MURPHY'S ENEMA: WHAT IT CONSISTS OF, PREPARATION AND USES - MEDICINE - 2025

The enema Murphy is a clinical procedure in which a probe is inserted into the rectum of the patient through which solutions and drugs administered. It can also be understood as the equipment used for said procedure and some authors even attribute this eponymous to one of the infused mixtures.

It is another of the great contributions of the famous American surgeon John Benjamin Murphy, mentioned in some previous publications, who also described the Murphy sign (typical of cholecystitis), the Murphy blow, the Murphy test and the Murphy button, in addition of various surgical instruments.

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Unlike most other enemas, this one is not intended to promote bowel movements or defecation. The purpose of the Murphy enema is the administration of treatments through the rectum when no alternative route is available, taking advantage of the great absorption capacity of the intestinal mucosa.

It is also known by the name Murphy's drip. This term is sometimes preferred to distinguish it from traditional enemas and because its use more closely resembles the classic infusion of medications or intravenous solutions, which is ordered in a count of drops per minute.

What does it consist of?

The use of the rectal route for the administration of treatments has been recognized for centuries. The ancient enema or proctoclysis procedures, known as enemas, were already used by the Sumerians and by the Egyptians, 3500 and 1500 years before Christ respectively. It was Hippocrates who formally introduced him to the medical world.

When talking about the Murphy drip, it is important to clarify that from a medical point of view, it corresponds more to a proctoclysis or rectoclysis than to an enema.

The difference lies not only in the purpose of the procedure, but in the administration protocol. It should be noted that this route is not usually of choice but rather as an alternative in specific cases.

In proctoclysis, large volumes are infused through the rectum at a slow rate. Enemas, which may have diagnostic or therapeutic intentions, are usually administered in a single dose at a rapid rate. The equipment used is also different as well as the knowledge to carry it out. Certain training may be required.

Physiology

Although it is not a usual route of administration, as already mentioned before, the infusion of drugs through the rectum is a completely valid option. Absorption can be erratic due to the presence of fecal material, but there are several benefits to using this method.

The important vascularization of the colon is a plus point. The veins of the hemorrhoidal plexus can carry the drug from the rectum to the rest of the body.

Furthermore, since it is absorbed in this distal region, the hepatic passage is obviated, so the "first-pass effect" is not present, which can alter the behavior of the drug.

The absorption capacity of the intestinal mucosa is another great advantage. The epithelium of the rectum is the continuation of the intestine, with a certain capacity to reabsorb certain elements, especially liquid. For this reason it has a pharmacological filtration rate similar to that of the rest of the gastrointestinal tract.

Preparation

Originally, Murphy's enema was carried out with a solution devised by John Benjamin Murphy himself. It contained large amounts of water (between 1000 to 1500 milliliters) in addition to sodium and calcium chloride. Later other elements were added and even many hospitals completely modified the mix.

Murphy's initial intention was to provide hydration and electrolytes to people who were dehydrated and could not tolerate the oral route. In his time the intravenous route was not yet perfected, which is why proctoclysis was widely practiced. It was then used as an alternative feeding medium and as a stimulant for evacuation.

Whatever the mixture was, it was heated and placed in a sterilized glass container. This vial was raised to the ceiling near the patient's feet and was connected to a system of elastic tubes terminated in a small rectal cannula that was inserted into the patient's anus. The dripping was controlled with gravity and height.

Applications

As mentioned in the previous section, the original purpose of the Murphy enema or drip was the administration of fluids in dehydrated patients who could not tolerate the oral route or in whom it was not possible to catheterize a vein.

Later it was used as an alternative for food and to promote defecation.

Hydration

During World War I, the Murphy drip was frequently used as an alternative to rehydrate wounded soldiers. Many of them suffered catastrophic facial, abdominal or limb injuries and could not be hydrated orally or intravenously. The alternative described by Murphy in 1909 showed moderate success.

Although saline or physiological serum was described in 1896 by Hartog Jacob Hamburger, its clinical use was not studied until many years later.

For this reason, the mixture used by Murphy to hydrate patients consisted basically of water in abundant quantity to which they added calcium chloride (used in the cheese industry) and sodium.

In current practice, 500 cc of 0.9% saline is mixed with 10% calcium chloride. Hydrogen peroxide is sometimes added to create foam, which works as a warning if the solution leaks from the rectum. Some authors recommend adding magnesium and potassium sulfate to improve the quality of hydration.

Feeding

Due to the encouraging results in hydration of patients, its use was attempted to feed others. Mixes containing milk, honey, vitamins and even fruit porridges and compotes were proposed.

Due to the consistency of the preparation, the dripping was inefficient. Despite this, the initial mixture of milk and honey is still used in nursing homes.

Evacuating enema

The Murphy enema technique can also be done for bowel movements. It is traditionally used by mixing 1000 to 1500 cc of saline solution with common salt.

This solution is administered by slow drip through a rectal tube and serves as a stool softener and generator of osmotic bowel movements.

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Controversial uses

In 2014, a great controversy broke out in the United States and the rest of the world over the use of Murphy's drip as a torture technique.

The CIA's "torture report" revealed the use of this method as "forced feeding and hydration" in prisoners who were on hunger strike and as a technique for "behavior control."

References

1. Tremayne, Vincent (2009). Proctoclysis: emergency rectal fluid infusion. Nursing Standard, 24 (3): 46-48.
2. Cosiani Bai, Julio Cesar (2000). Special enemas: Murphy's drip. Fundamental Knowledge for the Primary Management of the Elderly, Practical Unit Nº1, 173-174.
3. Tricañir, Magdalena (2006). Drip or Murphy enema. Biblioteca Popular Hospitalaria Dora signa, 58-60. Recovered from: hospitaltrelew.chubut.gov.ar
4. Guillermo Bustos, Pedro (2006). Inflammatory Bowel Disease. Guides and Guidelines in Internal Medicine, Part 2. Recovered from: portalesmedicos.com
5. Merchant, Brian (2014). Rectal Feeding: The Antiquated Medical Practice the CIA Used for Torture. Recovered from: motherboard.vice.com
6. Wikipedia (2017). Murphy Drip. Recovered from: en.wikipedia.org