptoms that

prompted parents and caregivers to give enema were

also recorded. The type of enema given, the period from

enema administration to admission or presentation in the

hospital and the reason for enema administration was

also noted. Findings at physical examination were re-

corded. The associated findings observed following ad-

ministration of enema were documented. The electrolyte

profile, blood culture, abdominal x- ray and abdominal

ultrasound scan were carried out where applicable.

Tables and simple proportions were used to analyse the

data.

Table 3: Type of enema administered in 22 children

Type of enema

Number

Percentage

Herbal enema

Plain water enema

Salt water enema

Total

13

8

1

59.1

36.4

4.5

22

100

Electrolytes derangement such as Hypokalaemia, hypo-

natraemia, hypernatraemia and hyperkalaemia/acidosis

were the commonest associated findings. Others were

convulsions/coma, intestinal perforation, acute renal

failure and severe dehydration. (Table 4)

Table 4: Associated findings in 22 children who re-

ceived enema

Results

Associated findings

Number of children

%

Of the 845 children admitted into CHU of the University

of Calabar Teaching Hospital during this period, 22 had

history of enema abuse representing 2.6% of the admis-

sions within the period. Thirteen were males while nine

were females.

Hypokalaemia

Hyponatraemia

Hyperkalaemia/acidosis

Hypernatraemia

Diarrhoea with hypovolaemic shock

Intestinal perforation

Convulsion/coma

Acute renal failure

No complication

4

3

1

4

2

1

5

22

18.2

13.7

4.5

18.2

9.1

4.5

22.8

100

Table 1 shows the age and gender distribution of the

children with enema abuse. Diarrhoeal disease and fever

were the predominant reasons why care givers adminis-

tered enema. Other reasons were convulsions, abdomi-

nal pains, cough and vomiting (Table 2). Herbal con-

coction was the commonest substance used by parents in

Total

1

3(59.1%) children followed by plain water enema in

eight (36.4%) and salt water enema in one (4.5%) child

Table 3).

(

Discussion

Table 1: Age/sex distribution among children who

received enema

Enema is widely used and largely abused in our locality.

It is a popular phenomenon₁i₀n this region as previously

reported by Archibong et al.

Age

Sex

0-12 13-24

25-36

>36

Total

Major reasons why care givers give enema include treat-

ment of diarrhoea and fever. Others are for abdominal

pains, vomiting, cough and convulsions in contrast to

western series where constipation and fecal impaction

w₁₁_,e₁₂re the primary reasons for administration of enema.

Males

Females

6

4

2

1

3

2

13

9

Total

10

4

3

2

22

Table 2: Reasons for administration of enema

Clinical deterioration associated with electrolyte abnor-

malities have been previously reported with the use of

many types of enemas. These abnormalities include hy-

pokalemia, hypocal₃c_,₄emia, hypophosphatemia, acidosis,

Reasons

Number

Percentage

Fever

7

4

2

1

31.8

18.3

9.1

4.5

Diarrhoea

Abdominal pain

Vomiting

Convulsion/coma

Cough

and hypernatremia.

In our study hyponatremia, hypo-

kalemia, hypernatraemia, hyperkalaemia and acidosis

were the main associated electrolytes abnormalities .

While it is not clear whether this were primarily due to

enema abuse it may at least have contributed to this and

worsened the condition of the child.

1

22

Total

100

1

Moore et al described children with an “enema syn-

drome” where hyperkalemia was noted following ad-

ministration of a variety of enemas. In their study, hy-

1

17

perkalemia was a predictor of fatal outcome. We found

only one child with associated hyperkalaemia who re-

ceived herbal enema. The same child also had meta-

bolic acidosis and renal failure. He fortunately recovered

and was discharged home.

Conclusion

Children were and are still routinely given enema ‘to

cleanse the bowel’. This practice has been associated

with severe consequences.

Enema abuse should form part of history taking in this

environment and child care practitioners should actively

search for complications. Most importantly health edu-

cation to stem this widespread practice should be em-

phasized.

Intestinal perforation is another described hazard of en-

ema administration and is suggested to occur from₇_,₈either

tip injury or increased intraluminal pressure.

We

found two children with intestinal perforation in our

study. Both had surgery, unfortunately one died at sur-

gery and the other survived. Typhoid perforation was

excluded by stool and blood cultures and no other expla-

nation could be found except enema abuse.

Conflict of interest : None

Funding : None

The present study observed convulsion in one child who

also lapsed into coma. This child had received plain wa-

ter enema and developed hyponatraemia and this may

probably be responsible for the convulsions and coma.

Acknowledgement

We are grateful to the parents and children who participated in

the study for their cooperation in supplying relevant informa-

tion. We are also grateful to resident doctors and nurses in

children emergency room for their roles in the management of

these children.

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