Colon cleansing

This article is about the alternative medicine technique. For uses in standard medicine, see Enema and Bowel cleansing.

Colon cleansing, also known as colon therapy, or colon hydrotherapy, or a colonic, or colonic irrigation encompasses a number of alternative medical therapies claimed to remove unspecified toxins from the colon and intestinal tract by removing supposed accumulations of feces. Colon cleansing in this context should not be confused with an enema which introduces fluid into the colon, often under mainstream medical supervision, for a limited number of purposes including severe constipation^[1] and medical imaging.^[2]

Colon cleansing
Large enema equipment for colon cleansing
Alternative therapy
Claims	Removal of unspecified toxins

Some forms of colon hydrotherapy use tubes to inject water, sometimes mixed with herbs or with other liquids, into the colon via the rectum using special equipment. Oral cleaning regimes use dietary fiber, herbs, dietary supplements, or laxatives. Those who practice colon cleansing believe in autointoxication, that accumulations of putrefied feces line the walls of the large intestine and that these accumulations harbor parasites or pathogenic gut flora, causing nonspecific symptoms and general ill-health.

Autointoxication, a term coined in 1884 by the French physician Charles Jacques Bouchard,^[3] is a hypothesis based on medical beliefs of the ancient Egyptians and Greeks and was discredited in the early 20th century.^[4] Nonetheless, during the 2000s Internet marketing and infomercials of oral supplements supposedly for colon cleansing increased.^[5]

There is no scientific evidence for the alleged benefits of colon cleansing.^[4] Certain enema preparations have been associated with heart attacks and electrolyte imbalances, and improperly prepared or used equipment can cause infection or damage to the bowel. Frequent colon cleansing can lead to dependence on enemas to defecate and some herbs may reduce the effectiveness of, or increase the risks associated with the use of prescription medications.^[6]

Effectiveness and risks

The symptoms that are attributed to autointoxication—headache, fatigue, loss of appetite and irritability—may be caused by mechanical distention within the bowel, such as irritable bowel syndrome, rather than toxins from putrefying food.^[7][8][9] The benefits anecdotally attributed to colon cleansing are vague and the claims made by manufacturers and practitioners are based on a flawed understanding of the body.^[3][10] There is little evidence of actual benefit to the procedure, and no evidence that it can alleviate the symptoms that are attributed to the theories of colon cleansing.^[11]

As the colon normally expels waste, colon cleansing is generally unneeded.^[12][13] Colonic irrigation can disrupt the bowel's normal flora, and, if done frequently, can result in electrolyte depletion with dehydration.^[13] Rare but severe adverse events have been rectal perforation,^[14] as well as amoebic infection, from poorly sterilised equipment.^[15] Others claim that colon cleansing may impede the colon's shedding of dead cells.^[16]

Excessive use of enemas has also been associated with heart problems, such as heart failure,^[13] as well as heart attacks related to electrolyte imbalances when performed as a coffee enema.^[17] Frequent enemas or other colon-cleansing tools may lead to dependence and inability to defecate without assistance, as well as potential withdrawal symptoms.^[6][7] Herbs taken orally may modulate the absorption or the activity of prescription medications.^[6]

Medical doctor Harriet Hall writes that "The colon cleanses itself... The idea that its walls are coated with years-old hamburger residue is preposterous".^[18]

Supplement effectiveness

The consumer advocacy news program Marketplace conducted a consumer trial with three women on the effectiveness of two colon supplements versus fiber.^[5] The results showed the supplements did not assist in weight loss and provided no additional benefit over a basic fiber supplement. According to the American Cancer Society, "Available scientific evidence does not support claims that colon therapy is effective in treating cancer or any other disease".^[4]

Colon hydrotherapy

Colonic irrigation, also known as colon hydrotherapy, colonic hydrotherapy, or a "colonic", is a treatment which is used "to wash out the contents of the large bowel by means of copious enemas using water or other medication."^[19]

During a cleansing enema, liquid is introduced into the colon and retained for five to fifteen minutes.^[20] During a colonic, liquid is introduced into the colon and then it is flushed out and this is repeated until the entire colon is cleared.^[21]

Colonic irrigation has been described as an "unwise" procedure as it carries the risk of serious harm and has no proven benefit.^[22]

Regulation

In the United States, the Food and Drug Administration (FDA) regulates the production of equipment used in colon hydrotherapy but does not regulate their use, or the supplements used in oral colon-cleansing regimens. Manufacturer claims do not require verification or supporting evidence. The contents of the products are also not verified or tested.^[16] The FDA has issued several letters warning manufacturers and suppliers of colon hydrotherapy equipment about making false claims of effectiveness, safety issues, and quality control violations.^[7]

History

The concept of autointoxication, the idea that food enters the intestine and rots, provides a rationale for colon cleansing.^[7][23] The ancient Egyptians believed that toxins formed as a result of decomposition within the intestines,^[24] and moved from there into the circulatory system, causing fever and the development of pus. The Ancient Greeks adopted and expanded the idea, applying their belief in the four humours. In the 19th century, studies in biochemistry and microbiology seemed to support the autointoxication hypothesis, and mainstream physicians promoted the idea.^[8] Daly notes that, historically, "purging was one of the few procedures that a physician could perform with visible, often impressive results and without immediate or obvious dangers".^[25]

Ilya Ilyich Mechnikov (1845-1916) became the strongest supporter of the idea of colon cleansing; he thought that toxins could shorten the lifespan. Over time, the concept broadened to autointoxication, which supposes that the body cannot fully dispose of its waste products and toxins, which then accumulate in the intestine.^[23] In some cases, the concept led to radical surgeries to remove the colon for unrelated symptoms.^[26]

Autointoxication enjoyed some favor in the medical community in the late 19th and early 20th centuries, but clinicians discarded it as advances in science failed to support its claims.^[3][11][23] A 1919 paper entitled "Origin of the so-called auto-intoxication symptom" in the Journal of the American Medical Association marked the beginning of the rejection of the auto-intoxication hypothesis by the medical community.^[8][27]

Despite a lack of scientific support, autointoxication persists in the public imagination. In the 1990s the practice of colon cleansing experienced a resurgence^[3] in the alternative-medical community, supported by testimonials and anecdotal evidence and promoted by manufacturers of colon-cleansing products.^[3][23]

See also

• Mucoid plaque
• Whole bowel irrigation

References

1. Emmanuel, A V; Krogh, K; Bazzocchi, G; Leroi, A-M; Bremers, A; Leder, D; van Kuppevelt, D; Mosiello, G; Vogel, M; Perrouin-Verbe, B; Coggrave, M; Christensen, P (20 August 2013). "Consensus review of best practice of transanal irrigation in adults". Spinal Cord. 51 (10): 732–738. doi:10.1038/sc.2013.86. PMID 23958927.
2. "Barium enema". MedlinePlus. U.S. Department of Health & Human Services – National Institutes of Health (NIH). Retrieved 6 August 2014.
3. Ernst E (June 1997). "Colonic Irrigation and the Theory of Autointoxication: A Triumph of Ignorance over Science". Journal of Clinical Gastroenterology. 24 (4): 196–8. doi:10.1097/00004836-199706000-00002. PMID 9252839.
4. . American Cancer Society. Archived from the original on 24 April 2015.
5. . Marketplace. CBC Television. 2009. Archived from the original on 2010-03-15. Retrieved 2010-05-03.
6. Schneider, K (2003-02-27). "How Clean Should Your Colon Be?". American Council on Science and Health. Retrieved 2014-07-19.
7. Barrett, S (2008-03-09). "Gastrointestinal Quackery: Colonics, Laxatives, and More". Quackwatch. Retrieved 2008-09-02.
8. Wanjek, C (2006-08-08). "Colon Cleansing: Money Down the Toilet". LiveScience. Retrieved 2008-11-10.
9. Donaldson, AN (1922). "Relation of constipation to intestinal intoxication". JAMA. 78 (12): 884–8. doi:10.1001/jama.1922.02640650028011.
10. "Colon Cleansing: Don't Be Misled By the Claims". Ebsco. 2013-01-14. Retrieved 2013-11-13.
11. Adams, C (1990-05-25). "Does colonic irrigation do you any good?". The Straight Dope. Retrieved 2008-09-02.
12. Brody, J (2008-07-22). "Health 'Facts' You Only Thought You Knew". The New York Times. Retrieved 2012-10-06.
13. Picco, M (2007-03-21). "Colon cleansing: Is it helpful or harmful?". The Mayo Clinic. Retrieved 2008-11-09.
14. Handley DV, Rieger NA, Rodda DJ (November 2004). "Rectal perforation from colonic irrigation administered by alternative practitioners". Med. J. Aust. 181 (10): 575–6. doi:10.5694/j.1326-5377.2004.tb06454.x. hdl:2440/42823. PMID 15540974. S2CID 6541837.
15. • Centers for Disease Control and Prevention (CDC) (March 1981). "Amebiasis associated with colonic irrigation—Colorado". MMWR Morb. Mortal. Wkly. Rep. 30 (9): 101–2. PMID 6789134.
    • Istre GR, Kreiss K, Hopkins RS, et al. (August 1982). "An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic". N. Engl. J. Med. 307 (6): 339–42. doi:10.1056/NEJM198208053070603. PMID 6283354.
16. Tennen M (June 2007). . HealthAtoZ.com. Archived from the original on 2008-06-13. Retrieved 2008-09-01.
17. Eisele JW, Reay DT (October 1980). "Deaths related to coffee enemas". JAMA. 244 (14): 1608–9. doi:10.1001/jama.1980.03310140066036. PMID 7420666.
18. Hall, Harriet (2018). "The Care and Feeding of the Vagina". Skeptical Inquirer. 42 (5): 28–29.
19. McFerran, Tanya (21 February 2008). Martin, Elizabeth A (ed.). Colonic irrigation. Oxford University Press. p. 103. ISBN 978-0-199-21177-7. {{cite book}}: |work= ignored (help)
20. MarileeSchmelzer, Lawrence R.Schiller, Richard Meyer, Susan M.Rugari, PattiCase (November 2004). "Safety and effectiveness of large-volume enema solutions". Applied Nursing Research. 17 (4): 265–274. doi:10.1016/j.apnr.2004.09.010. PMID 15573335.{{cite journal}}: CS1 maint: multiple names: authors list (link)
21. Youngson M.D., Robert M.; et al. (2005). Encyclopedia of Family Health. Vol. 3. USA: Marshall Cavandish. p. 384. ISBN 978-0-7614-7489-0.
22. Mishori, Ranit; Jones, Aminah Alleyne; Otubu, Aye (2011). "The dangers of colon cleansing: patients may look to colon cleansing as a way to 'enhance their well-being,' but in reality, they may be doing themselves harm". Journal of Family Practice. 60 (8): 454.
23. Chen TS, Chen PS (1989). "Intestinal autointoxication: a medical leitmotif". J. Clin. Gastroenterol. 11 (4): 434–41. doi:10.1097/00004836-198908000-00017. PMID 2668399.
24. Ebbel, B. (1937). The Papyrus Ebers. Copenhagen: Levin and Munksgaard. pp. 30–32.
25. Daly, Ann (1996). Fantasy Surgery 1880-1930. The Wellcome Institute Series in the History of Medicine. Vol. 38. Rodopi (published 1997). p. 67. ISBN 9789042000094. Retrieved 2013-11-25. [...]purging was one of the few procedures that a physician could perform with visible, often impressive results and without immediate or obvious dangers.
26. Smith JL (March 1982). "Sir William Arbuthnot-Lane, 1st Baronet, chronic intestinal stasis, and autointoxication". Annals of Internal Medicine. 96 (3): 365–9. doi:10.7326/0003-4819-96-3-365. PMID 7036818.
27. Alvarez, WC (1919). "Origin of the so-called auto-intoxication symptom". JAMA. 72 (1): 8–13. doi:10.1001/jama.1919.02610010014002.