Definitions

Douching: technically refers to cleansing the vaginal canal with liquid

Enema: delivers water or a solution directly into the rectum to loosen fecal matter and stimulate a bowel movement (i.e. pooping). Can be done as a way of relieving constipation or as a way to “clean house” before anoreceptive sex

Ways to douche

1. Bulb enema: a common “over the counter” option you can find at drugstores. Includes a bulb (filled with fluid) attached to a nozzle which can be inserted into the rectum

Can buy reusable rubber enemas that you fill with tap water, or can buy brand names (such as Fleet enemas) that come pre-filled with solutions designed to help stimulate a bowel movement - more on these solutions later.

Bag enema: 

A rubber bag with a small tube attached. You fill the bag with water, lock the tube shut with a small plastic piece and insert the other end of the tubing into the anus

A great option for folks who need to be in certain positions while douching or have mobility differences 

Shower nozzle:

What it sounds like. Beware of the high velocity and large volumes that come with shower nozzle douching. These can be damaging to the rectum!

Best practices – or, how to ace your douching exam

1. Dietary fiber

What to buy: something with psyllium husk or high soluble fiber as the active ingredient. No need to buy brand names (all you’re paying for is the muscular torsos on the labels, which...fair)

The dose: scale up slowly (every other day) to avoid bloating, cramping and other side effects. Increase gradually, and goes best with water

2. The actual gymnastics – er, mechanics

Positioning: bent at the waist (this straightens the rectum, making it easier to get liquid where it needs to go)

Place lube on the tip of the device to prevent local trauma to the area

Insert the device into the rectum but not too far (otherwise water goes too far in and you pull down unformed stool into the very area you want to cleanse)

Hold a Coke can-volume of water for about a minute

Expel into the toilet

Myth-busting

“The harder and faster I douche, the better”

Douching at high volumes/speeds (e.g. with shower nozzles) can can physically damage the rectum 

Water can travel too far and risk pulling extra feces into the rectum

“I can douche as often as I’d like”

Aim to douche no more than 1x/day and 3x/week 

When we say once a day, we mean the entire process of clearing the rectum, knowing that you may need more than one rinse per sitting, so to speak

Some experts have pointed out that douching runs the risk of stripping the colon of its mucosal layer – which plays an important protective role

“Douching with ~fancy~ commercial solutions is better than douching with plain water”

Douching with water - tap water - is preferable over other solutions (such as those found in brand-name enemas)

No need to look for “pH balanced” solutions – the anus is a neutral pH with the rest of the body

Moreover, some of these solutions are designed to irritate the colon/rectum to help you poop, which – while useful for constipation – should be avoided if you plan on inserting something else into your rectum shortly thereafter

“Using warmer water helps cleanse more effectively”

Remember: the tips of our fingers can handle water temperatures a lot higher than than what our insides can

Lukewarm water is the way to go (since cold water, while safe, is not terribly pleasant) 

“Douching after sex will help me avoid sexually transmitted infections”

In fact, the opposite may be true, as further local mucosal injury and introduction of pathogens may increase the risk of injury and/or acquiring an infection. 

Overall, douching after sex does not decrease the risk of getting a sexually transmitted ifnection and has no proven health benefit.

Douching and sexually transmitted infections

There’s very little scientific literature on this subject. However, the few studies we’ve found suggest that those who douche > 1x per week may have an increased association with getting an STI, such as chlamydia, gonorrhea, or HIV

The reasoning behind this: in those who douche, the outer protective layer of cells in the rectum can sometimes be removed. This means that bugs that cause STIs have increased access to their port of entry, so to speak.

For people who have sex without condoms, remember that part of being a responsible sex partner is getting screened for STIs in the sites you use for sex (including your butt and throat)

Is there anyone who should think carefully about douching?

Patients with high-inflammatory states affecting their rectum: 

Particularly underlying colitis, active rectal or anal infections, active HPV. 

In these cases, douching may exacerbate the underlying condition by further irritating the rectum.

Patients whose immune systems aren’t running at 100% (such as those with HIV and low CD4 counts): 

These folks can be susceptible to a greater number of infections. 

Important to make sure filtered or bottled water is being used

Patients with chronic kidney disease:

Folks with chronic kidney disease have a hard time clearing phosphate from their systems.

Here, the pro-tip is to avoid using phosphate solutions (such as those found in Fleet enemas) since this introduces extra phosphate to your retum which can then be absorbed into your body.