How to use a sucralfate enema

Having radiotherapy to your bowel can cause fragile blood vessels to break and easily bleed.

These damaged blood vessels can be treated by having a sucralfate enema. This is given by inserting a small tube into your bottom so the medicine goes directly into your lower bowel. 

These instructions explain how to prepare and use the enema at home.

Your prescription and equipment

Sucralfate will be provided by our pharmacy and can come in different forms:

• a liquid (suspension)
• dissolvable tablets that will need to be dissolved in water to form a paste

A nurse will supply you with a mini irrigation device or:

• a large syringe
• several catheters (tubes) for giving the enema
• a small plastic medicine pot
• some lubricating jelly

Preparation

Wash your hands and prepare a clean surface in your bedroom or bathroom to work on. 

Tablets

You will need to use a small cup to dissolve the tablets.

1. Fill the cup with 5ml of water
2. Add the tablets to the water
3. Allow the tablets to fully dissolve
4. Draw up all the liquid into the syringe
5. Put the nozzle of the syringe into the open end of the catheter and apply some lubricating jelly to the other end of the catheter

The sucralfate is now ready to use.

Liquid (suspension)

You will need to set aside a particular jug to use just for your enemas. Do not use it for any other purpose like drinking or food preparation. 

1. Fill the jug with at least 40ml of warm tap water 
2. Shake the bottle of sucralfate 
3. Open the bottle and pour just over 10ml (2 x 5ml teaspoons) into the small plastic medicine pot
4. Put the nozzle of the syringe into the pot, and draw up the liquid until the syringe is at the 10ml level
5. Place the syringe on a clear surface while you replace the lid on the bottle
6. Put the nozzle of the syringe into the jug of warm tap water, and draw up water until the plunger is at 50ml
7. Carefully, turn the syringe so that the sucralfate mixes with the water
8. Put the nozzle of the syringe into the open end of the catheter and apply some lubricating jelly to the other end of the catheter

The sucralfate is now ready to use.  However it will settle after a while, so gently shake the syringe just before you use it.

How to use the enema

• Find somewhere comfortable to lie down
• Have a towel to lie on in case of a little leakage
• Make sure you are near a toilet

The enema may be given at room temperature or warmed in warm (not hot) water.

1. Remove the cap from the nozzle
2. Lie on your left side on the towel with your knees drawn up towards your chest
3. Hold the prepared enema in one hand and feel for your bottom with the other
4. Gently guide and insert the lubricated nozzle or tip of the catheter (about 8cm or 3 inches) into your bottom
5. Push down the syringe plunger gently so that all the solution goes into your lower bowel
6. Remove the nozzle from your bottom and stay lying down
7. Try to hold the liquid inside for as long as possible, ideally for at least 15 minutes, even though it will make you feel like you need to go to the toilet to have a poo (open your bowels).  
8. Remain lying down during this time and roll over several times 
9. Spend at least half the time on your tummy as this makes sure the medicine gets to the worst affected parts of your lower bowel
10. Wash and rinse out the medicine pot, syringe and catheter with warm water
11. When you have finished wash your hands

How often to use the enema

Do this procedure every morning and every evening. 

We strongly recommend that you continue to use the enema like this for 10 to 14 days after the bleeding has stopped.  

When the bleeding has stopped, you can use the enema just 1 time each day at a convenient time for a further week. This will make sure the bleeding does not start again.  

If bleeding starts again, go back to using sucralfate enemas 2 times a day. 

To help heal the blood vessels, your doctor may advise you to continue using a sucralfate enema 1 time each day, even if there is no bleeding. 

If you have any difficulties in using a enemas, contact the specialist nurse to discuss any alternatives.  

Storing the medicine and equipment

Store the sucralfate and equipment in a safe place in case the bleeding starts again.