The Big Picture
A rectal suppository is a solid medication inserted into the rectum. An enema introduces fluid into the rectum and lower colon.
These procedures involve inserting something into a body opening. Because of this, safe preparation, correct positioning, gentle insertion, privacy, observation, and reporting all matter.
Giving an enema also has role requirements. Permission must be allowed by the employer’s policy, and the worker must meet the other requirements that apply before performing the procedure.
Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.
Quick tip: Tap, click, or press Enter on any term with a dotted underline and an ⓘ icon to see its plain-English definition.
Start Here If You’re Overwhelmed
Focus on these core ideas:
- Giving an enema is a controlled act, and the authority to perform it should usually be delegated by a nurse. If giving an enema is part of the client’s ADLs, the task is exempt from being considered a controlled act. Employer policy must always allow you to give the enema.
- Before a delegated enema, check whether laws and employer policies allow it, whether you have the required education and training, whether you reviewed the procedure with a nurse, and whether a nurse is available for questions and supervision.
- For an adult, both a suppository and commercial enema tip are inserted about 5 cm (2 in.) into the rectum.
- Stop the procedure if the client has pain, you feel resistance, or bleeding occurs. Report bleeding to the nurse immediately.
- Prepare all needed equipment before beginning because the urge to have a bowel movement may happen quickly.
- Afterward, observe the results and follow employer policy for reporting and recording.
Jump to:
Course Notes: Key Ideas You Need to Know
What an Enema Is
An enema introduces fluid into the rectum and lower colon. A designated health care provider orders an enema.
Enemas may be ordered to:
- remove feces
- relieve constipation
- relieve fecal impaction
- clean feces from the bowel before certain surgeries or X-ray procedures
- relieve excessive flatulence, intestinal distension, and constipation
Constipation means bowel movements happen less often than usual, with stool that is hard, dry, and difficult to pass.
Fecal impaction is a prolonged buildup and retention of feces in the rectum.
Flatulence means excessive gas forms in the stomach and intestines.
Clients with severely limited mobility or paralysis are at risk for constipation or fecal impaction.
Different Types of Enemas
Most enemas are commercial enemas. They come pre-packaged and ready to administer.
Some enemas, such as a saline enema, need preparation before administration.
A commercial enema is a small-volume, pre-packaged enema. It stimulates and distends the rectum to cause defecation, which means passing feces from the rectum through the anus.
Commercial enemas are often ordered for constipation when complete bowel cleansing is not needed. Children should receive only the amount stated in their care plan.
Why Enemas Require Care
Enemas are usually safe, and some clients give themselves enemas at home.
Still, an enema is invasive because a tube enters a body opening. The procedure can be dangerous for any adult and carries greater danger for people with certain heart and kidney diseases.
Giving an enema is a controlled act , so the authority to perform it should usually be delegated to you by a nurse.
Before Accepting a Delegated Enema
Before performing a delegated enema, you must first answer these questions:
- Do provincial or territorial laws and your employer’s policies allow you to perform it?
- Do you have the required education and training?
- Have you reviewed the procedure with a nurse?
- Is a nurse available to answer questions and supervise you?
When giving an enema forms part of the client’s activities of daily living, or ADLs, the task is exempt from being considered a controlled act.
Key rule: Permission for you to give an enema must always appear in your employer’s policy.
Nova Scotia CCA Note
Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition describes an enema as a controlled act that should usually be delegated by a nurse. Nova Scotia’s current Continuing Care Assistant Occupational Standards of Practice gives more detail about delegation. It specifically lists suppositories as an example of a client-specific or delegated task from a regulated healthcare professional.
When a task is delegated in Nova Scotia, it must be employer-approved and specified in the care plan by a regulated healthcare professional. The task is client- and situation-specific, is not transferable, and includes time restrictions. The regulated healthcare professional provides training, verifies the CCA’s competency, and determines the type and level of supervision. A CCA must not work outside the CCA Occupational Standards of Practice or the employer’s policies and procedures.
Why this matters in Nova Scotia: For Nova Scotia study and practice, delegation involves more than permission to perform a task. Employer approval, the care plan, training, competency verification, and supervision all matter.
Official source: Continuing Care Assistant Occupational Standards of Practice (novascotiacca.ca)
Last checked: September 23, 2026
Key Facts About a Commercial Enema
The solution is usually given at room temperature.
When giving the enema:
- squeeze the sides of the bottle with enough pressure to move the solution into the rectum
- roll the bottle upward from the bottom as it empties
- keep pressure on the bottle while the tip remains inside the rectum
- release the pressure only after removing the tip
Releasing pressure too early can draw solution from the rectum back into the bottle.
Encourage the client to keep the solution inside until they feel the urge to have a bowel movement. A commercial enema usually takes 5 to 10 minutes to work. Some people feel the urge immediately, while others become incontinent of stool.
Because the response can happen quickly, have all equipment ready before starting.
Remaining in Sims’ position on the left side can help the client retain the enema longer.
Protect the Client’s Quality of Life
During the procedure, promote:
- dignity
- independence
- individualized care
- preferences
- privacy
- safety
Pre-Procedure Steps
Keep these steps in order.
- Identify the client according to employer policy. This prevents confusing one client with another.
- Explain the procedure to the client.
- Perform hand hygiene.
- Collect all required supplies before starting.
Supplies include:
- rectal suppository or commercial enema
- bedpan, commode chair, or clean incontinence briefs when needed
- waterproof pad
- water-soluble lubricating jelly
- toilet tissue
- gloves
- robe and nonskid footwear
- sheet
- bag or container for used toilet tissue
If the care plan says the client can use a toilet, try to make sure the toilet is available before starting.
Gathering the equipment first means you do not need to leave the client’s side to retrieve forgotten items.
- Provide privacy.
- If the client uses an adjustable bed, raise it to a comfortable working height. This reduces the risk of back strain. This step may not apply in a community setting.
- Read the directions for safe administration of the enema. This helps reduce the risk of client injury and supports the effectiveness of the enema.
Preparing the Client
Continue the sequence:
- Lower the bed rail near you if it is raised.
- Cover the client with a sheet. Fan-fold the top linen toward the foot of the bed.
- Place the client in Sims’ position on the left side with the right knee bent.
- Put on gloves.
- Place the waterproof pad under the client’s buttocks.
- Expose the anal area.
- Position the bedpan close to the client.
The left-side Sims’ position allows the solution to follow the natural curve of the colon and rectum and helps the client retain it.
Keeping the bedpan nearby prepares for the possibility that the client cannot retain the enema.
Inserting a Rectal Suppository
A suppository is a cone-shaped solid medication inserted into a body opening.
Follow these steps after completing the earlier preparation.
Step 15: Prepare and Insert the Suppository
- Remove the suppository from its package.
- Lubricate its tip with water-soluble lubricating jelly.
- Ask the client to relax the buttocks.
- Separate the buttocks so you can see the anus.
- Ask the client to take a deep breath through the mouth.
- As the client exhales, gently insert the narrow end into the rectum.
- Use your middle finger to push it gently but firmly past the rectal sphincter.
The sphincter is the muscular opening of the rectum.
Number to remember: For an adult, insert the suppository about 5 cm (2 in.), or about the length of your finger.
For children, depending on their size, insert it 1 to 2.5 cm, or about one-half inch to 1 inch.
For infants, insert it about 1 cm, or about one-half inch.
Lubrication helps insertion and reduces the chance of injury. Exhaling helps the sphincter relax.
Step 16: Check Placement and Watch for Problems
If you see or feel a fecal mass, place the suppository between the rectal wall and the fecal mass.
Avoid: Do not insert the suppository into the fecal mass. It will not work effectively there.
Be gentle when hemorrhoids, swollen veins in the anal canal, are present. Insertion can cause pain.
Stop: Stop the procedure when:
- the client complains of pain
- you feel resistance
- bleeding occurs
If bleeding occurs, notify the nurse immediately. Rectal bleeding can indicate a dangerous health concern and must be reported immediately.
After insertion, ask the client to sit or lie with the buttocks closed for at least 15 minutes.
For a child, gently holding the buttocks closed may be necessary.
The waiting time allows the suppository to melt and lubricate the stool for easier evacuation.
Inserting a Commercial Enema
Complete the earlier preparation steps first.
Step 17: Prepare the Enema Tip
- Remove the cap.
- Check whether the tip has enough lubricant.
- Add water-soluble lubricating jelly if needed.
- Gently squeeze the container to remove excess air.
The tip can dry over time. Lubrication helps insertion and lowers the possibility of injury.
Removing excess air matters because air can cause distension.
Insert the Enema Tip
- Separate the buttocks so you can see the anus.
- Ask the client to take a deep breath through the mouth.
- As the client exhales, gently insert the enema tip 5 cm (2 in.) into the rectum.
- Be gentle if hemorrhoids are present.
Exhaling helps the sphincter relax.
Stop: Stop the procedure if the client reports pain, you feel resistance, or bleeding occurs.
If bleeding occurs, notify the nurse immediately.
Give the Enema Solution
- Squeeze the sides of the bottle with enough pressure to push the contents into the rectum.
- Roll the bottle upward from the bottom as it empties.
- Keep pressure on the bottle until the tip is out of the rectum.
- After removing the tip, release the pressure gently.
- Place the empty bottle into its box with the tip going in first.
The enema tip can have stool and microorganisms on it.
After Either a Suppository or Commercial Enema
Continue the ordered procedure.
- Help the client onto the bedpan and raise the head of the bed, help the client into a sitting position, or help the client to the bathroom or commode.
If the client stays in bed, raise the bed rail when it is used.
If the client gets up, make sure they wear a robe and nonskid footwear. Keep the bed in its lowest position.
An upright sitting position helps defecation through gravity.
- Place the call bell, when in a facility, and toilet tissue within reach. Tell the client not to flush the toilet.
Not flushing allows the support worker to observe the colour and amount of stool or urine.
- Discard disposable items according to agency policy.
- Remove your gloves and perform hand hygiene.
Feces can spread pathogens. Wear gloves whenever contact with feces is possible.
- Leave the room if the client can safely remain alone. Stay within hearing distance.
The client can become weak after the procedure and need assistance.
- Return when the client calls. Knock before entering.
- Perform hand hygiene and put on gloves.
- Lower the bed rail if it is raised.
Observe and Report the Results
- Observe the enema results for:
- amount
- colour
- consistency
- odour
Follow employer policy for reporting the results.
In some facilities, the support worker calls a supervisor to observe the results. In a community setting, report the effectiveness of the enema according to agency policy.
Abnormal results can indicate illness or other health concerns.
Complete Client Care and Cleanup
Continue the sequence:
- Help the client clean the perineal area. This provides comfort and can help prevent skin breakdown around the anus.
- Remove the bed protector.
- Follow employer policy for emptying, cleaning, and disinfecting the bedpan or commode. Flush the toilet.
- Return equipment to its proper place.
- Remove your gloves and perform hand hygiene.
- Help the client wash their hands. Wear gloves if needed.
- Replace the top linen and sheet.
Post-Procedure Steps
- Provide for the client’s safety and comfort.
- Place the call bell within reach. This step may not apply in community settings.
- Return the bed to its lowest position and follow the care plan for bed rail use. This step may not apply in community settings.
- Remove the privacy measures.
- Follow employer policy for handling soiled linen and used supplies. Wear gloves.
- Perform hand hygiene.
Report and record: Report and record your actions, observations, and basic assessments according to employer policy.
These records and reports help keep the health care team informed and are also completed for legal reasons. Abnormal observations can indicate illness or health problems.
Nova Scotia CCA Note
Sorrentino uses the broad phrase “basic assessments.” In Nova Scotia’s current CCA Occupational Standards of Practice, the CCA role includes an observational point of care assessment, or POC assessment. The CCA observes the person and the care environment before, during, and after care to recognize changes that need to be escalated to a supervisor.
A POC assessment is not a nursing assessment. It does not permit a CCA to complete a comprehensive evaluation that analyzes and evaluates information to make care-planning decisions. The CCA remains limited to observations that support care-plan delivery and help identify changes that require escalation.
Why this matters in Nova Scotia: When you see the word “assessment,” separate CCA observation from a comprehensive nursing assessment. The Nova Scotia CCA observes, follows the care plan, documents required care, and escalates changes within the CCA role.
Official source: Continuing Care Assistant Occupational Standards of Practice (novascotiacca.ca)
Last checked: September 23, 2026
Exam Clue Words
- First: Before performing a delegated enema, first check the four requirements involving laws and policies, your training, review with a nurse, and nurse availability.
- Must: Employer policy must always give permission for you to perform an enema.
- Avoid: Do not place a suppository inside a fecal mass, and do not release pressure on an enema bottle while the tip remains in the rectum.
- Report: Report rectal bleeding to the nurse immediately.
- Follow the care plan: Follow the client’s care plan for matters such as the amount of enema given to a child and bed rail use.
Common Mix-Ups
| Wrong Idea | Better Idea |
|---|---|
| An enema that is part of ADLs needs no employer permission. | Employer policy must still allow you to give the enema. |
| Release the enema bottle while the tip is still inserted. | Keep pressure on the bottle until the tip is removed. |
| Keep going when the client has pain or you feel resistance. | Stop if there is pain, resistance, or bleeding. |
| Put the suppository into a fecal mass. | Place it between the rectal wall and the fecal mass. |
| Flush before the worker checks the results. | Leave the toilet unflushed so the results can be observed. |
Fast Review
There are many steps, so focus first on the rules that change what you do. Then review the procedure in order.
- An enema introduces fluid into the rectum and lower colon.
- A commercial enema comes pre-packaged and ready to administer.
- Giving an enema is a controlled act, and the authority to perform it should usually be delegated by a nurse. When giving an enema is part of the client’s ADLs, the task is exempt from being considered a controlled act.
- Employer policy must always permit you to give an enema.
- Before starting, collect all supplies and provide privacy.
- Position the client in Sims’ position on the left side with the right knee bent.
- For an adult, insert either the suppository or commercial enema tip about 5 cm (2 in.).
- Never insert a suppository into a fecal mass. Place it between the rectal wall and the fecal mass.
- Stop if the client has pain, you feel resistance, or bleeding occurs.
- Report bleeding to the nurse immediately.
- A commercial enema usually works within 5 to 10 minutes, although the urge to defecate can occur immediately.
- After the procedure, observe the results and follow employer policy for reporting and recording.
Final Pep Talk
This topic has a long sequence, so study it in sections instead of trying to hold every step in your head at once. Keep reviewing the preparation, insertion, stop rules, and aftercare until the order starts to feel familiar.