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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Why Colonics Aren’t Helpful and What Works Better Than a Colon Cleanse

Written by Dr. Michael Ruscio, DC on July 17, 2021

Written by Dr. Michael Ruscio, DC on July 17, 2021 — Reviewed by Hilary Watts

What is Colonic Hydrotherapy, and What are the Downsides?

• What is a Colonic?|
• Downsides of a Colon Cleanse|
• What’s Happening in Your Gut?|
• Healthy Diet|
• Probiotics|
• Additional Approaches|
• Recommended Products|

Colon hydrotherapy or having a “colonic” has become a wellness trend in recent years. Colon hydrotherapy is billed as an ultimate detoxification regimen — you may have considered this therapy if you’re struggling with chronic constipation, dysbiosis, or related symptoms such as stomach pain, bloating, fatigue, or brain fog.

During this fairly extreme type of colon cleanse, a large amount of water is flushed through the colon via a tube inserted into the rectum.

However, you might want to take a pause before having a colonic.

In this article, we’ll look at what colon hydrotherapy is, whether it works, and the scientifically-tested alternatives that can improve your gut and overall health instead.

What is a Colonic?

A colonic (also known as colon hydrotherapy, colonic hydrotherapy, colonic irrigation or a colon cleanse) is offered by some alternative practitioners to remove waste material, toxins and bacteria from your system.

During a colonic, large amounts of filtered water — up to 16 gallons, or about 60 liters — are flushed through the bowel (colon/large intestine). The whole process can take about 1-1.25 hours 1.

To administer a colonic, a colon hydrotherapist has the person lie on their side with their knees bent, in much the same position as might be adopted for a colonoscopy. A hose then delivers a pressurized stream of water into the rectum. The water and waste material drain back out of the hose and into a plumbing unit.

Proponents of colonic hydrotherapy say that the process offers these health benefits 2:

• Improves the immune system and general well-being
• Relieves constipation and helps digestive health
• Eases allergies
• Helps weight loss
• Improves headaches
• Helps with acne 

Unfortunately, after digging into the research on colonics, we found the scientific backing for these assertions to be weak to non-existent. One systematic review of 17 studies concluded that “the practice of colonic cleansing to improve or promote general health is not supported in the published literature and cannot be recommended at this time” 1 3.

This can be hard to handle if you’ve been struggling with symptoms and hear glowing anecdotal reports. You may have met someone who swears by colonics and of course it is always great that someone feels better. However, it’s highly likely that the effect is a placebo one.

It’s always worth remembering that the placebo effect can be a really powerful one. In IBS, for example, research has shown that a placebo medication produces positive results on average 40-72% of the time 4.

If you feel better, that’s a good thing, but with colon hydrotherapy you risk becoming dependent on a placebo that can be expensive, invasive, and potentially harmful. The bottom line is that you’re better off exploring treatment options that have more thorough evidence and fewer risks behind them.

What About Enemas?

An enema also involves introducing a liquid into the bowel via the rectum, but a smaller quantity that generally only reaches the bottom half of the bowel. Enemas can be 5:

• Evacuative: Typically for constipation, in place of laxatives.
• Retentive: When the enema is held in. Often used as a way to deliver medication to the bowel.

Enemas may be administered by a doctor or self-administered with kits bought from the pharmacy. They are scientifically more accepted than colon hydrotherapy, but they can still have risks 6. 

This is especially the case with enemas used without good medical reason, such as coffee enemas that involve injecting brewed coffee and water into the rectum. These have been claimed (incorrectly) to detoxify the body and even help cure cancer 7. 

Transanal Irrigation

Another form of irrigating the colon — called transanal irrigation — has specific, medically advised uses, for people who cannot have normal bowel movements due to nerve damage, (ex., as a result of multiple sclerosis, spina bifida or stroke) 8 9 10.

In this method, a device pumps warm water into the bowel, and an inflated balloon holds the water in until bowel contractions begin. Then the balloon is deflated and the contents of the bowel come out into the toilet.

Why a Colon Cleanse Misses the Mark

The whole concept of colon cleansing has a long and checkered history, including many misconceptions around what the process may achieve. One of these misconceptions is a colon cleanse could fight “intestinal autointoxication”, or being poisoned by the contents of the gut, a theory which was discredited in the 1930s 3. 

Today, the colon cleansing industry still promotes everything from purgative herbs and colon hydrotherapy to coffee and apple cider vinegar enemas as a way to improve health, despite no good evidence for benefit 3. 

A colon cleanse might seem an attractive idea and might temporarily help digestive system symptoms. But when you compare science-backed methods to improve gut health with colon cleansing, you’ll find two main problems with the latter:

• Colon cleansing only targets your bowel — not the whole gastrointestinal tract, including the small intestine where nutrients are absorbed and gut imbalances, such as SIBO (small intestinal overgrowth), can also occur.
• A colon cleanse can be harsh — it can cause issues such as cramping. It also flushes good as well as bad bacteria from the bowel 11.

Without being alarmist, it’s important to mention some of the dangers associated with colon hydrotherapy and self-administered cleansing enemas in particular. 

These include colorectal perforation, inflammation of the lining of the rectum, lower abdominal pain, and bloody stools 12 13 14.

What’s Going on in Your Gut?

If you’ve been investigating colon cleanses or colonic hydrotherapy you’ve likely pinpointed some gut-related health issues.

But rather than settle for an unproven colon cleansing regimen, an approach that targets the underlying causes more thoroughly and holistically is a better choice.

Let’s consider what may be going wrong with your gut and the distressing symptoms this can cause. 

Common underlying gut issues include: 

• Dysbiosis, or imbalances in the gut bacteria (microbiome) 
• Inflammation
• Abnormal immune function
• Increased gut permeability (leaky gut)

These four issues tend to cluster together causing chronic health symptoms.

The many health issues that can occur as a result include:

• Fatigue: Research shows that fatigue is extremely common in patients with IBS 15 16, non-celiac gluten sensitivity 17, leaky gut 18, and people with gastrointestinal complaints 19.
• Depression and anxiety: Research connects poor mental health (anger, irritability, tension, depression, and anxiety) to inflammatory bowel disease 20 and IBS 19 21 22.
• Brain fog: Inflammation that travels to the brains from the gut can also cause brain fog 15 17, characterized by slowed thinking, forgetfulness, inability to focus, and poor mental stamina 23. 
• Skin problems: Skin issues related to gut health include acne 24, eczema 25 26 27, psoriasis 28 29, and other autoimmune skin conditions.
• Thyroid issues: Inflammation originating in the gut also damages your body’s ability to use thyroid hormone — this can lead to hypothyroid symptoms 30.

Using Diet to Reset Gut Health

When addressing any of these chronic symptoms, changing your diet should be your first approach. With the groundwork established, you can add other therapies, should they be needed. 

Because many common foods can inflame the gut, a gut healing diet should focus on:

• Reducing or removing foods that may irritate your gut lining or feed imbalanced gut bacteria
• Healing and sealing any intestinal permeability 
• Feeding your good gut bacteria
• Reducing inflammation
• Helping you understand which foods are triggering your symptoms

For many people, a Paleo-style diet ticks most of these boxes. I generally recommend you try this healthy eating plan before other more restrictive diets. On a Paleo diet, you eat a lot of fruit and vegetables and lean protein, while avoiding gluten-containing grains, dairy, and processed foods. This helps to calm inflammation by minimizing your exposure to foods that provoke an immune response 31 32. 

If a Paleo diet doesn’t alleviate symptoms after a week or two, you can try progressively more restrictive diets such as the low FODMAP diet. The low FODMAP diet helps to reduce bacterial overgrowth by restricting foods that feed bacteria, and has many scientifically validated benefits, such as:

• Reducing IBS symptoms such as bloating, abdominal pain, diarrhea, and gas 33 34 35 
• Improving symptoms in those diagnosed with inflammatory bowel disease (IBD) 36 37 38 39
• Reducing pain for fibromyalgia patients 40

It can take a few weeks to find a diet that makes you feel healthier. When you’ve arrived at this point, it’s a good idea to also support your diet with probiotics.

Supporting Your Gut With Probiotics

Probiotics — or friendly bacteria supplements— are the second essential step in a gut health protocol.

Whatever the reason you sought out colon hydrotherapy, probiotics can probably help relieve your symptoms more effectively. There’s some great research backing to support this. 

For example, probiotics help to: 

• Increase stool frequency and improve stool consistency 41 42 43
• Reduce bloating 42
• Improve IBS symptoms 44 45 46 47 48
• Increase bacterial diversity, which is a measure of the health of your microbiome 49
• Promote a healthy immune response in your gut and reduce gut inflammation 49 50 51
• Reduce damage to your gut lining 52 53 54

Many people don’t seem to achieve balance in their microbiota with just one probiotic formula. I have seen the best results with my patients when they include one probiotic from each of these three categories:

1. Lactobacillus and Bifidobacteria blends, including species of probiotics such as Lactobacillus acidophilus and Bifidobacterium infantis
2. Saccharomyces boulardii (a beneficial yeast)
3. Soil-based probiotics, usually Bacillus species

For many patients who have tried just one type of probiotic, this approach makes all the difference. 

Research also supports combining different probiotic strains — for example, two systematic reviews and meta-analyses indicated that multi-strain probiotics were more effective than single-strain probiotics for treating IBS 48.

Additional Approaches

If you’re still not on top of your symptoms after making changes to your diet and taking probiotics, there are plenty more strategies to try. It still isn’t a good idea to resort to therapies science doesn’t support, such as colonic hydrotherapy.

For example, herbal antimicrobial agents such as oil of oregano can be a useful strategy that can help further reduce gut inflammation and damage 55 and help get rid of lingering bad microbes and parasites 56.

If you have indications that your stomach acid is low, you could also consider supporting your digestion with enzymes and hydrochloric acid supplements 57 58.

Everybody’s recovery progress tends to be different, and healing is not linear  — it’s a process that can go in stops and starts. But sticking with these tried and tested protocols can help support better health, helping you to enjoy life.

The Bottom Line

Colon hydrotherapy comes with some extravagant claims but no real evidence to support them. It therefore makes sense to try the trusted route of diet and probiotics instead.

Finding your way through troublesome ailments may not be easy on your own though. If you require more personalized help with gut-related or other symptoms, you can schedule a virtual or in-person consultation at our functional medicine center.

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