05 June 2018

Colonic Irrigation

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By Erin Dwyer - Research Dietitian

As there are no ‘cures’ for IBS people often find themselves looking for alternative therapies to help treat their symptoms. Colonic Irrigation is one of those, and a procedure we get many questions about. 
What is it? 

The colon is the large intestine and is about 1.8m long. The main role of the colon is to reabsorb water and electrolytes into the body and remove waste by defecation. However, sometimes you can experience functional issues with your gut, such as constipation, diarrhoea or abdominal discomfort. Colonic irrigation is a popular complementary therapy (that dates back to the 19th Century) used to  ‘wash out’ the gut and proposed to treat some of these complaints. 

The process of colonic irrigation involves warm water (40 – 60L), often with added herbs or probiotics being flushed into your colon, via a tube in your rectum. The water fills your large bowel and ‘flushes’ out the contents of your colon. 

Does it work?

In 2009, a systematic review published in American Journal of Gastroenterology looked at the clinical effects of colonic cleansing for general health promotion. The review concluded that the current literature did not support the notion that colonic irrigation improves or promotes general wellbeing (2).  Unfortunately, we do not know the effects of this therapy in people with IBS. Only 1 small pilot study from Taiwan assessed the effects of colonic irrigation in people with IBS-C and IBS-D. While this study showed that participants felt more satisfied with their bowel motions after completing colonic irrigation twice per day for six consecutive days, the long-term effects of the therapy were not assessed, as participants were only followed up for 7 days after completing the treatment (3). 

How is it different to an enema?

Enemas involve specific medically formulated liquids being inserted into the rectum to help someone pass a bowel motion when constipated. Colonic irrigation is not too dissimilar to an enema, however, enemas tend to only use small amounts of liquid ~5mL, whereas colonic irrigation can pump between 40-60 litres into the colon over the course of the session. Passing this volume of fluid into the colon poses risks, including bowel perforations. 

Are there risks involved in Colonic irrigation?

There are several risks involved in colonic irrigation that can range from mild to severe, including;

  • Imbalance of minerals and electrolytes – disturbances could lead dehydration and more seriously to heart failure and kidney damage.
  • Interference/removal of bacteria that line the colon
  • Infections such as Hepatitis B and C 
  • Perforation of intestine

The bottom line

There virtually no evidence to suggest that colonic irrigation is effective in people with IBS, and it may pose several risks. If you are considering undergoing colonic irrigation, talk to your GP or Gastroenterologist first so you are very clear on the possible risks and benefits. Despite the marketing claims, it may be that your effort, time and money would be better spent on other, more evidence based therapies. 

References
  1. Acosta RD, Cash BD. Clinical effects of colonic cleansing for general health promotion: a systematic review. Am J Gastroenterol 2009; 104(11): 2830-6.

  2. Hsu HH, Leung WH, Treatment of irritable bowel syndrome with a novel colonic irrigation system: a pilot study. Techniques in Coloproctology 2016; 20: 551-7



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