Arachis Oil Enema

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Arachis Oil Enema on Prescriptsy

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Arachis Oil Enema is a faecal softening retention enema containing 130ml of arachis oil (refined peanut oil) for rectal administration in adults with constipation or faecal impaction.

The oil works by penetrating, softening, and lubricating hardened faecal matter in the rectum and lower colon, facilitating subsequent evacuation either spontaneously or with the aid of a follow-up evacuant enema.

It is commonly used in hospital, community nursing, and palliative care settings, and is also available from pharmacies as a pharmacy medicine (P) for home use.

Constipation is one of the most common gastrointestinal complaints in the United Kingdom, affecting an estimated 1 in 7 adults at any given time.

Faecal impaction, the accumulation of hard, dry stool in the rectum that cannot be passed spontaneously, is a particularly distressing complication seen most frequently in elderly patients, those with reduced mobility, individuals taking opioid medications, and patients with neurological conditions affecting bowel function.

NICE clinical knowledge summary CKS on constipation recommends rectal interventions including retention enemas when oral laxatives alone have failed to resolve impaction.

This product information has been reviewed by Dr.

Claire Phipps, MBBS MRCGP (GMC 7014359), and provides a comprehensive clinical guide to Arachis Oil Enema, including how it works, correct administration technique, important allergy warnings, and when to seek further medical assessment.

Critical allergy warning

Arachis Oil Enema is manufactured from peanut oil. It must not be used by anyone with a known allergy to peanuts or soya.

This is the single most important safety consideration for this product. Allergic reactions to peanut can range from mild skin reactions to life-threatening anaphylaxis.

Key points regarding allergy risk:

• Although the oil is refined, which removes most peanut proteins, trace amounts may remain sufficient to trigger reactions in highly sensitised individuals.
• Soya allergy frequently co-exists with peanut allergy due to cross-reactivity between legume proteins. Patients with soya allergy should also avoid Arachis Oil Enema.
• If you experience any symptoms of allergic reaction during or after administration (itching, rash, swelling, difficulty breathing, feeling faint), stop immediately and call 999 for emergency medical assistance.
• Healthcare professionals administering this enema in clinical settings must check the patient's allergy status before use and document this check.

Alternative enema products that do not contain peanut or soya include sodium phosphate enemas (Fleet Enema), sodium citrate micro-enemas (Micralax), and glycerol suppositories.

Your pharmacist, GP, or district nurse can recommend an appropriate alternative. Learn more about online GP consultations for advice on constipation management.

What Arachis Oil Enema is and how it works

Arachis Oil Enema contains 130ml of refined peanut oil (arachis oil PhEur) as its sole active ingredient. The oil acts through two complementary physical mechanisms:

Faecal softening: When retained in the rectum, the oil gradually penetrates hardened, desiccated faecal matter through capillary action and osmotic effects.

The oil molecules infiltrate the compacted stool mass, hydrating and softening it from within.

This process is most effective when the enema is retained overnight (8-12 hours), allowing prolonged contact between the oil and the impacted faeces.

Mucosal lubrication: The oil coats the rectal and lower colonic mucosa, reducing friction between the stool mass and the intestinal wall.

This lubrication facilitates passage of the softened stool through the rectum and anal canal during subsequent evacuation.

The lubricant effect is particularly valuable in patients with anorectal pain from haemorrhoids or fissures, where passage of hard stool would otherwise cause significant discomfort and potential mucosal tearing.

Arachis Oil Enema does not stimulate peristalsis or cause direct colonic contraction. It is a purely physical (mechanical) intervention.

For this reason, it is often used in combination with a subsequent stimulant or osmotic enema the following day.

A typical protocol for faecal impaction involves administering an Arachis Oil Enema at night, retaining it overnight, and following it with a sodium phosphate enema or sodium citrate micro-enema the next morning to promote complete evacuation.

When Arachis Oil Enema is used

Faecal impaction

The primary indication for Arachis Oil Enema is the management of faecal impaction in adults.

Faecal impaction occurs when a mass of hard, dry stool accumulates in the rectum and cannot be expelled by normal defecation.

It is diagnosed by digital rectal examination, which reveals a hard or putty-like faecal mass in the rectum.

Symptoms include inability to pass stool despite the urge, rectal fullness and discomfort, abdominal distension and pain, paradoxical overflow diarrhoea (liquid stool leaking around the impacted mass, sometimes mistaken for diarrhoea), nausea, and loss of appetite.

Faecal impaction is most common in elderly care home residents, hospitalised patients (particularly post-operatively), patients taking opioid analgesics, individuals with neurological conditions (spinal cord injury, stroke, Parkinson's disease, multiple sclerosis), and people with severe learning disabilities who may not respond normally to defecation cues.

NICE recommends addressing impaction before commencing regular laxative therapy, as maintenance laxatives are ineffective while impaction persists.

Severe constipation

Arachis Oil Enemas may be used for severe constipation that has not responded to oral laxatives.

The NICE stepped approach to constipation management begins with lifestyle advice (increased fluid, dietary fibre, physical activity), progresses through oral laxatives (osmotic agents such as macrogol, or stimulant agents such as senna or bisacodyl), and escalates to rectal interventions when oral measures fail.

An Arachis Oil Enema softens rectal stool and may be followed by a stimulant suppository or enema to promote evacuation.

Bowel management programmes

In palliative care and neurorehabilitation settings, Arachis Oil Enemas form part of structured bowel management programmes.

Patients with spinal cord injury, for example, often require a scheduled bowel care routine involving softening enemas, digital stimulation, and manual evacuation performed by trained nurses.

Arachis Oil Enemas administered the evening before planned bowel care sessions soften the stool and reduce the time, discomfort, and autonomic dysreflexia risk associated with the procedure.

How to administer Arachis Oil Enema correctly

Correct administration technique is important for both comfort and effectiveness. Follow these steps carefully:

Preparation: Warm the sealed enema container by placing it in a bowl or basin of warm water (approximately body temperature, 37 degrees Celsius) for 10-15 minutes.

Test the temperature on the inside of your wrist before use: it should feel warm but not hot.

Never microwave the enema or heat it directly on a stove, as this creates a risk of thermal injury to the rectal mucosa and uneven heating.

Positioning: Lie on your left side on a bed or firm surface, with your knees drawn up towards your chest.

Place a disposable absorbent pad beneath your hips to protect bedding.

This left lateral position aligns the rectum with the sigmoid colon, facilitating flow of the enema into the lower bowel.

An alternative position is kneeling with chest lowered to the bed.

Insertion and administration: Remove the protective cap from the nozzle. Apply a small amount of water-soluble lubricating jelly to the nozzle tip.

Gently part the buttocks and insert the lubricated nozzle into the rectum, angling it slightly towards the umbilicus (forward, towards the navel).

Insert to a depth of approximately 3-4 centimetres. Squeeze the container slowly and steadily, allowing the oil to flow in without causing discomfort or the urge to expel.

If resistance is felt, stop, withdraw slightly, and re-angle the nozzle.

Once the container is empty, withdraw the nozzle while keeping the container compressed to prevent suctioning oil back.

Retention: Remain lying down for at least 15-30 minutes, and ideally retain the enema overnight.

Lying on your left side with a pillow between your knees is the most comfortable retention position. Place a disposable pad beneath you in case of leakage.

Some leakage of oil is normal and does not indicate that the treatment has failed.

The longer the oil remains in contact with impacted stool, the more effective the softening action.

What happens after administering the enema

After adequate retention time, the softened stool may be passed spontaneously when using the toilet.

If spontaneous evacuation does not occur, a healthcare professional may administer a follow-up evacuant enema (typically a sodium phosphate enema) to stimulate colonic contraction and complete bowel clearance.

In cases of severe impaction that do not respond to enemas, manual evacuation under sedation may be necessary, performed by a trained healthcare professional in a clinical setting.

After successful evacuation, a maintenance laxative regimen should be established to prevent recurrence of impaction.

NICE recommends starting with an osmotic laxative (macrogol 3350 with electrolytes, such as Laxido or Movicol) at a maintenance dose, adding a stimulant laxative (senna or bisacodyl) if needed, and continuing lifestyle modifications including adequate hydration, dietary fibre, and physical activity.

Side effects and adverse reactions

Expected effects

Mild rectal discomfort, a sensation of fullness or pressure, transient abdominal cramping, and oily leakage from the rectum are expected effects of administration rather than true adverse reactions.

These are generally well tolerated and resolve after evacuation. Using a disposable absorbent pad protects clothing and bedding from oil soiling.

Adverse reactions requiring medical attention

Allergic reactions in patients with unrecognised peanut or soya allergy represent the most serious risk associated with Arachis Oil Enema.

Symptoms may include localised perianal itching and redness, generalised urticaria (hives), facial or throat swelling (angioedema), difficulty breathing or wheezing, and cardiovascular collapse (anaphylaxis).

Any signs of allergic reaction require immediate cessation of the procedure and emergency medical assistance (call 999).

Adrenaline auto-injectors (EpiPen) should be available in clinical settings where Arachis Oil Enemas are administered.

Rectal perforation is an extremely rare but life-threatening complication that may occur if the enema nozzle is inserted too forcefully, if the rectal wall is weakened by disease (e.g.

radiotherapy, inflammatory bowel disease, rectal tumour), or if the patient is elderly with fragile tissues.

Warning signs include sudden severe abdominal pain, rigidity of the abdominal wall, fever, and rectal bleeding. This constitutes a surgical emergency requiring immediate hospital assessment.

Contraindications and precautions

Absolute contraindications: peanut allergy, soya allergy, known or suspected intestinal obstruction, known or suspected bowel perforation, acute surgical abdomen, and recent rectal or colonic surgery.

Relative contraindications and cautions: active inflammatory bowel disease affecting the rectum (risk of exacerbating inflammation), haemorrhoids or anal fissures (insertion may cause pain or bleeding), rectal prolapse, anticoagulant therapy (risk of minor mucosal bleeding from nozzle insertion), and reduced rectal sensation due to neurological conditions (risk of undetected perforation).

Arachis Oil Enema is generally safe during pregnancy and breastfeeding for short-term use, as systemic absorption of the oil from the rectum is negligible.

However, pregnant women should discuss constipation management with their midwife or GP before using any rectal preparation, as safer first-line options (glycerol suppositories, lactulose, macrogol) are usually preferred during pregnancy.

Availability and NHS access

Arachis Oil Enema is classified as a pharmacy medicine (P) in the United Kingdom, meaning it can be purchased from a pharmacy without a prescription but must be sold under the supervision of a pharmacist.

It can also be prescribed by a GP on the NHS.

When prescribed on the NHS in England, the standard prescription charge of 9.90 pounds per item applies; prescriptions are free in Scotland, Wales, and Northern Ireland.

District nurses and community nurses can supply Arachis Oil Enemas as part of a Patient Group Direction (PGD) or nurse prescriber formulary for patients in the community requiring bowel care.

In hospital settings, the product is administered by nursing staff as part of a bowel management protocol, usually under medical orders.

Frequently asked questions about Arachis Oil Enema

Can I use Arachis Oil Enema if I have a peanut allergy?

No. Arachis Oil Enema must not be used by anyone with a known peanut or soya allergy, even though the oil is refined.

Alternative rectal preparations that do not contain peanut or soya include sodium citrate micro-enemas (Micralax), sodium phosphate enemas, and glycerol suppositories.

Your pharmacist or GP can recommend a suitable alternative.

How long should I retain the enema?

For best results, retain the enema overnight (8-12 hours). If overnight retention is not possible, retain for a minimum of 15-30 minutes.

The longer the oil remains in contact with impacted stool, the more effective the softening action. Some oil leakage is normal and expected during the retention period.

Can I buy Arachis Oil Enema without a prescription?

Yes. Arachis Oil Enema is a pharmacy medicine (P) and can be purchased from a pharmacy under pharmacist supervision without a prescription.

The pharmacist will confirm that you do not have a peanut or soya allergy and that the product is appropriate for your symptoms before supplying it.

Is Arachis Oil Enema safe to use regularly?

Occasional use for acute constipation or impaction is well established.

Regular long-term use should be supervised by a healthcare professional, as the underlying cause of recurrent impaction or constipation should be investigated and addressed.

In palliative care and spinal injury settings, regular scheduled use is common and appropriate under clinical supervision.

If you find yourself needing enemas frequently, discuss your bowel management with your GP to optimise oral laxative therapy and dietary measures.

Sources and further reading

• Arachis Oil Retention Enema, Electronic Medicines Compendium (EMC)
• BNF: Arachis oil
• NICE CKS: Constipation
• NHS: Constipation
• MHRA Yellow Card Scheme