“”Know your enema.
|—Probably not Sun Tzu|
An enema is an injection of fluid into the lower bowel through the rectum. Enema may also refer to the fluid used for this. While enemas may sometimes be genuinely useful as a medical treatment, most commonly for severe constipation, enemas (and certain enema solutions) are often falsely marketed as cures or treatments for certain diseases and conditions.
Since the beginning of human medicine, healers have induced diarrhea in an attempt to "purge" the body of "ill humors," which is believed to accumulate in the large intestines. Before the advent of modern medicine this was a standard treatment. One of the signers of the United States Declaration of Independence, Dr. Benjamin Rush, later served as the medical adviser to the Lewis and Clark expedition of 1804-1806. One of the best-known early American physicians, he became popularly known for his "Rush's Pills" (a.k.a. "Thunderclaps" or "Rush's Thunderbolt"), which induced a rather violent and complete self-cleansing of the colon. Rush's Pills contained 10 grains (0.648 gm) of jalap (Ipomoea purga) and 10 grams of calomel (mercurous chloride). (Incidentally, Rush was big on bloodletting, too, and recommended removing 75% of the person's blood.) The rather violent effect of some medicines of the 18th-19th centuries, such as Rush's Pills, actually helped to promote homeopathy, which has no effect beyond placebo because it consists of water.
Supposed reasons to get an enema
Proponents of enema use claim that toxins (usually unspecified) accumulate in the large intestines, as we are surrounded by toxic components in the environment. Since the large intestines do absorb some matter through their surface (particularly water), it is believed that the toxins get spread through the bloodstream and are thus responsible for a large variety of ailments, especially seemingly unrelated ones. This is because the human body seemingly cannot handle the deluge of those compounds without a little treatment. Additionally, hole-istic practitioners claim that enemas can remove intestinal parasites without affecting the flora. If the idea that the body doesn't do a good job at removing toxic compounds was true, and it gets overloaded with toxins, without some invasive intervention, humans would have long been extinct.
Things claimed to be caused by a dirty colon include the following:
- Constipation, which is ironic since the diet itself probably caused it.
- Bladder and kidney infections, which have nothing to do with the colon
- Vaginal yeast infections - (wtf how does that work?)
- Bad breath and body odor, probably caused by naturopathy.
Pregnancy (even in cis men)Abdominal cramps
- Toe and fingernail fungus (wait, what?)
- Chronic fatigue, insomnia (caffeine from coffee enemas are absorbed) and fibromyalgia
- Lack of abundance of anatomical knowledge
- Spontaneous appearance of goat within your immediate vicinity[citation NOT needed]
Despite the lack of evidence that these treatments have any benefit, they are still quite popular, with late-night television and internet advertising offering to separate the consumer from their stool (and their money). The hallmark of these products is lack of proven efficacy and safety, and much higher cost than similar ingredients bought at the drug store.
“”Fill it to the rim, with Brim!
|—Coffee advertisement taken out of context|
Coffee enemas came into use medically as early as the beginning of the 20th century, and appeared in Merck Manual of the Materia Medica starting in 1901. Coffee enemas stopped appearing in the Merck Manual in 1972. It's much more pleasant to drink coffee, anyway.
Coffee enemas are the favored method of the Gerson "therapy", which developed in the 1930s as a quack alternative-medicine treatment for cancer. The Gerson therapy also requires a diet consisting entirely of fruit and vegetable juice, so you probably won't even need the enemas. The purpose of the coffee enemas is supposedly to eliminate "toxins" (never mind that coffee contains toxins such as caffeine which the enema is actually introducing into your body). These evil "toxins" are apparently chemical compounds of some sort that no scientist has ever discovered yet but somehow quacks know about... Additionally, coffee somehow stimulates the liver and can speed up detoxification. It doesn't. The liver is working fine, being an excellent product of evolution.
Livingston-Wheeler Therapy (or Livingston Therapy), another quack cancer treatment, also includes coffee enemas.
Ironically, Gwyneth Paltrow via her Goop.com website has promoted sales of a $135 coffee enema kit called "Implant O'Rama", and has also promoted "detox" diets that eliminate coffee. This is particularly ironic because for most people drinking coffee reduces the likelihood of several serious diseases and increases longevity, whereas coffee enemas can have some very serious side effects (see below).
In 2013, a Florida couple claimed to be addicted to coffee enemas and featured on a reality TV show on TLC. Caffeine has some addictive properties, and withdrawal from caffeine causes some relatively mild symptoms, so it is possible.
Despite what Dr. Axe may assert, coffee enemas are not entirely safe — they have caused several different medical ailments, such as the following:
- acute colitis
- polymicrobial enteric septicemia
- Salmonella brain abscess
But who bothers about a little thing like that when there are toxins to get out of your system?
Chlorine dioxide is a toxic, corrosive substance that is commonly used as an industrial bleaching agent, and in the form of an enema by some incredibly stupid parents, as a way to cure autism in children. In reality, autism has no known medical cause or cure, and thus, this practice, in fact, does not, cure autism, and unsurprisingly to any sensible person results in extreme pain at best, and often severe damage to the gastrointestinal tract, sometimes even death. Many parents who follow this practice will share pictures on social media of what are supposedly parasites expelled as a result of this practice, which in reality are parts of the intestinal lining and membranes. In 2017, a six-year-old boy needed to have his bowel removed and a colostomy bag fitted after his parents administered bleach enemas in an attempt to "cure" his autism. More recently, bleach enemas (along with just drinking bleach) have been claimed to be "cures" or "preventions" for COVID-19.
Several products are on the market under names like "Colon Cleanse", which contain only psyllium fiber (Plantago spp.). Psyllium is also the active ingredient in over-the-counter laxatives such as Metamucil, and does add fiber to the diet. The psyllium products found in the health-food store as "colon cleansing" products are usually more expensive than over-the-counter laxatives containing the same active ingredient. They may be useful for somebody suffering from constipation, or needing to add fiber to their diet, but there is no evidence for any additional health benefits in occasional use for general "cleansing the colon". Barring a few specific medical conditions, a person should eat a high-fiber diet all the time, rather than going through a "colon cleansing" regimen once or twice a year, as some proponents suggest.
Some products contain bentonite clay. This substance, when combined with psyllium, absorbs colon liquid and expands. This will result in the release of mucoid plaque, claimed to be a build-up of natural mucus in the colon, but it is really a substance that only appears if you consume the bentonite clay and psyllium.
Herbal teas contain a mixture of a variety of herbs purported to "cleanse" those famous toxins from the body, and may contain herbs which do have a laxative effect, plus other herbs purported in natural remedies to "cleanse" the liver or kidneys in addition to the colon. Some of these, depending on the active ingredients, are effective as laxatives, but - as with the psyllium products - their only genuine usefulness is for somebody suffering from constipation. Some of them are just good-tasting herbal teas.
The "salt-water flush", another purported colon-cleansing regimen, involves drinking a quart or more of salt water, using sea salt (not table salt) (which is still almost pure NaCl), first thing in the morning, then spending the next several hours near the bathroom while your "colon" gets "cleansed". Some alternative medicine-regimens (such as the so-called "lemonade diet") recommend this practice as an alternative to enemas.
Not only is it gross, it is potentially very dangerous. If the salt water ingested is not isotonic (the same salinity as the human body, 9.0 g NaCl per liter of H2O) the hypertonic solution will dehydrate you as the human body ends up expending its own water to dilute the salt enough to prevent overloading the body with sodium. Consuming enough salt at once or depleting the body's water reserves can eventually overwhelm even this protective mechanism, resulting in hypernatremia (salt overload in the blood), which can cause seizures, cardiac arrhythmia, and death. Do not do this.
Familiar to American insomniacs and shilled by a creepy John Waters look-alike, this product purports to "tone and cleanse the colon while eliminating unnecessary toxic build-up". It contains such exotic ingredients as psyllium fiber (Metamucil), guar gum (used in many food products as an emulsifier, but here touted as "regulating glucose levels"), and Lactobacillus (the active culture in yogurt). It also contains Cascara Sagrada (Rhamnus purshiana), a bark-derived laxative first approved by the FDA in 1939, but "not generally recognized as safe and effective for OTC [over-the-counter] use… Any available OTC products containing Cascara Sagrada are to be considered misbranded. Many OTC products have already been discontinued by the manufacturers."
The two ingredients in the Dual-Action cleanse most likely to have a laxative effect are the psyllium fiber and the Cascara Sagrada. The least expensive product offered by this company costs $60.00 if you order monthly shipments. For comparison, generic psyllium capsules cost about $6.00 for 160 capsules, depending on the brand and formulation, and generic senna extracts (the closest equivalent to cascara) cost about $8.00 for 200 pills.
These products sell themselves with "testimonials" which tend to be vague. For instance, on their website, Dual-Action lists two separated customers as feeling "healthier and happier, wonderful".
The website does not seem to make the same claims of increased health as the TV infomercial. The spokesman for the product claims that "toxins" build up in the colon, as do food residues that reduce the "caliber" of the colon. These "facts" lead to all manner of illnesses. There are no studies showing any efficacy of colon purging. This product is essentially a very high-priced laxative and fiber supplement that perhaps could treat irritable bowel or constipation.
Colon hydrotherapy is the fancy name woo-meisters use for an enema. According to the "International Association for Colon Hydrotherapy", "the colon has been referred to as the sewer system of the body. It is the place where we store the waste material that most of us would rather not think about and most of us don't until our health becomes poor or we feel constipated or have diarrhea. It best benefits the body due to release of this accumulated congestion in the bowel."
Advocates of enemas list many reasons for choosing to have one. According to one website: "parasites are man's deadliest enemy… they kill more people annually than cancers!" It is directly implied that colonics can help remedy this problem. They fail to mention that the parasites that kill so many people are not colonic parasites, but parasites associated with diseases such as malaria.
Woo-meisters also make the argumentum ad populum, claiming that many people subscribe to alternative therapies, therefore they must work. QED.
According to the FDA, colonic irrigation systems are Class III devices that cannot be legally marketed except for medically-indicated colon-cleansing (such as before a radiologic or endoscopic examination). No system has been approved for "routine" colon-cleansing to promote the general well-being of a patient.
Colon hydrotherapy is essentially unregulated, so practitioners can charge whatever they wish. Insurance does not pay. A typical cost would involve about $100 for a session, compared to $2.39 for Fleet's osmotic laxative solution. Quacks often offer these therapies along with other unproven treatments, like "manual lymphatic drainage" and "iridology". In fact, the waste passing through the colon has little to do with systemic disease. Most absorption of nutrients takes place in the small bowel, and what water is absorbed from the colon is essentially sterile.
Enemas have no benefits except in a small number of very specific medical conditions relating to malfunctioning bowels, and can be harmful. Colonic perforation and electrolyte imbalances can occur. Infection from improperly sterilized equipment (Giardia, Clostridium difficle), and severe cramping can all occur. In addition, enemas may cause symbiotic bacteria in the colon to disappear, resulting in more diarrhea.
As a "detox" or general health therapy, enemas are pure bunk.
"Side effects of colon cleansing include nausea, vomiting, diarrhea, dizziness, dehydration, electrolyte abnormalities, acute kidney insufficiency, pancreatitis, bowel perforation, heart failure, and infection." Colonics are particularly dangerous for some pre-existing conditions, such as: gastrointestinal disease, prior colon surgery, severe hemorrhoids, kidney disease, or heart disease.
- Quackwatch on colonics.
- Mayo Clinic on colon cleansing.
- Scientific American podcast reports on how colon cleansing is a terrible idea.
- My Addiction: Coffee Enemas, a preview from "My Strange Addiction" (TLC)
- "Natural Colon Cleansing: Is It Necessary?" WebMD.
- Benjamin Rush, MD: assassin or beloved healer? by Robert L. North, Proc. (Baylor Univ. Med. Cent.) 2000 Jan; 13(1): 45–49.
- Fads and Quackery in Healing: An Analysis of the Foibles of the Healing Cults, with Essays on Various Other Peculiar Notions in the Health Field by Morris Fishbein (1932) Blue Ribbon Books, 382 pp.
- Gavura, S. (July 11, 2013) Ask the (Science-Based) Pharmacist: What are the benefits of coffee enemas?. Science-Based Medicine. Retrieved January 3, 2020.
- http://www.alive.com/articles/view/17406/the_best_colon-cleansing_diet This site is ridiculous
- See the Wikipedia article on Vaginal yeast infection.
- Merck's 1901 Manual of the Materia Medica: A Ready-Reference Pocket Book for the Physician and Surgeon, page 264.
- Coffee: The Royal Flush by Ralph W. Moss (1990). The Cancer Chronicles nos. 6 & 7.
- Livingston-Wheeler Therapy Memorial Sloan Kettering Cancer Center.
- Now Charles backs coffee cure for cancer: Angry doctors warn of dangers as Prince of Wales lends support to controversial alternative treatment by Jo Revill (26 June 2004 20.07 EDT) The Guardian.
- Coffee Enemas: Even Prince Charles endorses them by Elaine Hollingsworth (2013) Doctors are Dangerous
- Fight Cancer & Detoxify with a Coffee Enema Dr. Axe
- Some Notes on Michael Gerber, M.D. by Stephen Barrett (revised on July 15, 2012) Quackwatch.
- Gwyneth Paltrow's Goop Promotes A $135 Coffee Enema Kit by Bruce Y. Lee (Jan 6, 2018 @ 08:09 PM) Forbes.
- The Beauty & Wellness Detox Guide Goop.com
- Implant O'Rama
- Is Coffee Actually Good for You? by Rachael Smith, Goop.com
- Couple Addicted to Coffee Enemas, Up to Four Times a Day by Susan Donaldson James (Feb. 8, 2013) ABC News.
- Caffeine Myths and Facts. Caffeine Myth No. 1: Caffeine Is Addictive by Melinda Ratini (April 30, 2017) WebMD.
- [Coffee enema induced acute colitis] by C. J. Lee et al. Korean J. Gastroenterol. 2008 Oct;52(4):251-4. In Korean.
- Polymicrobial enteric septicemia from coffee enemas by K. A. Margolin & M. R. Green (1984). West. J. Med. 140(3):460.
- Letter to the Editor: Proctocolitis Caused by Coffee Enemas by Bora Keum et al. (2010). Am. J. Gastroenterol. 105:229–230; doi:10.1038/ajg.2009.505.
- Campylobacter sepsis associated with "nutritional therapy" — California MMWR Morb. Mortal. Wkly. Rep. 1981 Jun 26;30(24):294-5.
- Medical complications of "alternative" cancer therapy by M. Markman (1985). N. Engl. J. Med. 312(25):1640-1.
- Deaths related to coffee enemas by J. W. Eisele & D. T. Reay (1980). JAMA 244(14):1608-9.
- See the Wikipedia article on Metamucil.
- Mayo Clinic: Healthy Lifestyle, Nutrition and healthy eating
- "What would happen to you if you drank seawater?" The Straight Dope. 2003 November 11.
- http://www.infomercialwatch.org/reports/dualaction.shtml - his name is Klee Irwin.
- See the Wikipedia article on Endoscopy.
- Gastrointestinal Quackery: Colonics, Laxatives, and More by Stephen Barrett
- See the Wikipedia article on Enema.
- The dangers of colon cleansing by Ranit Mishori et al. J. Fam. Pract. 2011 August;60(8):454-457.