The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies klismaphilia under the diagnosis of "Paraphilias, Not Otherwise Specified". The diagnostic code is 302.9. Proactive treatment for klismaphilics is not generally recommended, due to the lack of any significant desire to be "cured". Health treatment for klismaphilia thus is typically only focused on ensuring the techniques employed and chemicals used are not harmful to the practitioner. Caution should always be maintained on the part of the practitioners experimenting with new techniques and concoctions; in certain cases cramps produced by the chemicals used have led to hospitalizations, in other circumstances the effects can even be life-threatening.

Most psychologists believe that paraphilic sexual interests cannot be altered. Instead, the goal of therapy is normally to reduce the person's discomfort with their paraphilia and limit any criminal behavior. Both psychotherapeutic and pharmacological methods are available to these ends.

Cognitive behavioral therapy, at times, can help people with paraphilias develop strategies to avoid acting on their interests. Patients are taught to identify and cope with factors that make acting on their interests more likely, such as stress. It is currently the only form of psychotherapy for paraphilias supported by evidence.

The DSM-5 adds a distinction between "paraphilias" and "paraphilic disorders", stating that paraphilias do not require or justify psychiatric treatment in themselves, and defining "paraphilic disorder" as "a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others".

The DSM-5 Paraphilias Subworkgroup reached a "consensus that paraphilias are not "ipso facto" psychiatric disorders", and proposed "that the DSM-V make a distinction between "paraphilias" and paraphilic "disorders". [...] One would "ascertain" a paraphilia (according to the nature of the urges, fantasies, or behaviors) but "diagnose" a paraphilic disorder (on the basis of distress and impairment). In this conception, having a paraphilia would be a necessary but not a sufficient condition for having a paraphilic disorder." The 'Rationale' page of any paraphilia in the electronic DSM-5 draft continues: "This approach leaves intact the distinction between normative and non-normative sexual behavior, which could be important to researchers, but without automatically labeling non-normative sexual behavior as psychopathological. It also eliminates certain logical absurdities in the DSM-IV-TR. In that version, for example, a man cannot be classified as a transvestite—however much he cross-dresses and however sexually exciting that is to him—unless he is unhappy about this activity or impaired by it. This change in viewpoint would be reflected in the diagnostic criteria sets by the addition of the word "Disorder" to all the paraphilias. Thus, Sexual Sadism would become Sexual Sadism Disorder; Sexual Masochism would become Sexual Masochism Disorder, and so on."

Bioethics professor Alice Dreger interpreted these changes as "a subtle way of saying sexual kinks are basically okay – so okay, the sub-work group doesn’t actually bother to define paraphilia. But a paraphilic disorder is defined: that’s when an atypical sexual interest causes distress or impairment to the individual or harm to others." Interviewed by Dreger, Ray Blanchard, the Chair of the Paraphilias Sub-Work Group, explained: "We tried to go as far as we could in depathologizing mild and harmless paraphilias, while recognizing that severe paraphilias that distress or impair people or cause them to do harm to others are validly regarded as disorders."

Charles Allen Moser pointed out that this change is not really substantive as DSM-IV already acknowledged a difference between paraphilias and non-pathological but unusual sexual interests, a distinction that is virtually identical to what is being proposed for DSM-5, and it is a distinction that, in practice, has often been ignored. Linguist Andrew Clinton Hinderliter argued that "Including some sexual interests—but not others—in the DSM creates a fundamental asymmetry and communicates a negative value judgment against the sexual interests included," and leaves the paraphilias in a situation similar to ego-dystonic homosexuality, which was removed from the DSM because it was realized not to be a mental disorder.

The DSM-5 acknowledges that many dozens of paraphilias exist, but only has specific listings for eight that are forensically important and relatively common. These are voyeuristic disorder, exhibitionistic disorder, frotteuristic disorder, sexual masochism disorder, sexual sadism disorder, pedophilic disorder, fetishistic disorder, and transvestic disorder. Other paraphilias can be diagnosed under the Other Specified Paraphilic Disorder or Unspecified Paraphilic Disorder listings, if accompanied by distress or impairment.

Klismaphiles can gain satisfaction of enemas through fantasies, by actually receiving or giving one, or through the process of eliminating steps to being administered one (e.g., under the pretense of being constipated). Klismaphilia is practiced by men and women, although men are more likely to be klismaphiles, as with most paraphilias. Klismaphiles might gain pleasure from a large, water distended belly or the feeling of internal pressure. Often, klismaphiles report discovering these desires after a chance administration of an enema sometime in their childhood, but some do report discovering these feelings later on. Klismaphilia is practiced both heterosexually and homosexually. The paraphilia may be used as a substitute or as an auxiliary by its practitioners for genital sexual activity. Usually, klismaphiles carry out normal lives and successfully engage in this behavior secretly. If this is the case they will probably try to conceal the pleasure they receive from these administrations.

For administering enemas not intended for medical purposes there are specialty items, such as the aluminium nozzle shown to the right, that are commonly used in activities involving klismaphilia. Such items are available on the Internet and in sex shops in a great variety of sizes, styles, and materials.