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 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.
Despite these facts, 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 "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 for a distance of up to 20 or even 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. The risk involved in "cleansing" depends on the ingredients and duration of use. Those that contain cascara segrada can cause abdominal cramps that usually are not serious. However severe reactions, including one case of intestinal perforation, have been reported . Cleansing products can also be expensive.
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 [6-8]. Cases of heart failure (from excessive fluid absorption into the bloodstream) and electrolyte imbalance have 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 .
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 .
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 physician should be consulted if constipation persists or represents a significant change in bowel pattern.
- 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.
- Barrett S. Don't buy Dual Action Cleanse. Infomercial Watch, May 20, 2010.
- 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.
- NCAHF position paper on colonic irrigation. National Council Against Health Fraud, 1995.
- Kenny 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.
This article was revised on May 20, 2010.