Colonic lavage, colon cleanse, enemas

Patients often ask whether or not intermittent use of enemas or ‘professional’ colonics are safe or appropriate.  Such patients usually suffer from constipation or irritable bowel syndrome.  They refer to photographs provided by colon cleans companies that show large amounts of ugly debris removed from colons by people who used their product.  This debris is likely congealed dead cells and denatured normal protein and mucus found in a healthy colon.  Other companies talk about the ‘spackle’ that coats the colon that needs to be removed for personal health and weight loss.  This is complete fantasy, and marketing of products or treatments for this reason should be regulated.

Having said all this, it is true that sometimes the use of small, prepackaged enemas such as those available in drugstores, can be useful as part of a program of management of constipation.  The term ‘lavage’ refers to a more aggressive wash-out, either by a program of substances taken orally, or an aggressive enema program using much more than the modest enemas mentioned above.

In general, if these treatments are taken or given carefully, most patients will tolerate them.  Some will not, however.  Not all patients have the same margin of safety when taking treatments that can cause significant shifts of body fluids and possible changes to electrolyte (blood salt) balance.  Those with congestive heart failure, kidney disease, or other metabolic problems can be harmed by such treatments.  Individuals with obstructing lesions of the colon such as a tumor or inflammation from diverticulitis may become constipated and so decide to take a course of purgatives to ‘clean themselves out”.  This can result in a worsening of the obstruction or possible colonic perforation in extreme cases.  So it is best to check with a personal physician as to whether you can safely tolerate this kind of thing.  Just remember, anything that you can imagine ever happening in medicine, has happened and can happen.  Dr. Pezim has personally operated on four patients with life-threatening perforations of the rectum following the administration of enemas by well-meaning individuals.  Whether these treatments are of any real long-term benefit is another story entirely. There is not much good evidence for that.

© Pezim Clinic, Vancouver, British Columbia, Canada