Gayle Nicholas Scott, PharmD

Disclosures

November 18, 2011

Question

What health risks are associated with the use of colonics?

Response from Gayle Nicholas Scott, PharmD
Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center, Chesapeake, Virginia

The use of colonics is illustrated by an observation of Sir Arthur Hurst, a British gastroenterologist, more than 75 years ago: "No organ in the body is so misunderstood, so slandered and maltreated as the colon."[1] The idea that the colon requires cleaning assistance beyond normal physiologic processes is not new. The Roman physician Galen and the ancient Egyptians and Greeks before him believed that food putrefies in the intestine and causes ill health and disease (also known as autointoxication).[2] Proponents of colonics perpetuate this ancient belief.

Colonics, also known by various names such as colonic irrigation, high colonics, colonic hydrotherapy, and colon lavage, is the process of delivering water and sometimes other ingredients (eg, herbs, coffee, probiotics, enzymes, or sodium phosphate)[3] into and out of the rectum for "cleansing of the large intestine (colon) and sigmoid (lower bowel) of metabolic waste..."[4] Colonics can be performed by so-called colon therapists, also known as colonic hygienists, or can be self-administered. Water is pumped into the rectum through a rectal tube and removed through another tube. Amounts ranging from one-half to 25 gallons are described on various Websites. This process may be repeated multiple times.

Colonics advocates recommend regular sessions for optimal benefit. Some problems that colonics are claimed to address include constipation, headaches, hemorrhoids, backaches, arthritis, allergies, diarrhea, distended abdomen, bad breath/halitosis, skin problems, chronic fatigue, asthma, irritability, depression, prostate trouble, difficult weight loss, frequent colds, hypoglycemia, insomnia, food cravings, abdominal gas, hypertension, foul body odor, and menstrual problems.

The benefits and risks of any medical intervention must be considered. A systematic review of the mainstream and complementary and alternative literature on the benefits of colon cleansing found no methodologically rigorous trials to substantiate claims.[5] Many more reports have been published that address possible risks and adverse events associated with colonics.

Mild adverse effects include cramping, abdominal pain, fullness, bloating, nausea, vomiting, perianal irritation, and soreness.[3] More serious but rare instances of intestinal perforation,[6,7] electrolyte imbalance,[8] heart failure,[8] extensive abscesses,[9] and amebiasis from contaminated equipment[10] have been reported.

People with a history of gastrointestinal disease, such as diverticulitits, Crohn disease, or ulcerative colitis, are at higher risk for adverse effects of colonics. Other conditions such as severe hemorrhoids, a history of colon surgery, heart disease, or renal impairment also increase risk.[3]

Patients should be aware that the devices used in such procedures are only approved by the US Food and Drug Administration for medically needed colon cleansing. In addition, those who perform such colon-cleansing procedures are not licensed by any scientifically based organization.[3]

In summary, colonics appear to provide psychological benefit to some people, despite the lack of credible evidence for physiologic benefit.[11] Clinicians should avoid recommending any treatment or procedure for which evidence of potential harm outweighs evidence of benefit.

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