Colonics for Maintaining and Enhancing Health
May 1999; Volume 2: 55-58
By Vance Dietz, MD, MPH, TM
"The serpent is in man. It is the intestine. The belly is a heavy burden; it disturbs the equilibrium between the soul and the body. It is the mother of vices. The Colon is King."
Victor Hugo
"The sins of the colon are its diseases. But I sometimes wonder whether it is not more sinned against than sinning, for what with attacks from above with purges, attacks from below with douches, and frontal attacks by the surgeon, its sorrows are numerous and real."
Arthur Hurst
BMJ 1922;1:941-943
Although both enemas and colonic irrigation are used for constipation and pre- and postoperatively, colonic irrigation (aka colonic hydrotherapy or detoxification) for maintaining health is poorly understood by the practicing physician. What is the evidence that the use of irrigation promotes or enhances health?
Theoretical Bases of Colonics
Three theories are relevant: stasis, ptosis, and auto-intoxication. The theory of stasis holds that as humans began to walk on two instead of four legs, anatomical pressure was placed on the abdominal contents, resulting in "ptosis" of the intestines. The pressure on the tissue holding the intestines in place produced thickening of these tissues and the creation of stress bands that narrowed the lumen of the gut. The advent of the germ theory of disease proposing that microorganisms, including those in the intestines, cause putrefaction and infection may also have helped to strengthen the argument that stasis and ptosis cause disease.1 Important remedies for stasis were mechanical in nature and included massage to move the bowel contents, devices that "kneaded" the intestines, and colonic irrigation.
The theory of autointoxication had many early adherents but Charles-Jacques Bouchard received the Legion of Honor for his work in this field.2 An early worker in what we now term biochemistry, Bouchard postulated that the body normally produces toxins from metabolism, from secretory organs, and from foodstuffs and putrefaction. Autointoxication occurs when the liver and kidneys cannot eliminate the toxins or when there is an increased production of toxins. Thus, "Man... is always working towards his own destruction; he makes continual attempts at suicide by intoxication."3 Bouchard went on to postulate that, due to the slowness of peristalsis and subsequent movement of fecal material through the colon, toxins could have difficulty being eliminated and could be absorbed.
The theory of autointoxication was also promoted by Eli Metchnikoff who received a Nobel Prize in Medicine for his theory of phagocytosis. Metchnikoff later proposed a link between autointoxication, senility, and aging. He proposed colonic resection as an aid to general health. His name and Nobel Prize were widely used to promote the theory. However, by the early 1900s, colonic irrigation as a treatment to remove toxins and enhance health was under attack from conventional medicine and the American Medical Association and lost favor.
Historical Practice and Folklore
The use of enemas dates to antiquity. Records indicate that enemas or clysters were used as health practices by the Egyptians, Assyrians, Babylonians, Sumerians, Chinese, Hindus, Greeks, and Romans.1 The Greeks believed that a putrefactive agent from feces was the cause of disease.4 It was believed that the more effective enemas were those that used the more powerful means to administer the enema, i.e., more volume and more rapid administration led to better results. Ingredients used in enemas include honey, beer, and milk. Enemas with wine, urine, and tobacco smoke were said to be particularly useful for consumption, dropsy, and hernias.
Not true colonic irrigation since only the distal colon is affected—only removing fecal material without cleaning the colon—enemas rose again in the 18th century.2 In medical practice and with the public, enemas became health interventions to rid the body of toxins. Enemas with mineral oil were felt to be ideal, as they both provoked elimination and prevented stasis by lubricating the intestines. Termed "lavages," enema use became widespread at fashionable spas in Europe. In the U.S., such spas were called "colon laundries."
In this century, colonic irrigation is said to be good for arthritis.5 Autointoxication, for which colonic irrigation is prescribed, is said to cause fatigue, depression, anxiety, headache, and seizures,6 and colonic irrigation may be prescribed for these complaints. Other "indications" include alcoholism, allergies, arthritis, asthma, colitis, hypertension, parasites, skin disorders, fevers, and ulcerative colitis.6,7
Colonic hydrotherapy is performed by inserting a sterile tube into the rectum connected to a machine that gently pumps water into the rectum. Most machines have light pressure, e.g., 1½ pounds, to ensure that the water enters the colon. Colonic hydrotherapy machines that are registered with the FDA come with a charcoal filter and a UV filter to remove bacteria from the water, which is generally municipal water. Repeated sessions of hydrotherapy are required to ensure that the entire colon is cleaned. The first sessions may only reach the sigmoid colon depending on the amount of fecal material present. Sessions are performed in hospitals as well in physicians’ private offices or in colon hydrotherapy centers. According to the International Association for Colon Hydrotherapy (I-ACT), only water is used in colon hydrotherapy to cleanse the colon. However, physicians, particularly naturopaths, may add other substances such as medication or herbs. The I-ACT makes a clear distinction between colon hydrotherapy that is used to cleanse the colon with water and its use in conjunction with other alternative practices.
Data Analysis
To prepare this article, we performed a detailed search of the scientific literature and conducted a telephone interview with a representative of the International Association for Colon Hydrotherapy (I-ACT).
Clinical and Laboratory Studies
No clinical or laboratory studies assessing the impact of colonic hydrotherapy or irrigation on general health could be found.
Anecdotal Data
Discussions with the medical director of an Atlanta wellness center that specializes in colonic hydrotherapy indicate other claims and theories. Because the body must exert energy to eliminate waste and neutralize toxins, colonic hydrotherapy "frees energy" that would have been used and strengthens the liver and kidneys by decreasing their exposure to toxic substances. As a negative pressure balance supposedly develops inside the lumen, the colon acts as a "sponge" to draw in toxins that have leaked to surrounding tissues. The net effect, it is claimed, is fewer toxins in the body, more energy to fight infection, and five to 10 pounds less fecal material (some persons have been said to lose 20-30 pounds). This loss also relieves distention, bloating, and other sensations associated with constipation.
Unfortunately, there are no empirical data to support or refute this concept. Those who claim enhancement of health from hydrotherapy may be reacting to a placebo effect induced by their belief that toxins are eliminated from the body.8 Of course, the elimination of 5-10 pounds of fecal material could indeed make one feel better.
I-ACT has about 3,000 members and promotes the safe use of colonic hydrotherapy equipment that has been approved by the FDA as safe for colonic irrigation. The organization issues a certificate in colonic hydrotherapy. The I-ACT representative in our interview stated that colonic irrigation was indicated for constipation and pre- and postoperative treatment. The representative also stated that many practitioners make claims as to the effect of colon hydrotherapy on the treatment of a variety of disorders for which there is no evidence of effectiveness. He stated that colon hydrotherapy was indicated to cleanse the bowels of those individuals who suffered from poor bowel habits for medical, physiologic, or non-medical reasons. He knew of no controlled trials that had been conducted to assess effectiveness. I-ACT is interested in identifying research centers to collaborate in the design and implementation of such studies.
Adverse Effects
Colonic irrigation has been associated with at least one outbreak of amebiasis in Colorado.9,10 Investigation of the outbreak revealed that the colonic-irrigation machine had heavy contamination with fecal coliform bacteria. Elsewhere, other cases of enteritis associated with colonic irrigation have been reported.11 Two deaths associated with the receipt of coffee enemas as a form of therapy for cancer have also been reported.12 The cause of death was attributed to sodium and chloride depletion and fluid overload.
Some have postulated that colonic irrigation could disrupt the normal bacterial flora of the gut, thereby leading to disease.13 This has not been documented. Frequent use may be associated with loss of both intestinal muscle tone and normal defecation reflex.14 Concern has been expressed over the risk of "water intoxication" and hypokalemia; these risks are logical but remain unproven.7 Colonic perforation is a potential complication but no reports were located.
Contraindications
Colon hydrotherapy is contraindicated in persons with diverticulosis, intestinal bleeding, intestinal neoplasm, hemorrhoids, or enteritis.
Formulation/Dosage
Different practitioners use differing procedures to perform hydrotherapy. The center we visited recommends five to 10 procedures that each last 30 to 45 minutes. I-ACT stated that generally 10-12 sessions are performed depending on the amount of fecal material and the rapidity of the patient’s response. Generally, two procedures are performed during the first week of therapy; the next week is skipped; then two more procedures are performed in the third week; and procedures are performed once weekly thereafter. Sessions range from $30-$120 each and often cost more in large metropolitan areas. Some practitioners combine colon hydrotherapy with diet and herbal therapy.
Conclusion
In summary, no studies have been conducted that assess the claim that colonic hydrotherapy enhances health. There is no medical reason to perform or prescribe colonic irrigation other than for constipation or pre- and postoperative indications. Occasional, very serious adverse effects have been reported.
Recommendation
Physicians should discourage the use of colonics for general health enhancement, and should point out that colonics have been evaluated only for the treatment of constipation and pre- and postoperatively and that theories on enhancing health from colonics have not been validated. Physicians should determine whether a patient’s interest indicates a need for nutritional counseling and attention to bowel function.
If patients proceed to undergo colon hydrotherapy, they should be advised to determine if the hydrotherapy center has staff accredited by I-ACT and if they use equipment recommended by I-ACT and registered by the FDA. Patients should be cautioned that transmission of parasitic and bacterial infections have been reported from the use of contaminated equipment.
References
1. Sullivan-Fowler M. Doubtful theories, drastic therapies: Autointoxication and faddism in the late nineteenth and early twentieth centuries. J Hist Med Allied Sci 1995;50:364-390.
2. Hudson RP. Theory and therapy: Ptosis, stasis, and autointoxication. Bull Hist Med 1989;63:392-413.
3. Bouchard CJ. Lectures on Auto-Intoxication in Disease, or, Self-Poisoning of the Individual. Philadelphia, PA: FA Davis; 1894:281.
4. Chen TS, Chen PS. Intestinal autointoxication: A medical leitmotif. J Clin Gastroenterol 1989;11:434-441.
5. Snyder RG, Fineman S. A clinical and roentgenologic study of high colonic irrigations as used in the therapy of subacute and chronic arthritis. Am J Radium Therapy 1927;17:27-43.
6. Ernst E. Colonic irrigation and the theory of autointoxication: A triumph of ignorance over science. J Clin Gastroenterol 1997;24:196-198.
7. Kelvinson RC. Colonic hydrotherapy: A review of the available literature. Comp Ther Med 1995;3:88-92.
8. Hunt TC. Colon irrigation. Practitioner 1972;208: 523-524.
9. Istre GR, et al. An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. N Engl J Med 1982;307:339-342.
10. CDC. Amebiasis associated with colonic irrigation—Colorado. MMWR Morb Mortal Wkly Rep 1981;30:101-102.
11. Sorvillo F, Auerbach DM. More on enteric infections from colonic irrigation [letter]. New Engl J Med 1983;308:400.
12. Eisele JW, Reay DT. Deaths related to coffee enemas. JAMA 1980;244:1608-1609.
13. Sisco V, et al. Potential impact of colonic irrigation on the indigenous intestinal microflora. J Manipulative Physiol Ther 1988;11:10-16.
14. Hunt T. Colonic irrigation. Nurs Mirror Midwives J 1974;139:76-77.
May 1999; Volume 2: 55-58You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content