Colon hydrotherapy: 11 essential questions

Colon hydrotherapy (CHT) is an intestinal irrigation often used by naturopaths as part of intestinal rehabilitation. In several sessions, water is introduced into the intestine through the anus (rectally) and combined with an abdominal massage. This is intended to loosen blockages and old stool residues from the intestinal wall, and change the bacterial colonization of the intestine. The treatment seeks to improve chronic diseases and general well-being. However, conventional medical research considers the treatment to be ineffective—if not risky. The following text explains how colon hydrotherapy works, what the costs are, and how the effects are currently being assessed.

1. What should colon hydrotherapy help?

First and foremost, colon hydrotherapy is intended to help free the colon from stuck stool residues When the intestine has been “cleaned”, it should function as an excretory organ and also be able to discharge “pollutants” that have accumulated in the body tissue.

Bacterial overgrowth (dysbiosis, SIBO), which is supposedly caused by stress, an unhealthy diet and medication, as well as intestinal fungi, is said to be flushed out by the water so that "healthy" bacteria can settle in the intestine again. Intestinal dysfunction, such as constipation and diarrhea, as well as chronic bowel diseases (e.g. Crohn's disease, diverticulosis) should be helped by the treatment. This therapy may also help patients with the following diseases:

• Eczema
• Acne
• Allergies
• Rheumatism
• High blood pressure
• Anxiety
• Fatigue
• Depression
• Irritable bowel syndrome (IBS)
• Weakened immune system

For many of these diseases, however, no study results so far can confirm an actual effect. Most information is based on pure, unreliable reviews. No general recommendations should be derived from these reports.

2. How to prepare for colon hydrotherapy?

Colon hydrotherapy is used by alternative practitioners for a fee. Use at home is not recommended. At the beginning of therapy, a detailed medical history is taken because treatment is not possible if a person has certain diseases. In the case of inflammatory bowel diseases, it should also be determined whether or not the patient is in an inflammatory phase. In addition, a blood test of the stool should exclude this. Before colon hydrotherapy, the patient is advised not to eat or drink anything so that the bowel is already slightly emptied.

3. How is colon hydrotherapy performed?

For the actual treatment, the patient lies on their back or side on a couch. A short plastic tube is inserted into the rectum via the anus. Several liters of water are introduced into the colon without pressure. The temperature of the water varies between about 68 and 104 degrees Fahrenheit. In addition to the water itself, this is supposed to stimulate intestinal activity and thus strengthen the intestinal muscles. Additives may be added to the water, including herbs, vinegar, or coffee.

At the end of the treatment, oxygen is also added to the water. During the water discharge, the alternative practitioner gently massages the patient's stomach and tries to track down relevant constipations and stool residues and direct the water there. The water with stool residues is channeled out of the intestine via a closed system and disposed of directly in the sewage system—there are therefore no unpleasant odors, and it is not necessary to go to the toilet during treatment. After the treatment there may be an urge to defecate, which is why some waiting time should be scheduled in the practice.

If colon hydrotherapy is done as part of a colon cleanse, probiotics may be prescribed after treatment. These contain health-promoting bacterial cultures that are supposed to settle in the now “cleaned” intestine.

4. Who shouldn't use colon hydrotherapy?

People who have acute intestinal inflammation must not be treated with colon hydrotherapy. This applies to gastrointestinal infections as well as to patients with Crohn's disease or ulcerative colitis. Bleeding and tumors must also not be present in the intestine. Since an intestinal irrigation can put a heavy burden on the circulatory system, people with heart issues or pregnant women in particular should refrain from treatment. Electrolyte disorders can also occur, which could be particularly dangerous for people with kidney dysfunction.

5. Does colon hydrotherapy help?

The intestine and thus the intestinal flora have a major influence on body functions, on mental well-being, and on various chronic diseases. In recent years, conventional medicine has accepted this as a fact and incorporated it into research.

Conventional medicine and alternative medicine also agree that too few research results are available to be able to speak of the objective effect of colon hydrotherapy. Frequently, the few existing studies also refer to different types of colon irrigation and not specifically to colon hydrotherapy. Instead, alternative medicine refers to the subjective improvement of the condition of most patients and is based on experiential reports.

6. Does colon hydrotherapy help to increase stool diversion and general well-being?

There is no question that colon hydrotherapy at least temporarily helps clear blockages, as it frees the intestines of large amounts of stool. The theory of “self-poisoning”, in which old stool residues release toxins into the blood on the intestinal wall is unsupported by conventional medicine.

These assumptions would be based on the old four-fluids theory and are therefore considered outdated. So far, there is no study that examines the effect of colon hydrotherapy on general well-being. The procedure is not recommended for colon cleansing before a colonoscopy, where oral laxatives and preparation solutions are preferred.

7. Does colon hydrotherapy help against constipation, fecal incontinence, and IBS?

Few studies examined the effect of regular colon irrigation on chronic blockages. In patients who had already tried medication and biofeedback without success, a moderate positive effect through treatment has been shown. This also applied to patients who were unable to hold their stool willingly due to surgery or other reasons (i.e. patients who had fecal incontinence).

For patients with IBS—both with diarrhea-type and with constipation-type—the pain and stool symptoms could be improved by intestinal irrigation. However, all of these studies covered a small group of patients, which is why larger studies are needed to confirm the effect.

8. Does colon hydrotherapy help against bacterial overgrowth?

According to supporters of colon hydrotherapy, the treatment should help to protect against bacterial overgrowth and restore bacterial balance in the gut. So far, however, this has not been confirmed, especially because it has not yet been finally clarified what exactly a “healthy” intestinal flora should look like.

It is feared that an excessive intestinal lavage would affect the intestinal flora so much that it could ultimately lead to an increase in pathogens causing disease. A warning was also given against a weakening of the intestinal barrier with the subsequent spread of bacteria into the tissue. In addition, a long-term effect is doubted, since the bacterial colonization of the intestine is also controlled by genetic elements. For a healthy intestinal flora, gastroenterologists recommend a high-fiber diet without too many fats and sugars, combined with drinking about 1.5 to 2 liters. A positive effect could also be achieved by giving probiotics, which are also used by naturopaths for intestinal rehabilitation.

9. Does colon hydrotherapy help against other diseases?

So far, no positive effect of colon hydrotherapy on conditions such as rheumatism, high blood pressure, skin diseases, alcoholism, anxiety disorders, or depression has been demonstrated. One study found heroin withdrawal treatment to be marginally successful when colonic irrigation was performed. However, the procedure and evaluation of the study does not meet international criteria.

10. Is colon hydrotherapy dangerous?

As few studies as there are on the effectiveness of colon hydrotherapy, there are many publications on its possible complications. This can at least in part be attributed to the bias that scientific magazines often only deal with naturopathic practice when it becomes relevant for conventional medicine (for example, if complications require surgery or the like). Nevertheless, possible benefits, which currently appear to be limited, must be balanced with a possible damage caused by the procedure. Although many thousands of treatments are carried out annually without complications, serious complications can occur, especially if handled improperly.

11. What complications can occur?

Bleeding and injuries including intestinal tears may occur. Infection by bacteria or amoeba can also occur if tools are not sufficiently disinfected. If there is acute inflammation during treatment, it can worsen, and bacteria can be flushed into the bloodstream—dangerous systemic body reactions such as fever and circulatory shocks can result.

The danger of colon hydrotherapy is comparable to that of stool transplants. Electrolyte derailment, bacteria in the blood (sepsis), and colon inflammation (colitis) have been reported, especially in connection with coffee additives in the water. Overall, colon hydrotherapy is therefore rated negatively, since the possible benefits do not outweigh the possible damage.