In the past, enemas were a routine part of home medicine. Until approximately 60-70 years ago, the tool used to administer enemas was typically a rubber or plastic container connected to tubing, and nozzles were a standard item in many household medicine cabinets. This practice involves rectal administration of liquids or gases that contain nutrients or medications and is used both preventively and therapeutically for a wide range of conditions.

A traditional Italian saying reflected how widespread the practice once was: “Diet and enema cure every illness.” Historically, enemas have been regularly administered to children, a practice that raises ethical and medical concerns.

Ancient Origins

The use of enemas dates back thousands of years. According to historians Herodotus and Diodorus Siculus, ancient Egyptians believed that the ibis cleansed itself with seawater using its long beak during grooming. Egyptians imitate this behavior and practice rectal cleansing as a monthly ritual.

Diverse cultures have developed their own techniques for administering enemas. Some used animal bladders that could be compressed manually and connected to improvised tubes that served as reservoirs for medicinal liquids. Others hollowed out gourds and forced air through an opening to deliver fluid rectally. More simply, mothers administered medicines by blowing them into the rectum of infants lying face down on their laps. It is possible that expressions such as “to blow sugar or pepper into someone’s ass,” meaning to flatter or motivate someone, originated from this practice.

Medical Expansion

The invention of syringes before the 15th century marked a major turning point in the history of enemas. Historians continue to debate whether the device originated with scholars in Alexandria, the Persian physician Avicenna, or his follower Marco Gattinara. As the use of enemas spread across Europe, syringes became a symbol of medical practice in the 17th century, similar to the caduceus.

The French playwright Molière (1622-1673), protégé of King Louis XIV, satirized the widespread use of enemas in his comedy. Paintings from this period, including those displayed in the Louvre in Paris, depicted apothecaries with oversized enema syringes. Detailed records kept by the king’s physicians (Le Journal de la Santé du Roi) found that Louis XIV received approximately 2000 enemas during his lifetime. At times, the procedure was performed up to three times a day, except during the final years of his reign, when his health declined significantly.

Enemas as a Fashion Trend

Bowel-cleansing enemas eventually became fashionable at the court of Louis XV in France. Aristocrats own personal enema syringes made of precious materials. Madame de Pompadour owned one made of ivory, whereas Cardinal Richelieu owned one crafted from silver. Even the anal fistula of the king, which had been surgically treated by his physician Charles-François Félix, became a subject of imitation at court, with some courtiers claiming to suffer from the same condition.

As was common before the French Revolution, the everyday use of enemas was sometimes eroticized in art and literature. Illustrations portrayed the procedure in provocative poses or situations and occasionally referred to it with suggestive expressions such as “the lady’s pleasure.”

Modernization of Practice

Dutch physician Regnier de Graaf (1641-1672) made an important contribution to modernizing enemas. The enema cannula was connected to a flexible rubber tube, thereby reducing the risk associated with rigid syringe tips and easing self-administration. He described this technique in his 1668 treatise, De Clysteribus, which appeared in a 19th-century French translation under the title Molière’s Instrument.

Despite this association with enemas, de Graaf was one of the most influential medical scientists at the time. He published important studies on the physiology of the pancreas and stomach, as well as on reproductive anatomy, and the ovarian Graafian follicle was later named in his honor. This work reflects the broad therapeutic role of enemas. They are used as emollients, laxatives, astringents, analgesics, cleansing agents, and even as a form of nutritional support. Rectal mixtures sometimes contain egg yolk, chicken or beef broth, olive oil, red wine, and other substances.

In his treatise, de Graaf described several types of enemas, the recommended methods of administration, and their medical indications. One example is a smoke enema. Within the framework of humoral medical theory, English physicians have introduced the rectal insufflation of tobacco smoke as a treatment for asphyxia, particularly in victims of drowning. By the 18th century, surgeons aboard British Royal Navy ships had reportedly carried specialized equipment for this purpose.

Modern Medicine

The era, sometimes described as “enema mania,” has ended. Although certain alternative health practices continue to promote enemas, including coffee enemas, modern dietary approaches such as intermittent fasting, short-term fasting, and fasting-mimicking diets do not rely on them.

Currently, enemas are used more selectively in clinical medicine. Current indications for enema use include rectal administration of glucocorticoids and laxatives, bowel preparation before endoscopic procedures, and fecal microbiota transplantation.

This story was translated from Univadis Germany, part of the Medscape Professional Network.