By Steve Hodges, M.D.
Some years ago, I began recommending olive oil enemas as part of a treatment regimen for intractably constipated children — kids whose rectums harbored hard, dry masses of stool that just wouldn’t budge
Though this remedy, referenced in old textbooks and first added to my bag of tricks by an Icelandic mom, had not been tested scientifically, I could see that oil enemas were safe and highly effective for impacted stool and made a ton of sense. That was good enough for me.
Well, here’s something even better: This old-school remedy has now been validated by published research.
Doctors at a children’s hospital in Kobe, Japan, reviewed records of 118 severely constipated children who were prescribed olive oil enemas in the outpatient pediatric surgery department. The study, published in the Journal of Pediatric Surgery, arrived at two conclusions supported by my own clinical experience: 1.) “Olive oil enemas are a safe and effective remedy for chronic constipation,” and 2.) “Olive oil enemas followed by glycerin enemas are useful for fecal disimpaction.”
The Japanese study included children with “functional constipation” — otherwise healthy kids with a garden-variety clogged rectum — as well as children with anatomical or neurological conditions that make pooping difficult, such as Hirschsprung disease and spina bifida.
Among both groups, olive oil enemas were deemed useful in about 77% of cases.
This result would no doubt have pleased the 19th-century German physician who apparently pioneered this treatment, Dr. Adolph Kussmaul, as well as his colleague, one Dr. Fleiner, a “tremendous supporter” of olive oil enemas.
Indeed, according to an 1892 medical journal, Dr. Fleiner considered oil olive enemas “a ready and safe method of relieving even the most obstinate cases of spasmodic constipation.”
I second the notion!
The mom who reminded me of this remedy was a member of our private Facebook support group. She’d posted that her 7-year-old son’s chronic poop accidents (encopresis) had resolved quickly with a daily enema regimen but that his bedwetting and daytime pee accidents (enuresis) persisted.
This scenario is quite common and easily explained: Whereas even a modest improvement in constipation can halt encopresis (in the short run, anyway), enuresis typically does not resolve until a child’s rectum is more thoroughly cleaned out, allowing the enlarged rectum to shrink and stop aggravating the bladder nerves.
The dried-out lump of stool in the Icelandic 7-year-old’s rectum was stubborn as heck, and a veteran nurse at his pediatrician’s office suggested overnight olive oil enemas, a remedy used back in the day. As the boy’s mom posted in our support group, the treatment helped her son.
While the boy slept, the olive oil softened the impacted poop. In the morning, a large-volume enema with glycerin, the boy’s usual daily treatment, flushed out crusty remnants. The boy continued with his daily large-volume enemas, and soon his enuresis diminished. An x-ray showed the child’s rectum was, at long last, emptying.
Before long, other families in our Facebook group, stuck in the same boat, so to speak, were trying overnight oil enemas. As one mom posted, “Years of poop build-up is hard to clean out. I feel like I am chipping away at a cement block with a garden hose!”
Enough of our Facebook members reported success with this treatment that I began recommending these overnight oil-retention enemas, followed by morning large-volume enemas, to my own stubbornly constipated patients. In 2018, I included this method in my guidebook for treating enuresis and encopresis, The M.O.P. Anthology. I even gave overnight oil-enema treatment a name: Double M.O.P., because the child would be receiving two enemas in a 24-hour period: an oil enema followed a stimulant enema to wash out the remains.
(M.O.P., the Modified O’Regan Protocol, is the enema regimen I typically recommend for treating both encopresis and enuresis.)
In the most recent version of the M.O.P. Anthology, I expanded my section on oil-retention enemas. Turns out, my rough guidelines jibe with those of the doctors who championed this method 120 years ago.
Dr. Fleiner, for instance, recommended patients repeat olive oil injections daily “until the intestine is cleared of its contents” — typically 2 or 3 consecutive days, followed by periodic oil enemas as needed.
Dr. George Herschell, a London physician who considered oil enemas “without question most valuable,” espoused a more extended regimen: overnight oil enemas for 2 or 3 weeks, followed by injections on alternate nights and then periodically as needed.
I’ve had patients try both approaches and many schedules in between, whatever their families can manage. Let’s face it: an overnight oil enema followed by a morning stimulant enema isn’t ideal for any kid rushing off to school. Plus, oil can continue to leak out during the day.
The ensuing stimulant enema is important for evacuating the crusty detritus. The Japanese study reports that olive oil enemas followed by glycerin enemas were “significantly more effective for treating fecal impaction than olive oil enemas alone.”
Based on patient reports, I'd say a morning large-volume enema, with a reusable enema kit, more effectively washes out the remain than smaller volume, store-bought varieties. (I discuss the difference at length in the Anthology.)
For most folks, weekends work best for oil-retention enemas, though the pandemic lockdown afforded some eager families a chance to experiment with this remedy on weeknights.
One mom in our support group, whose 8-year-old who had oil enemas nightly for several weeks during the lockdown, posted that her son had made noticeable progress: “For the first time in my son’s life, he’s had no poo accidents for one month. He also went three weeks without any pee accidents during the day.”
The children in the Japanese study were not specifically instructed to let the olive oil sit overnight. In most of the cases, the oil enemas were followed several hours later by a glycerin enema. But I’m with Dr. Herschell: I think the longer can penetrate the hardened lump, the better, so an oil enema before bedtime makes a lot of sense.
My patients inject the olive oil with an enema syringe or bulb or via a store-bought enema bottle that’s been cleaned out. Alternately, some use pre-packaged mineral-oil enemas, which work just as well.
An interesting side note: Dr. Herschell’s patients had no access to such ready-made options, so he developed an apparatus — featuring a glass funnel, 27 inches of rubber tube, and a nozzle — that patients could use to self-administer oil enemas. He deemed his device so safe that “even when roughly or unskillfully used it is impossible to damage the mucous membrane of the rectum.”
I typically recommend oil enemas when an x-ray shows a patient’s rectum remains clogged after a month or more of daily phosphate or glycerin enemas. But many kids don’t need an x-ray to tell them they’ve got poop stuck in there.
“Every night after the pediatric enema, my son, age 6, would say he could still feel a big
poop but that it wouldn’t come out,” one mom posted in our support group. “He kept asking if we could do another enema to make it come out. With the mineral oil, he was able to get out some really hard looking chunks!”
Another mom offered: “Fleet enemas weren’t getting enough of the old stuff out. Mineral oil makes the hard poop slippery enough that by bearing down, My daughter can push some out. Fleet in the morning produces hard pieces followed by fresh, soft poop.”
Oil enemas aren’t a difficult treatment to administer. In the Japanese study, 115 of the 118 families complied with the hospital’s recommendation.
Among the children with impacted stool, only 9 still needed manual evacuation under general anesthesia. Thanks to the olive oil, the others were able to avoid such an invasive treatment.
Yes, general anesthesia is sometimes needed for severe constipation! Impacted stool is no joke. Though constipation among children is often dismissed as a temporary, trivial condition, in reality, millions of children end up with chronic pee or poop accidents, and tens of thousands of kids land in the emergency room, visits often triggered by severe abdominal pain.
Today’s doctors push high-dose PEG 3350 (Miralax) clean-outs for resolving severe constipation, a method that often creates a mess and doesn’t even work. Enemas of any kind seem to provoke a collective freak-out.
In my experience, an rectal clean-out — regardless of the method is used — is only fully effective if followed by daily regimen that stimulates daily evacuation of the rectum.
As the Japenese study found, and my own experience confirms, oil enemas can help both with the disimpaction and, in the most stubborn of cases, with the follow-up treatment, too.
Back in 1904 Dr. Herschell lamented that olive oil enemas, commonly used in Germany at the time, “appear to have been much neglected” in England.
I’m pleased that 21st-century Japanese doctors are not neglecting this remedy, and I urge my American colleagues to follow suit.