Independent medical reviews, articles and research.
We are including articles accumulated over the years on scientific research, medical reviews and projects carried out in the field of colon hydrotherapy.
The following list intends to bring an external view-point on the subject. Hydrocleanse does not accept any responsibility for the evidence of information contained in the articles below. Nevertheless we believe it is of value for our clients and visitors of our website to present the information so that we may further the education and awareness process for which we stand for.
Colonic irrigation may help greatly in enhancing the ability to absorb many vitamins, minerals and essential fatty acids
Colon Hydrotherapy and its clinical applications – by Donald J. Mantell M.D.
In our medical clinic we find colonic irrigations are one of the most important treatment modalities available for a multitude of health problems. Many health authorities feel that disease begins in the colon. To be in optimum health the colon must be functioning normally. I believe that the colon is one of the most neglected areas in the medical establishment. One of the major indications for colon hydrotherapy is constipation. Before discussing the effects of constipation, I will first give a description of how a colonic irrigation is carried out (some technical aspects about the colonic machine) and what some of the benefits would be from such a treatment.
The usual colonic treatment lasts 45 minutes. A small speculum is inserted into the patient’s rectum. This speculum is then attached to a plastic hose which connects to the colonic machine. The colonic therapist then adjusts the volume and temperature of the water coming out of the machine which runs through a plastic hose into the patient’s rectum and through the entire colon. The patient is temporarily filled with a certain volume of water to individual tolerance. This will induce peristaltic contractions in the colon, and the patient will begin to expel fecal matter through the colonic hose which leads back to the colonic machine and through a clear plastic viewing tube. It is quite interesting to see what is expelled during a normal colonic treatment. One may see mucous, parasites and very old feculent material (noted by its dark black color) pass through this tube. This old feculent material may have been lying in the patient’s colon for years. It looks like vulcanized rubber and has that kind of consistency. In addition, the patient may experience sensations of warmth due to the presence of toxins is the feculent matter.
While the patient is receiving the colonic treatment, the colonic therapist slightly massages various parts of the abdomen to help loosen and dislodge areas of fecal impaction. It is very important that the therapist use proper amounts of water. If the therapist uses too much water, the treatment may be uncomfortable or painful and may lead to negative results. If this therapy is conducted properly, it should not be painful or uncomfortable. In addition, when less rather than more water is used, the patient’s colon is forced to do more work, which is an important first step in restoring normal peristaltic activity to the diseased colon.
It should be noted that most patients need a series of colonic irrigations, not just one. The patients may expel considerable gas during the first few treatments. It usually takes a few treatments before one starts dislodging old encrusted feculent matter. One should remember that it usually takes years for the colon to become clogged up with its own waste products. Therefore, one should not be impatient when pursuing a therapeutic course of colonic irrigations.
Indications for Colonics–Who can benefit from colonic irrigation?
Constipation is one of the major reasons people pursue this form of treatment. I will discuss this problem later in this article. Colon problems such as colitis, ileitis and diverticulitis affect conservatively two million people in this country. These problems can be directly addressed by colonic therapy.
Anyone who suffers from bloating, abdominal distention, gas pains, stomach aches, or someone who gets filled very quickly after eating and can only eat small amounts of food may be a candidate for colonic irrigation.
In our clinic we find that people with all kinds of skin problems, i.e., acne, psoriasis, eczema, etc., usually can benefit from a therapeutic course of colonic irrigations. The skin is the largest excretory organ in the body, the skin may act as a major excretory organ. Unhealthy skin is usually a sign of an unhealthy colon and no amount of antibiotics or skin creams or medications will alleviate the problems until the cause of the problem is addressed. In addition, vitamin A plays an important role in skin health. When the colon is adequately cleansed, vitamin A can be more effectively absorbed through the intestinal tract.
I have found that arthritis patients may be helped tremendously with a series of colonic treatments. This may be due in part to the fact that arthritis patients suffer from some form of internal toxemia whereby toxins are continually being absorbed into their systems (i.e. the colon) causing further inflammation and aggravation of their joints.
A third group of patients who may benefit greatly from colonic irrigations are cancer patients. We know that cancer patients have a tremendous problem breaking down and assimilating proteins. But they may also be extremely deficient in many vitamins, minerals and essential fatty acids. They may also suffer from constipation and other varied digestive disorders. Colon irrigations may help greatly in enhancing their ability to absorb these various macro and micronutrients.
In addition, it very important that a cancer patient eliminate efficiently and effectively all internal toxins. This is especially true in the case of a cancer patient who is on an integrated metabolic program. When on such a program, the cancerous tumor may start breaking down resulting in the release of cancer cells and various toxins throughout the body. Colonics may perform a very important function in helping to expel these toxins from the body. Dr. Max Gerson described a comparable situation when he first started treating cancer patients with an intensive dietary approach. He stated that he lost a number of cancer patients because of toxemia. They literally died from their own internal pollution. As their cancerous tumors were being broken down they were unable to eliminate these toxic products effectively or efficiently with dire results as a consequence.
The expression constipation is derived from the Latin word “constiatus” which translated means to press or crowd together, to pack, to cram. Consequently, to be constipated means that the packed accumulation of feces in the bowel makes its evacuation difficult.
However, a state of constipation can also exist when movements of the bowel may seem to be normal, in spite of an accumulation of feces somewhere along the passageways of the colon.
Many health authorities believe that constipation is the number one affliction underlying nearly every ailment. This means that constipation would be the most prevalent ailment affecting the civilized world. It is vital to stress that constipation affects the health of the colon, upon which the health of the body in its entirety depends.
Constipation contributes toward the lowering of body resistance predisposing it to many acute illnesses and the creation of a great many degenerative and chronic processes. Almost every human ailment has been attributed to a malfunctioning colon, i.e., one that cannot perform its normal , regular and efficient functioning.
Intestinal constipation causes cellular constipation. It also increases the workload of the other excretory organs- kidney, skin, liver, lungs and lymph.
The functioning of these organs becomes depleted and overworked. The cellular metabolism becomes sluggish, repair and growth are delayed and the ability to eliminate waste materials is lowered. The cells, instead of being alive and active, become dead and inactive. This process results in a decline in tissue and organ functional ability.
There are two crimes against nature which civilization indulges in as a daily routine, which may be direct causes of constipation. One is the consumption of devitalized and refined foods which fail to nourish the organs responsible for the evacuation of waste matter. The other which is most prevalent particularly among young people, but not much less among the older and more mature, is neglecting to stop everything we are doing when the urge to evacuate the bowels should drive us headlong into the bathroom. Bowel movements every two or three days are considered normal and acceptable. It is my professional opinion, as in the opinion of many holistic healthcare professionals, that we should have a bowel movement for every meal we eat, each and everyday. For example, if we eat three meals per day, we should have three bowel movements per day.
If we are having less than two bowel movements per day, food residues are lying in the colon for more than twelve hours. Consequently, the fecal material in the colon becomes putrefied and fermented. Any nutritional element present in the fecal matter would pass into the bloodstream as polluted products. What would otherwise be nutritional becomes in fact, the beginning of toxemia. Toxemia is a condition in which the blood contains poisonous products which are produced by the growth of pathogenic or disease producing bacteria. Pimples for example are usually the first indication that toxemia has found its way into the body.
A number of years ago fifty-seven of the leading physicians of Britain met in London and discussed before the Royal Society of Medicine this problem of autointoxication caused by a toxic colon.
Autointoxication is defined as “the poisoning of the body, by toxic matter penetrated therein.” Twenty-two poisons were identified as originating in a toxic colon. They are as follows: Phenol, Cadaverin, Agamatine, Indel, lpheratted Hydrogen, Cresol, Bulvric Acid, Botulin, Putrescin, Urrobilin, Histidine, Ammonia, Muscatine, Methylgardinine, Indoethylamine, Sulpheffoglobine, Ptomaffopine, Pentmethylphamine, Neurin and Sepsin.
These are some of the many types of poisons which can be found in a toxic colon. Some of these poisons are highly active and may produce the most detrimental effects–even in very small quantities. In many cases, these toxins can seep out of the colon and poison the rest of the body. Here are a few examples:
Poisons from the colon can do the following:
* Weaken and stress the heart
* Go to the skin and cause blemishes, paleness
* Psoriasis, liver spots, wrinkles and other facial conditions
* Irritate the lungs and cause foul breath
* Go to the brain and disturb mental function and cause senility
* Go to the joints and cause pain and stiffness
* Go to the muscles and cause weakness and severe fatigue
* Rob you of your youth, ruin your health, and cause you to become old long before your time
How Constipation Effects the Colon’s Function
If solving the problem of constipation were merely a case of washing out loose material lying free inside any part of the colon, it would not be too great a difficulty to clear up the situation. A high enema would most likely be sufficient to take care of its removal. However, it is not so simple to dispose of this problem. Constipation not only involves the unnecessary retention of feces in the bowel, but also the retention present throughout the first half of the colon. From the cecum to the middle of the transverse colon. The cecum is found next to the iliocecal valve at the beginning of the colon.
The wall of this section of the colon is equipped with sensitive nerves and muscles whose function it is to create wavelike motions, known as peristaltic waves, to propel the contents of the colon to the cecum to the rectum for eventual evacuation. This is a distance of approximately five feet
Besides the formation of these peristaltic waves, the first half of the colon has two other very important functions. First, it must extract from all the residue coming from the small intestine any available nutritional material which the small intestine was unable to collect. For this purpose, it mulches the material which passes into it from the small intestine and transfers the liquid and other elements through its walls into the bloodstream. The nutrition which has thus been extracted from the colon is collected by the blood vessels lining the walls of the colon and is carried to the liver for processing.
The other important function of first half of the colon is to gather from the glands in its walls the intestinal flora needed to lubricate the colon. Far too many people, and laymen, think that enemas and colon irrigations wash out the intestinal flora and thus deprive the colon of a valuable means of lubrication. This school of thought is utterly false and totally devoid of truth and fact. Obviously, when the packed accumulation of feces in the bowel leads to fecal encrustation, it is not possible for the lining of the colon to function normally, and the glands in this lining cannot produce the necessary intestinal flora or lubrication. Such lack of lubrication only serves to intensify a state of constipation and to generate toxemia.
It is estimated that 200 million people are infected by intestinal parasites.
This fecal encrustation interferes with, if it does not actually prevent, the infusion of the necessary intestinal flora for colon lubrication, the formation of peristaltic waves for evacuation purposes, and the absorption and use of the additional and nutritional elements present in the waste residue coming into the colon from the small intestine.
It does not require much imagination to perceive that the adhesive quality of the feces in the colon is readily susceptible to creating a coating on the inside of the lining or wall of the colon, resembling a layer of plaster in its consistency. It is equally obvious that such a coating, in preventing the normal functioning of the colon, has the insidious effect of becoming a generator of toxicity, to the detriment of health, happiness and longevity.
When the bowel is toxic it can harbor an amazing variety of very harmful bacteria and parasites. It’s interesting to note that worms outrank cancer as man’s deadliest enemy on a worldwide basis. It is estimated that 200 million people are infected by these intestinal parasites.
These worms range in size from microscopic single celled animals to twenty-foot long tapeworms! These parasites kill more people annually than does cancer. One in four people in the world today is infected by roundworms. The United States is not immune to these parasites, as the number of cases has increased in the past few years.
Other Benefits of Colon hydrotherapy
Colon hydrotherapy also functions as an important diagnostic tool for the physician in extracting useful information concerning digestive and clinical disorders:
A. It is an excellent screening device for colo-rectal cancer.
B. Useful in diagnostic procedures for evaluation of the colon.
C. May prove valuable in the preparation for bowel surgery, providing a more optimal surgical field potentially decreasing the risk of post-operative complications due to the presence of bacteria at the sutureline.
D. Offers the location and relief of fecal impactions,. amount and color of mucous and the presence of increased amounts of gas.
E. Provides detection for parasites.
F. Useful for detoxification of drug addicts and alcoholics.
The entire colon could be cleaned and examined for blood every six months or as directed by the physician or health care professional for early detection of colo-rectal cancer. Benefits from colon hydrotherapy extend to all diagnostic procedures for evaluating the colon including barium enema, sigmoidoscopy and colonoscopy, facilitating a more accurate study. Patient discomfort resulting from residual barium following the enema could be avoided utilizing colon hydrotherapy. In addition, this technique would eliminate the problem of residual opaque material on subsequent upper GI series, which would result in additional radiation exposure to the patient. Patients undergoing general anesthesia would benefit from colon hydrotherapy as it would dramatically reduce the problems associated with bowel functions following surgery.
Colon hydrotherapy may prove valuable in the preparation bowel surgery, providing a more optimal field potentially decreasing the risk of post-operative complications due to the presence of bacteria at the suture line. This procedure may be applied to all patients undergoing general or spinal anesthesia, as it would minimize the incidence of defecation in the surgical suite, while saving valuable surgical time.
Colon hydrotherapy would also be extremely useful to alcohol and drug detoxification centers as an aid in the internal cleansing process, enhancing the elimination of toxins from the colon and circulatory system.
Colon Hydrotherapy Contraindications
The contraindications of colon hydrotherapy include diverticulitis, ulcerative colitis, Chrone’s’ disease (in the acute inflammatory stages), severe hemorrhoids, or a tumor in the rectum or a tumor in the large intestine.
CONCLUSION
In conclusion, colon hydrotherapy is the safe, gentle infusion of purified warm water into the colon under conditions that offer safety, using no chemicals or drugs. It is the natural solution to conditions which interfere with the normal functions of the colon.
Why is colon hydrotherapy such a valuable treatment modality? A healthy colon is essential to a healthy body. Conventional diets of today comprised of refined, processed foods, high in saturated fats and low in natural fiber, contribute to the magnitude of the constipation problem. The elimination of undigested food and other waste products are as important as the proper digestion and assimilation of food stuffs. Waste material allowed to remain too long in the digestive system results in fermentation and putrefaction of these substances and proliferation of bacteria and their toxins.
Laxatives offer only temporary relief and do not address the cause of the real problem.
Colon hydrotherapy effectively removes stagnant fecal material from colon walls, preventing the build up of these bacterial toxins in the ports and lymphatic system, resulting in reduced load on the liver. In addition, the treatment removes mucous, gas, parasites, and cellular debris, facilitating peristaltic action and better absorption of nutrients.
This natural cleansing process effectively resolves the symptom directly and indirectly related to dysfunction of the large intestine.
Bacteria are involved in the production of several vitamins which are absorbed by the large intestine and stored in the liver (vitamins K and some of the B vitamins). In addition to vitamins, the colon absorbs larger amounts of water. Unfortunately toxins of bacterial metabolism also enter the circulatory system. These toxins, (Indol, Skatol, Phenol, etc.) are treated by the liver and excreted by the kidneys. Colon bacteria ferments starches releasing hydrogen and methane gasses which are absorbed and excreted through the lungs. Thus, halitosis may be a symptom of a stagnant fermenting colon. Intestinal toxemia may further result in conditions such as headaches, allergies, instability, malnutrition and can potentially lead to an overall lowering of an individual’s immunological defense mechanism.
Intestinal stasis can enhance the systemic absorption of bacteria and their toxins. The prolonged retention of food residues, bile,etc. results in increased numbers of parastalic bacteria present in the colon. Some of the colon’s normal flora may become pathogenic under stagnant or putrefactive conditions. For example, streptococcus and staphylococcus, which are a part of the normal flora of the large intestine under above conditions, could enter the systemic circulation and be a potential source of disease.
It is my own personal and professional opinion that colon hydrotherapy is one of the most valuable treatment modalities offered. It may be a valuable solution by itself or in conjunction with an integrated metabolic program for a myriad of health problems.
Note: The independent articles published in this section of the website are for educational purposes only. The opinions and methodologies described by the authors do not necessarily reflect the opinion and methodology employed at The Hydrocleanse Clinic.
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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 12, Number 4, 2006, pp. 389–393 © Mary Ann Liebert, Inc. Colonic Irrigations: A Review of the Historical Controversy and the Potential for Adverse Effects DOUGLAS G. RICHARDS, Ph.D., DAVID L. MCMILLIN, M.A., ERIC A. MEIN, M.D., and CARL D. NELSON, D.C. ABSTRACT Colonic irrigations enjoy widespread popularity among alternative medicine practitioners, although they are viewed with considerable skepticism by the conventional medical community. Although proponents make claims of substantial health benefits, skeptics cite the lack of evidence for health benefits and emphasize the potential for adverse effects. Yet historically, there are clinical reports of effectiveness and virtually no research refuting these reports. Instead there was a campaign against exaggerated claims by nonmedical practitioners that resulted in a movement away from this form of therapy without any scientific study of efficacy. Given the current popularity of colonic irrigations, it is important that such research be performed, which will require a quantitative estimate of the potential for adverse effects. Although there is little specific literature on colonic irrigations, a review of the literature on related procedures such as enemas and sigmoidoscopies suggests that the risk of serious adverse effects is very low when the irrigations are performed by trained personnel using appropriate equipment. 389 INTRODUCTION Colonic irrigations enjoy widespread popularity among alternative medicine practitioners, while being viewed with considerable skepticism by the conventional medical community. The medical objections include a belief that scientific research has proved that colonics are not effective therapy, and that they pose a high risk of serious adverse effects.1 Furthermore there is a concern that those administering colonics are primarily unlicensed, nonmedical practitioners who make exaggerated claims of health benefits.2,3 The goal of this paper is to provide a balanced perspective for clinicians and researchers through a review of the historical information on the safety and efficacy of colonic irrigations, and bring in relevant information on adverse effects. This paper focuses primarily on peer-reviewed sources, rather than attempting to evaluate the numerous books and papers on this topic in the popular literature. Colonics are distinguished from enemas in that they are not self-administered, but instead are provided by a person with some training; and they are administered using some type of device to control the water flow. Their purpose is to infuse the entire colon with water, in contrast to the more limited infusion of water in an enema. Water temperature and pressure are closely monitored and regulated during a series of fills and releases. Because the method involves an enclosed system, the waste materials are removed without the unpleasant odors or discomfort usually associated with enemas. The modern medical attitude toward colonic irrigations suffers from a lack of information about the historical debate on their safety and efficacy. The history that has been presented by some modern authors1,4 does not address the debate among physicians regarding the value of colonics, instead focusing on the campaign against the practitioners (called “quacks” by their opponents). In parallel with the crusade against quackery, there was a reasoned debate among physicians, conducted in the Journal of the American Medical Association (JAMA) and other medical journals, on the therapeutic value of colonics. That debate was Meridian Institute, Virginia Beach, VA. not resolved by scientific research on colonics, but rather from a combination of hostility toward colonics by the opponents of quackery and the shift in medical practice from physical therapies to drug therapies. This paper looks at the literature from the 1920s and 1930s that shows a serious debate on the value of colonics. BACKGROUND The rationale for colonic irrigation originally was based on the concept of “autointoxication.” Autointoxication is an ancient theory founded on the belief that toxins originating in the intestine can enter the circulation and poison the body. Colonic irrigations as a treatment for autointoxication became popular in the late 1800s and early 1900s. Kelvinson5 cites a variety of respected physicians of the time who advocated colonic irrigations, noting that even the Royal Society of Medicine in 1913 cited the colon as a major factor in health. Whorton4 says, “By the 1930s, most physicians no longer believed in autointoxication . . . even the most sober and fair minded physicians found it difficult to be dispassionate about colonic irrigation and evaluate it purely on its merits, because of their anger at the rampant exploitation of public gullibility by bowel purity hucksters” (p. 138). The political reaction against lay practitioners is most clearly seen in the position of Arthur Cramp, in what was originally called the “Propaganda Department” of the American Medical Association.1 The book, Nostrums and Quackery, that he edited for the AMA Press,6,7 particularly takes issue with Charles Tyrrell’s “J.B.L. Cascade,” a home enema device that consisted of a water-filled cushion with a nozzle. Despite the anticolonic stance of Cramp and his committee, the editor of JAMA8 provided a favorable description of the appliance and specific advice to a medical doctor with a question about the efficacy of the device. Again, there seem to be two separate communities, the antiquackery advocates, and the doctors seriously interested in the therapeutic possibilities of colonic irrigations. Notably absent, both from Whorton’s4 historical account, and reviews such as that of Ernst1 are references to objective research on either the safety or efficacy of colonic irrigations. Ernst cites Donaldson9 as refuting the autointoxication hypothesis, yet Donaldson’s study involved enemas, not colonic irrigations, had only five subjects, and ruled out autointoxication only by inference. Donaldson’s results are actually supportive of the clinical value of enemas. Donaldson, skeptical of the autointoxication hypothesis, performed an experimental study in which five subjects voluntarily made themselves constipated for 4 days. He measured the symptoms of “autointoxication” that appeared (i.e., coated tongue, markedly foul breath, chancre sores, impaired appetite, mental sluggishness, depression, restlessness, irritability, unrefreshing sleep, and headache). He measured reaction time of the nervous system, basal metabolism, blood sugar, and rate of muscle fatigue—all showed impairment. After cleansing enemas (not full colonic irrigations) in all cases the nervous system symptoms improved and the physiologic parameters returned to baseline levels. Assuming that the rapid relief was too sudden to be caused by toxicity, Donaldson concluded that the result had to result from relief of mechanical pressure (distention of the lower bowel by fecal masses). In this conclusion he was following Alvarez,10 who had found that mechanically plugging the rectum resulted in the same sorts of toxic symptoms. Donaldson replicated the Alvarez finding by packing and unpacking the rectums of four further subjects, with the same results as the constipation experiment. Alvarez,10 writing in JAMA, discusses the lack of evidence for the theory of intestinal toxemia. Alvarez makes a case for the “toxic” symptoms being produced by nervous system reflexes. He speaks of “how profoundly sensory inputs from our digestive tracts can influence our emotions, our mental processes and our vasomotor balance” (p. 11). It is not surprising that there are reflexes from the colon that affect the entire nervous system. It is estimated that 80% of vagal fibers are visceral afferents.11 There is also a vast overlap of neuropeptide activity in the gut and brain.12 Another issue regarding intestinal toxemia was addressed by Dragstedt et al.13 from the Mayo clinic. They accepted that intestinal toxemia could cause disorders, but questioned whether administration of antiseptics was a useful treatment. Working with dogs, by surgically closing isolated segments of bowel, they were able to produce the symptoms of toxemia, and showed that the symptoms disappear when the closed segment is removed. Regardless of the correctness of the autointoxication hypothesis, early experiments such as those of Alvarez, Donaldson, and Dragstedt demonstrate the widespread systemic effects of relatively minor manipulations of the colon. It is interesting, then, that both proponents and opponents of colonics have paid no attention to this finding, providing little new information beyond that from the 1920s. Clinical experience with colonic irrigations A variety of books from the 1920s and 1930s by the proponents of colonic irrigations attest to their clinical value.14–17 At the same time, the American Medical Association was zealously attacking “quackery,” with colonic irrigations as a particular target.7 However, in the absence of peer review, there is no way to evaluate the claims that are made on either side of the debate. Instead, this review focuses on the papers in the refereed journals of the time, especially JAMA. Satterlee and Eldridge,18 writing in JAMA, discussed the symptomatology of the nervous system in chronic intestinal toxemia. Far from considering autointoxication an outdated 390 RICHARDS ET AL. hypothesis, they note the “newly found and rapidly developing relationship between mental and nervous conditions and disturbances of the intestinal tract” (p. 1414). They describe a variety of treatments, some far more severe than colonic irrigations (e.g., surgery to remove parts of the colon). It is easy to see why, given the apparent relief from symptoms, the far less invasive colonic irrigations were preferred by many physicians. Further evidence that colonic irrigations were not universally condemned in the 1920s and 1930s is provided by an article by Bastedo19 in The New England Journal of Medicine. Bastedo was opposed to the “commercialized irrigation specialists, who are unduly numerous but do a thriving business” (p. 736). However, he emphasized that “The insertion of liquids into the rectum has been an approved therapeutic procedure since ancient times” (p. 865), distinguishes irrigations of the entire colon from simple enemas, and gives detailed recommendations for their administration. Arthritis is a disorder where there seemed to be some clinical evidence of efficacy of colonics.20,21 Snyder and Fineman22 give several case reports suggestive of the efficacy of colon cleansing in cases of arthritis and cite several clinicians in addition to Pemberton who have this perspective.23–26 A review article by Friedenwald and Morrison27 is especially detailed, and at a relatively late date assesses colonic irrigations very positively. These doctors (from the GastroEnterological Clinic of the Department of Medicine at the University of Maryland) begin with a historical perspective, noting that only recently (1932) the approval of the Council on Physical Therapy of the American Medical Association was sought for a large number of new colonic irrigation devices. Friedenwald and Morrison conclude by saying, “It is our opinion that if colonic irrigations are correctly used in selected cases they fulfill an important therapeutic need” (p. 1628). In 1936 JAMA published a review of colonic irrigations authorized by the Council on Physical Therapy, authored by Frank Hammond Krusen, Professor of Physical Medicine at the Mayo Clinic.28 Although generally skeptical, Krusen gives a balanced review of the pros and cons of colonics. He acknowledges that, “One finds that among physicians of unimpeachable medical integrity there are widely divergent views concerning the value of colonic irrigations” (p. 118). On the “pro” side, he notes that physicians treat a variety of conditions with colonic irrigation, including Pemberton’s claims in the treatment of arthritis. He also cites Stroud,29 who advocates colonics in the treatment of cardiovascular disease, and Weisenberg and Alpers,30 who note that, “High colonic irrigations are of value in some cases of so-called toxic myelitis” (p. 119). Krusen also cites Morgan and Hite,31 who see value in colon cleansing, but notes the need for recognition that such a treatment can be harmful if carried beyond limits called for by the specific ailment. On the “con” side, Krusen has two main points. The first is that colonics can have adverse effects, such as cramps, irritation, and perforation of the wall of the colon. It is interesting, though, that his source for these adverse effects is Bastedo, who is a proponent of the careful use of colonic irrigations. His second main point is that, in his own experience, colonic irrigations have little use in the hospital setting; his preference is for simple enemas to relieve constipation when necessary. Thus, in the late 1930s, there was a reasoned debate on colonic irrigations, documented in JAMA, despite the crusaders against “quackery.” The themes in these JAMA articles up through the 1930s are clear: The problem is not that there is anything intrinsically wrong with colonic irrigations. Rather: (1) there are clinical observations from a variety of physicians and studies supporting the efficacy of colonics; (2) evidence for the autointoxication hypothesis is weak, although there is support for aberrant nervous system reflexes in the colon as a pathophysiologic factor in some conditions; and (3) although administration under a physician’s supervision is a reasonable therapeutic procedure, the inflated claims and sometimes extreme procedures employed by nonmedical practitioners are not advised. This balanced perspective appears to have been squeezed out by the crusaders against quackery, a trend that has continued to this day. ADVERSE EFFECTS The potential for adverse effects from colonic irrigations must be addressed, both for informed consent in research, and for assessing risk of therapeutic applications. There is a need to determine to what degree the common medical criticism of colonic irrigations, that there are serious adverse effects,1 is valid. For informed consent it is important to have a quantitative estimate of the potential for adverse effects. However, reports of adverse effects from colonic irrigations of the type we are discussing (performed on individuals without serious bowel disease, by trained colon hydrotherapists, using disposable nozzles) appear to be very rare, despite the widespread popularity of colonics as an alternative health modality. We have found only two reports on MEDLINE®. One is the oft-cited case of amebiasis from improperly sterilized equipment at a chiropractic clinic in Colorado.32 The other is a case of rectal perforation in Singapore.33 Because there are no specific data on colonic irrigations, the closest comparisons would be enemas and sigmoidoscopies. Enemas typically only stimulate the first part of the colon, the sigmoid colon, and are not intended to cleanse the entire colon as is a colonic irrigation. Often an enema is given before a more invasive procedure such as a sigmoidoscopy in which a tube is introduced into the colon. In a sigmoidoscopy, the tube (with a fiberoptic camera) goes only as far as the sigmoid colon and may include biopsies or removal of polyps. In contrast, the tube for a colonic irCOLONIC IRRIGATION REVIEW 391 rigation is inserted approximately 3 inches into the colon, and no procedure such as biopsy is performed. For these reasons, any estimate of adverse effects based on sigmoidoscopies would likely show a substantially greater risk than is actually found with colonic irrigations. Risk of perforation Perforation of the wall of the colon is often seen as the most serious adverse effect of any procedure that introduces something into the colon. Perforation can be mechanical (e.g., puncture by the tip of the tube) or caused by excessive pressure causing a weak spot in the colon wall to rupture. Cleansing enemas are the closest comparison to colonic irrigations, but no systematic data have been collected on the incidence of perforation compared to the total number of enemas given. The most important risk factors for perforation relevant to colonic irrigations are advanced age and diseases of the colon such as diverticulitis and inflammatory bowel disease. The greatest risk (for those 65 with bowel disease) would be about 1 in 10,000 (based on the perforation rate for sigmoidoscopy), with the risk for younger people without bowel disease much lower.34,35 Given the much smaller insertion distance into the colon, the perforation risk for colonic irrigations should be substantially less than for sigmoidoscopy. Risk of other adverse effects Warnings against colonic irrigations often take the form of cautions about the adverse effects of substances administered during enemas. This is not relevant to colonics using only filtered tap water (which is a common application). There are no reports of adverse effects from tap water colonic irrigations in adults, although there is a concern based on the possibility of depletion of electrolytes. Collins and Mittman36 have performed the only study that has specifically looked at the effect on serum electrolytes of colonic irrigations as they are given in naturopathic clinics. Although there were small changes in some electrolyte levels, the subjects (n 17) experienced none of the symptoms of water intoxication. The authors also note that their experience at the Portland Naturopathic Clinic has been that even in debilitated and chronically constipated patients, serious reactions to colonic hydrotherapy have not occurred. For colonic irrigations, the risk to healthy adults of adverse effects from tap water or saline solutions is probably extremely small. It is important not to confuse the basic colonic irrigation with therapeutic procedures such as coffee enemas that may carry greater risks. Transmission of pathogens The potential for transmission of pathogens through enemas and irrigations was described as early as 1929,37 and followed by reports by Gilbert,38 Steinbach et al.,39 and Meyers,40 all making the point that pathogens ranging from bacteria to protozoa can survive on the parts of enema equipment that are insufficiently sterilized, and be transmitted rectally. Ever since the cases of amebiasis from improperly sterilized irrigation equipment reported by Istre et al.,32 disposable parts have become standard for colonic irrigation equipment approved by the U.S. Food and Drug Administration. CONCLUSIONS Clearly, the modern controversy between colon hydrotherapists and mainstream medicine has deep historic roots. Hopefully, the historical review and discussion of adverse effects provided in this paper provides basic information for informed consent that is essential for medical research to help resolve this debate. Future basic research should seek to clarify the autointoxication/nerve reflex models of colon pathophysiology discussed in the historical medical literature. Clinical research focusing on common conditions such as arthritis and headache, particularly when symptoms of autointoxication are present, also should be a priority. REFERENCES 1. Ernst E. Colonic irrigation and the theory of autointoxication: A triumph of ignorance over science. J Clin Gastroenterol 1997;24:196–198. 2. Barrett S. Gastrointestinal quackery: Colonics, laxatives, and more. Online document at: www.quackwatch.org/01QuackeryRelatedTopics/gastro.html Accessed June 28, 2004. 3. Jarvis WT. Colonic irrigation. National Council Against Health Fraud. Online document at: www.ncahf.org/articles/ c-d/colonic.html Accessed June 28, 2004. 4. Whorton JC. Inner Hygiene: Constipation and the Pursuit of Health in Modern Society. Oxford, UK: Oxford University Press, 2000. 5. Kelvinson RC. 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The Royal Road to Health, 94th ed. New York: Author, 1913. 16. Stemmerman W. Intestinal Management for Longer, Happier Life. Asheville, NC: Arden, 1928. 17. Wiltsie J. Chronic Intestinal Toxemia and Its Treatment. Baltimore: Wood, 1938. 18. Satterlee GR, Eldridge WW. Symptomatology of the nervous system in chronic intestinal toxemia. JAMA 1917;69: 1414–1418. 19. Bastedo W. Colon irrigations. N Engl J Med 1928;199: 865–866. 20. Pemberton R. The nature of arthritis and rheumatoid conditions. JAMA 1920;lxxv:1759–1765. 21. Pemberton R. Arthritis and Rheumatoid Conditions: Their Nature and Treatment. Philadelphia: Lea & Febiger, 1935. 22. 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 Roentgenol 1927;17:27–43. 23. Persson GA. Gastrointestinal infections in chronic arthritis. NY Med J 1923;cxviii:363–366. 24. Smith R. The surgical relief of intestinal foci in cases of arthritis deformans. 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An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. N Engl J Med 1982;307:339–342. 33. Tan MP, Cheong DM. Life-threatening perineal gangrene from rectal perforation following colonic hydrotherapy: A case report. Ann Acad Med Singapore 1999;28:583–585. 34. Gatto NM, Frucht H, Sundararajan V, et al. Risk of perforation after colonoscopy and sigmoidoscopy: A populationbased study. J Natl Cancer Inst 2003;95:230–236. 35. Anderson ML, Pasha TM, Leighton JA. Endoscopic perforation of the colon: lessons from a 10-year study. Am J Gastroenterol 2000;95:3418–3422. 36. Collins JG, Mittman P. Effects of colon irrigation on serum electrolytes. J Naturopath Med 1990;1:4–9. 37. Hervey CR. A series of typhoid fever cases infected per rectum. Am J Public Health 1929;19:166–171. 38. Gilbert R. Transmission of incitants of enteric disease by unsterile equipment used for administering fluid by rectum. JAMA 1938;110:1664. 39. Steinbach HL, Rousseau R, McCormack KR, Jawetz E. Transmission of enteric pathogens by barium enemas. JAMA 1960;174:1207–1208. 40. Meyers PH. Contamination of barium enema apparatus during its use. JAMA 1960;173:1589–1590. Address reprint requests to: Carl D. Nelson, D.C. 1397 Laskin Road Virginia Beach, VA 23451 United States E-mail: CDNDC@aol.com COLONIC IRRIGATION REVIEW 393
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Hydrocleanse follows the professional guidelines of the International Association of Colon Hydrotherapists I-ACT, the largest organisation in the world governing this profession.
