Colonic irrigation: therapeutic claims by professional organisations, a review

Colonic irrigation is a popular treatment promoted for a wide range of conditions. The aim of this analysis is to evaluate the therapeutic claims made by professional organisations of colonic irrigation. Six such organisations were identified. On their websites, a plethora of therapeutic claims were made. Common themes were detoxification, normalisation of intestinal function, treatment of inflammatory bowel disease and weight loss. None of these claims seemed to be supported by sound evidence. It is concluded that the therapeutic claims of professional organisations of colonic irrigation mislead patients. There are numerous synonyms for colonic irrigation, e.g. colonic treatment, colon cleansing, rectal irrigation, colon therapy, colon hydrotherapy, colonic. In complementary medicine, colonic irrigation is used for a wide range of indications: alcoholism, allergies, arthritis, asthma, backache, bad breath, bloating, coated tongue, colitis, constipation, damage caused by nicotine or other environmental factors, fatigue, headache, hypercholesterolaemia, hypertension, indigestion, insomnia, joint problems, liver insufficiency, loss of concentration, mental disorders, parasite infestation, proneness to infections, rheumatoid arthritis, sinus congestion, skin problems and ulcerative colitis (1). The treatment is based on the ancient but obsolete theory of ‘autointoxication’, i.e. the body is assumed to poison itself with, ‘autotoxins’ which, in turn, cause various illnesses (2). The treatment usually involves the administration of about ½ L of warm, filtered water through a proctoscope by means of an inflow/outflow intermittent flush out method (3). The purpose of this procedure is ‘to infuse the entire colon with water, in contrast to the more limited infusion water in an enema’ (2). Sometimes, ingredients such as herbal extracts are added to the water. To the best of my knowledge, there are no reliable data about the prevalence of usage of colonic irrigations. A UK survey suggested that 84% of the patients using colonic irrigation are women; many of them see it as a life-long therapy and believe this therapy to be three times more effective than conventional medicine. Commonly users think it ‘detoxifies, cleans, unblocks’ the system (3). This review is aimed at assessing the therapeutic claims made by professional organisations of colonic irrigation. The following search terms were used to locate all websites of professional organisations of colonic irrigation via the Google search engine: colonic, colonic irrigation, hydrotherapy, colon therapy, colon lavage. The search was conducted on 2 February 2009. Six such organisations were identified, and the contents of their websites were studied (4–9). All therapeutic claims were extracted. Table 1 shows that, directly or indirectly, all of the six organisations make therapeutic claims on their websites. Frequently mentioned themes are ‘detoxification’, normalisation of intestinal functions, treatment of inflammatory bowel diseases and body weight reduction. The claims are mostly confined to symptomatic improvements – but there are exceptions, e.g. prevention of bowel cancer (6) or sorting out Irritable Bowel Syndrome ‘once and for all’ (8). Other therapeutic claims pertain to asthma, menstrual irregularities (6), circulatory disorders (7), skin problems, improvement in energy levels (8) and no longer requiring pharmacotherapy (9). All these claims represent testable hypotheses. The question therefore arises whether these hypotheses have been tested and, if so, what the results of such investigations suggest? In conventional healthcare, colonic irrigation is occasionally used for postoperative defecation disorders, faecal incontinence or for the prevention of postoperative enterocolotis – and there is at least some evidence in support (10–15). Patients suffering from slow transit constipations sometimes report symptomatic relief after colonic irrigation; yet this is short lived and achievable with evidence-based treatments. Using searches in Medline and Embase, I was unable to find a single controlled clinical trial to substantiate the claims shown in Table 1. The previous reviews of the subject have also failed to find such evidence (e.g. 16,17). Therefore, it seems fair to say that the therapeutic claims made by professional organisations of colonic irrigation are unsubstantiated. A recent survey suggested that colonic irrigation is totally devoid of risks: during 8470 treatments administered by UK members of the ‘Association of Colonic Hydrotherapists’, no adverse events were noted (3). The previous reviewers also gave the impression that the procedure is safe (e.g. 18). However, other authors have stated that side-effects include nausea, diarrhoea, nervous disturbances (16) as well as cramps and irritations (19). Moreover, the documented risks include electrolyte depletion (20,21), water intoxication (22,23), bowel perforation (24–27) and infection (28). In view of both the absence of evidence of effectiveness and the possibility of harm, any attempt at a risk-benefit analysis must yield a negative verdict. Proponents of colonic irrigation seem to think that such a statement indicates ‘hostility towards colonics by the opponents of quackery’. I would argue that it reflects mere medical common sense. Moreover, one has to ask why the organisations concerned do not submit their chosen treatment modality to test. In conclusion, this analysis shows that professional organisations of colonic irrigation make therapeutic claims that are not based on scientific evidence. In the interest of our patients, we should find ways to correct this situation. None. None.

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