A 47-year-old woman underwent a self-administered coffee enema with
hot water for bowel cleansing. She immediately evacuated the enema because of
intense rectal pain. She was referred to our clinic 72 hours later with a 3-day
history of hematochezia, rectal pain, and pain with defecation. Flexible
sigmoidoscopy revealed erythematous, ulcerated mucosa extending to
approximately three-fourths the circumference of the rectal mucosa and
18 cm in length ([Fig. 1]). There was
normal mucosa beyond 18 cm. The patient was sent home with stool
softeners. Hematochezia continued for 3 days, after which bowel movements
became normal. Pain with defecation continued for 5 days. By the 7th day all
symptoms had resolved completely. On the 15th clinical day, endoscopy showed
improvement of the rectal mucosa with decreased erythema ([Fig. 2]). By 6 weeks after initial presentation, the
rectal mucosa was normal ([Fig. 3]) and the
patient had recovered well without any complications such as rectal
stricture.
Fig. 1 Erythematous, ulcerated
mucosa extending to 18 cm.
Fig. 2 Decreased erythema of
the rectal mucosa 15 days after clinical presentation.
Fig. 3 Normal rectal mucosa 6
weeks after presentation.
Enemas have long been used for bowel cleansing and for constipation.
Coffee enemas are one of many herbal remedies that are being increasingly
recommended to patients under the care of holistic practitioners. Some
alternative practitioners claim that coffee enemas detoxify the blood or liver
as well as provide relief of constipation. The proposed mechanism of action is
that caffeine stimulates relaxation of smooth muscles causing dilatation of
blood vessels and bile ducts. Enzymes present in coffee stimulate the removal
of toxins from the blood and the fluid of the enema results in peristalsis and
transit of bile from the duodenum into the rectum [1].
When coffee is used in an enema, care must be taken to ensure that the coffee
is cooled prior to use to prevent complications such as rectal burn, permanent
rectal stricture resulting from a rectal burn injury [2],
and bowel perforation.
Endoscopy_UCTN_Code_CCL_1AD_2AJ
