Colonics, Laxatives, and More
Stephen Barrett, M.D.
The importance of "regularity" to overall health has been greatly overestimated for thousands of years. Ancient Egyptians associated feces with decay and used enemas and laxatives liberally. In more recent times, this concern has been embodied in the concept of "autointoxication" and has been promoted by warnings against "irregularity." 
The theory of "autointoxication" states that stagnation of the large intestine (colon) causes toxins to form that are absorbed and poison the body. Some proponents depict the large intestine as a "sewage system" that becomes a "cesspool" if neglected. Other proponents state that constipation causes hardened feces to accumulate for months (or even years) on the walls of the large intestine and block it from absorbing or eliminating properly. This, they say, causes food to remain undigested and wastes from the blood to be reabsorbed by the body .
Around the turn of the twentieth century many physicians accepted the concept of autointoxication, but it was abandoned after scientific observations proved it wrong. In 1919 and 1922, it was clearly demonstrated that symptoms of headache, fatigue, and loss of appetite that accompanied fecal impaction were caused by mechanical distension of the colon rather than by production or absorption of toxins [3,4]. Moreover, direct observation of the colon during surgical procedures or autopsies found no evidence that hardened feces accumulate on the intestinal walls.
Today we know that most of the digestive process takes place in the small intestine, from which nutrients are absorbed into the body. The remaining mixture of food and undigested particles then enters the large intestine, which can be compared to a 40-inch-long hollow tube. Its principal functions are to transport food wastes from the small intestine to the rectum for elimination and to absorb minerals and water. Careful observations have shown that the bowel habits of healthy individuals can vary greatly. Although most people have a movement daily, some have several movements each day, while others can go several days or even longer with no adverse effects.
The popular diet book Fit for Life (1986) is based on the notion that when certain foods are eaten together, they "rot," poison the system, and make the person fat. To avoid this, the authors recommend that fats, carbohydrates and protein foods be eaten at separate meals, emphasizing fruits and vegetables because foods high in water content can "wash the toxic waste from the inside of the body" instead of "clogging" the body. These ideas are utter nonsense .
Some chiropractors, naturopaths, and assorted food faddists claim that "death begins in the colon" and that "90 percent of all diseases are caused by improperly working bowels." The practices they recommend include fasting, periodic "cleansing" of the intestines, and colonic irrigation.
- Fasting is said to "rejuvenate" the digestive organs, increase elimination of "toxins, and "purify" the body."
- Cleansing" can be accomplished with a variety of "natural" laxative products.
- Colonic irrigation is performed by passing a rubber tube through the rectum. Some proponents have advocated that the tube be inserted as much as 30 inches. Warm water—often 20 gallons or more—is pumped in and out through the tube, a few pints at a time, to wash out the contents of the large intestine. (An ordinary enema uses about a quart of fluid.) Some practitioners add herbs, coffee, enzymes, wheat or grass extract, or other substances to the enema solution.
The Total Health Connection and Canadian Natural Health and Healing Center Web sites provide more details of proponents' claims. The latter states that "there is only one cause of disease—toxemia" and offers "the most comprehensive in-depth colon therapy on the continent." The course costs $985 for 5 days of in-clinic training or $295 by correspondence.
Some "alternative" practitioners make bogus diagnoses of "parasites," for which they recommend "intestinal cleansers," plant enzymes, homeopathic remedies. Health-food stores sell products of this type with claims that they can "rejuvenate" the body and kill the alleged invaders.
The danger of these practices depends upon how much they are used and whether they are substituted for necessary medical care. Whereas a 1-day fast is likely to be harmless (though useless), prolonged fasting can be fatal. "Cleansing" with products composed of herbs and dietary fiber is unlikely to be physically harmful, but the products involved can be expensive. Some people have reported expelling large amounts of what they claim to be feces that have accumulated on he intestinal wall. However, experts believe these are simply "casts" formed by the fiber contained in the "cleansing" products.
Although laxative ads warn against "irregularity," constipation should be defined not by the frequency of movements but by the hardness of the stool. Ordinary constipation usually can be remedied by increasing the fiber content of the diet, drinking adequate amounts of water, and engaging in regular exercise. If the bowel is basically normal, dietary fiber increases the bulk of the stool, softens it, and speeds transit time. Defecating soon after the urge is felt also can be helpful because if urges are ignored, the rectum may eventually stop signaling when defecation is needed. Stimulant laxatives (such as cascara or castor oil) can damage the nerve cells in the colon wall, decreasing the force of contractions and increasing the tendency toward constipation. Thus, people who take strong laxatives whenever they "miss a movement" may wind up unable to move their bowels without them. Frequent enemas can also lead to dependence . A doctor should be consulted if constipation persists or represents a significant change in bowel pattern.
Colonic irrigation, which also can be expensive, has considerable potential for harm. The process can be very uncomfortable, since the presence of the tube can induce severe cramps and pain. If the equipment is not adequately sterilized between treatments, disease germs from one person's large intestine can be transmitted to others. Several outbreaks of serious infections have been reported, including one in which contaminated equipment caused amebiasis in 36 people, 6 of whom died following bowel perforation [7-9]. Cases of heart failure (from excessive fluid absorption into the bloodstream) and electrolyte imbalance have also been reported . Direct rectal perforation has also been reported . Yet no license or training is required to operate a colonic-irrigation device. In 1985, a California judge ruled that colonic irrigation is an invasive medical procedure that may not be performed by chiropractors and the California Health Department's Infectious Disease Branch stated: "The practice of colonic irrigation by chiropractors, physical therapists, or physicians should cease. Colonic irrigation can do no good, only harm." The National Council Against Health Fraud agrees .
In 2009, Dr. Edzard Ernst tabulated the therapeutic claims he found on the Web sites of six "professional organizations of colonic irrigations." The themes he found included detoxification, normailzation of intestinal function, treatment of inflammatory bowel disease, and weight loss. He also found claims elated to asthma, menstrual irregularities, circulatory disorders, skin problems, and improvements in energy levels. Searching Medline and Embase, he was unable to find a single controlled clinical trial that substantited any of these claims .
The FDA classifies colonic irrigation systems as Class III devices that cannot be legally marketed except for medically indicated colon cleansing (such as before a radiologic endoscopic examination). No system has been approved for "routine" colon cleansing to promote the general well being of a patient. Since 1997, the agency has issued at least seven warning letters related to colon therapy:
- In 1997, Colon Therapeutics, of Groves, Texas, and its owner Jimmy John Girouard were warned about safety and quality control violations of the Jimmy John colon hydrotherapy unit and related devices .
- In 1997, Tiller Mind & Body, of San Antonio, Texas and its owner Jeri C. Tiller, were ordered to stop claiming that their Libbe colonic irrigation device was effective against acne, allergies, asthma and low-grade chronic infections and improved liver function and capillary and lymphatic circulation .
- In 1997, Colon Hygiene Services, of Austin, Texas and its owner Rocky Bruno was notified that their colonic irrigation system could not be legally marketed without FDA approval .
- In 1999, Dotolo Research Corporation, of Pinellas Park, Florida, and its chief executive officer Raymond Dotolo were warned about quality control violations and lack of FDA approval for marketing its Toxygen BSC-UV colonic irrigation system .
- In 2001, Clearwater Colon Hydrotherapy, of Ocala, Florida, and its vice president Stuart K. Baker were warned about quality control violations and lack of FDA approval for marketing their colonic irrigators .
- In 2003. the International Colon Hydrotherapy Association, of San Antonio, Texas and its executive director Augustine R. Hoenninger, III, PhD, ND, were notified that it lacked FDA approval to sponsor "research" that had been proposed or actually begun on the devices of five companies .
- In 2003, Girourd and Colon Therapeutics were notified that his devices require professional supervision and cannot be legally marketed directly to consumers. The letter noted that he had obtained marketing clearance only for use in medically indicated colon cleansing, such as before radiologic or sigmoidoscopic examinations .
- In 2003, the Wood Hygienic Institute of Kissimmee, Florida, and its owner Helen Wood were warned about quality control violations and the use of unapproved therapeutic claims in marketing their devices .
Girouard, Colon Therapeutics, Tiller Mind & Body, operators of the Years to Your Life Health Centers, companies that manufactured several components of Girouard's colonic irrigation systems, and organizations that trained operators of the devices are being sued in connection with the death of a 72-year-old woman who perforated her large intestine while administering colonic irrigation. The suit alleges that the woman was unsupervised when she administered the "colonic," perforated her colon early in the procedure, required surgery the same day, and remained seriously ill for several months before she died from liver failure. The complaint also alleges that Years to Your Life Health Center falsely advertised colonic irrigations as "painless" procedures which provided health benefits including an improved immune system and increased energy, as well as relief from indigestion, diarrhea, constipation, weight loss, body odor, candida, acne, mucus colitis, gas, food cravings, fatigue, obesity, diverticulosis, bad breath, parasitic infections, and premenstrual syndrome . In response to the woman's death and reports of serious injuries to four other patients, the Texas Attorney General filed lawsuits against:
- Girouard and Colon Therapeutics
- Abundant Health and Wellness Institute, and its owner, Cordelia Beall
- Gentle Colonics Inc. and its owner, Denson Ingram
- Eternal Health Inc., doing business as Years to Your Life and Cynthia Pitre
- Jennifer Jackson, doing business as Body Cleanse Spa
- Tiller Mind Body Inc., doing business as Mind Body Naturopathic Institute and Jerri Tiller
- International Association for Colon Hydrotherapy, Class 3 Study Group and Augustine R. Hoenninger III
- Linda Gonzalez, doing business as El Paso Health Center.
- Soledad Herrera, doing business as Body Matters of El Paso
- Lisa Ramoin, doing business as Alternative Health (Houston)
- Janice Jackson, doing as InsideOut and Within (Houston)
The suits charged all of the defendants with engaging in the promotion, sale or unauthorized use of prescription devices for colonic hydrotherapy treatments without physician involvement. In 2004 and 2005, the cases involving Girouard, Ingram, Beall, the Jacksons, Herrera, Ramoin, and their companies were settled with consent agreements under which they would pay a total of $178,000 in civil penalties, fees, and costs to the state [23-25].
For Additional Information
- Chen TS, Chen PS. Intestinal autointoxication: A gastrointestinal leitmotive. Journal Clinical Gastroenterology 11:343-441, 1989.
- Ernst E. Colonic irrigation and the theory of autointoxication: A triumph of ignorance over science. Journal of Clinical Gastroenterology 24:196-198, 1997.
- Alvarez WC. Origin of the so-called auto-intoxication symptoms. JAMA 72:8-13, 1919.
- Donaldson AN. Relation of constipation to intestinal intoxication. JAMA 78:884-888, 1922.
- Kenney JJ. Fit For Life: Some notes on the book and Its roots. Nutrition Forum, March 1986.
- Use of enemas is limited. FDA Consumer 18(6):33, 1984.
- Amebiasis associated with colonic irrigation - Colorado. Morbidity and Mortality Weekly Report 30:101-102, 1981.
- Istre GR and others. An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. New England Journal of Medicine 307:339-342, 1982.
- Benjamin R and others. The case against colonic irrigation. California Morbidity, Sept 27, 1985.
- Eisele JW, Reay DT. Deaths related to coffee enemas. JAMA 244:1608-1609, 1980.
- Handley DV and others. Rectal perforation from colonic irrigation administered by alternative practitioners. Medical Journal of Australia 181:575-576, 2004.
- Jarvis WT. Colonic Irrigation. National Council Against Health Fraud, 1995.
- Ernst E. Colonic irrigation: therapeutic claims by professional organizations, a review. International Journal of Clinical Practcie 64:429-431, 2010.
- Baca JR. Warning letter to Colon Therapeutics, April 27, 1997.
- Baca, JR. Warning letter to Tiller Mind & Body, June 2, 1997.
- Baca JR. Warning letter to Colon Hygiene Services, June 20, 1997.
- Tolen DD. Warning letter to Dotolo Research Corporation, July 21, 1999.
- Singleton E. Warning letter to Clearwater Colon Hydrotherapy, Sept 13, 2001.
- Marcarelli MM. Warning letter to International Colon Hydrotherapy Association, March 21, 2003.
- Chappel MA. Warning letter to Colon Therapeutics, Oct 23, 2003.
- Ormond E. Warning letter to Wood Hygienic Institute, Oct 23, 2003.
- Barrett S. Colonic promoters facing legal actions. Quackwatch, Nov 11, 2003.
- Attorney General Abbott sues ' colonic hydrotherapy ' providers for abuse of medical devices; one death reported: Suits allege unsafe use of devices without physician oversight is a public health issue. Texas Attorney General news release, Dec 1, 2003.
- Barrett S. Texas Attorney General reaches settlement with three colonic hydrotherapy providers. Casewatch, July 16, 2004.
- Attorney General Abbott wins court judgment with six colon hydrotherapy providers. News release, March 1, 2005.
This article was revised on August 4, 2010.