Modern Naturopathic Colon Hydrotherapy

Naturopathic Colon Hydrotherapy

This Article was Featured in CAM (Complementary & Alternative Medicine) Magazine -

The promotion of colonics for vague "cleansing" purposes has earned this specialised form of hydrotherapy a bad name. But as Roger Groos, BSc, DHM, MACH, RC T, lecturer at the College of Naturopathic Medicine explains, the modern version is used as a specific treatment to improve bowel function. In cases of Candida it can also be used to implant probiotics.

The internal and external application of water as a means for healing has long been practised - references on the use of enemas in Egypt in 1500 BC (1), South America and India have been found. Aramaic scriptures give a detailed account. (2) It is likely many ancient civilisations developed the application of water independently, and it was a common traditional therapy.

Formalisation of the therapeutic effects of water have been attributed to a 17th century English doctor, John Floyer (3) who may have influenced Continental pioneers of naturopathy such as Johann Hahn, Vincent Preissnitz and Kneipp, and latterly in the USA, Kellog. Naturopathic doctors Bernard Jensen (4, 5) and Norman Walker (6) specialised in the use of colonic irrigation for cleansing purposes. Enemas and even radical surgery were propounded by conventional surgeons such as Arbuthnot Lane in the early 1900s. (7) The similarities between the external and internal use of water are striking; the same temperature range is used, similar results are evidenced (8, 9) such as increased white blood count (WBC) counts and influence on muscle tonus. This is not surprising since, although counter-intuitive, the gastro-intestine is an extension of the outside the body.


MS with worsening constipation - hypotonic

Female, age 50, multiple sclerosis sufferer for 11 years, progressively worsening constipation (1 bowel movement per 1-16 days), analgesic medication, senna and lactulose daily.

Initial observations: Palpably full transverse colon, flatus present, faecal rectal contents, reasonable sphincter tone.

Treatment 1: Partial evacuation of impacted faeces, large gas pocket released, water temp 29.4-39.4 deg C, 100 litres.

Recommendations: Chew food more thoroughly.

Treatment 2 (2 weeks later): reported some colic for 2 days after first treatment, but bowels moving 2-3 times weekly. Feeling "more human".

Observations: Abdomen more relaxed, stool softer.

Treatment details: Complete evacuation to ascending colon, water temp 36.7-38.9 deg C, 75 litres.

Treatment 3 (2 weeks later): Social scene improvement due to improved wellbeing, busy, dehydrated, bowel function poor.

Observations: ascending colon full, much gross flatus present, mucus present.

Treatment details: Complete evacuation with caecal flush, water temp 29.4-37.8 deg C, 75 litres. Recommendation to drink more water.

Comments: This patient went on to be a regular with a total of 51 treatments over a 5-year period. Exhibiting classic hypotonic bowel symptoms with hard impacted stool and poor regularity; with a chronic degenerative disease such as MS, symptom relief and improved quality of life are probably all that could be expected, together with improvement in diet and hydration. Cool treatment water indicated.

. . . . . . . . . . . . . .

IBS, using suppositories - hypertonic

Female, age 38, long term hospital-diagnosed IBS sufferer, tried everything without improvement. Classic IBS-type C with small hard, pelleted stool, 1 bowel movement per 3 days, incomplete evacuation; used senna and glycerol suppositories. Associated facial spots with IBS.

Initial observations: Symmetrical abdomen, good musculature, lower bowel in spasm.

Treatment 1: water temp 37 8-39.00 deg C, 75 litres, extremely strong peristalsis, complete bowel evacuation with caecal flush.

Recommendations: anti-spasmodic herbs and psyllium seed prescribed. Stop taking irritant laxatives.

Treatment 2 (6 months later): Greatly improved regularity with daily bowel movements, skin and menses much improved. IBS-C symptoms returned after 5 months.

Comments: A typical hypertonic bowel needing only periodic treatment with warm water to relax bowel muscle spasm. In this case 6 treatments needed over a 3-year period, symptoms returning when stressed.

. . . . . . . . . . . . . .

Constipated since pregnancy - mildly Hypotonic

Female aged 31, long-term constipation worsening since pregnancy 5 months previously, history of bowel cancer in family. Taking flax seed, various supplements. Regularity once per 3-4 days, variable stool form.

Initial observations: retained rectal faeces, poor abdominal musculature.

Treatment 1: water temp 26.7-36.7 deg C, 100 litres. Variable peristalsis, good evacuation eventually, water temperature varied to exercise bowel muscle.

Recommendations: More treatment needed, ask GP for routine colonoscopy.

Treatment 2 (2 weeks later): bowel movements much improved, skin better, feeling better and slimmer, less bloated, GP agreed to colonoscopy. Treatment similar to first, good results. Prescribed mild herbal aperient.

Treatment 3 (2 weeks later): Bowels now regular, taking aperient low dose for maintenance, feeling and looking much better and brighter. Peristalsis much improved, warmer water used.

Treatment 4 (3 months later): Bowel movements now regular, 1 daily, running and teaching fitness classes again. Colonscopy clear, recall in 5 years. Treatment normal with water at body temperature.

Comments: Mild hypotonic constipation often responds to differing water temperatures to exercise the bowel smooth muscle; coupled with better hydration, a mild low-dose aperient and ability to increase exercise, normal bowel function was attained. With a family history of bowel cancer, this patient was relieved to have regular colonoscopies booked.


Colonic hydrotherapy, sometimes referred to as irrigation, is a development from the use of enemas, and is used nowadays not so much to remove bodily "endotoxins" according to the controversial autointoxication theory (10), but more for functional bowel conditions such as constipation and irritable bowel syndrome, as well as conditions secondary to these. The use during structured fasting and cleansing regimes has also increased.

Colonic treatment uses filtered water heated to between 27-40 deg C which is fed at low pressure per rectum into the bowel via a speculum inserted approximately 5-6cm to keep the anal sphincter open; water and waste is discharged through the speculum and piped away.


Water has ideal properties for transferring or removing heat from tissue, and, like hydrotherapy, this may be more correctly be described as thermotherapy. The water distends the bowel, thereby stimulating mass peristalsis, and with careful application can modulate bowel muscle function, either relaxing a hypertonic or stimulating a hypotonic bowel. (11-14)

A naturopathic colonic hydrotherapist will apply massage during the treatment, may use herbal infusions per rectum, may implant probiotics if dysbiosis is evident and will always give dietary advice to reinforce treatment. All naturopathic colon hydrotherapists are qualified practitioners before postgraduate training (15) and apply the therapy according to naturopathic principles.

Modern CH has proven to be very safe as practised in the UK. Absolute contra-indications take into account the theoretical risks of water intoxication, so patients on dialysis or long-term diuretic use and those with renal insufficiency, uncontrolled hypertension or congestive heart disease are not treated, although a number of studies suggest the risks of water overload may be exaggerated (16, 17); the risk of bowel trauma is minimised by not treating any active inflammatory bowel disease or colo-rectal carcinoma; for obvious reasons, severe haemorrhoids, fissures or fistulae are not treated; and due to the theoretical risk of miscarriage, no treatment is carried out until after 20 weeks of pregnancy, and if afterwards, with great care. Other absolute contra-indications include severe anaemia, minors without a GP referral, long-term steroid use, irreducible hernias and recent surgery.

Treatments are carried out in a sympathetic manner, with obvious due regard for patient modesty, comfort and warmth; great care is taken with hygiene - either using hospital standard sterilants or fully disposable kits; in the UK, closed gravity systems are popular, although these are slowly giving way to closed pressure machines which give similar results, and are more therapist-friendly.


The overall effects of a colonic hydrotherapy treatment or a course of treatments are easy to specify - patients feel better almost instantly, and those with primary bowel problems often report a lasting improvement in bowel function, especially when treatment is combined with dietary modification and better oral hydration. Patients with health problems secondary to poor bowel function, such as arthritis or skin problems, may take longer to improve and need more treatments. An interesting observation is that any condition which is exacerbated by increased intraabdominal pressure, such as irritable bladder, endometriosis or even asthma is often improved by normalising bowel function.

The reasons for these effects are, however, difficult to tie down; pointers exist that treatment may effect such things as the neurology of the bowel (especially the mesenteric nerves), the neurotransmitters (18), the production of short-chain fatty acids, circulating leucocytes (9) muscle tonus or the bowel flora, but much more research needs to be performed to substantiate these. Other conjectured effects include an indirect effect upon the liver via the hepatic portal system, and a reduction in colonic bacterial metabolites.

There have been several articles and papers critical of colonic hydrotherapy (19-22), but these centre mainly on lack of evaluative research to prove efficacy, not on the mountain of clinical evidence.

Training to ARCH Standards

The high standards applying to naturopathic colonic hydrotherapy in the UK have been developed since 1987 by the lead UK association, ARCH (The Association and Register of Colon Hydrotherapists), and cover ethics, hygiene, safety, education, practice and continued professional development.

ARCH is a member of the General Naturopathic Council and is in the process of registering for independent regulation by the Complementary & Natural Health Council.

ARCH sets standards for colleges who train CH practitioners, and each course covers a minimum of 100 hours guided tuition including both theory and practical. ARCH says:

"Colon hydrotherapy courses are taught at postgraduate level only, and each college agrees only to train prospective students satisfying certain pre-requisites; it is important that we provide the public with therapists of the highest standard, and a certain amount of pre-acquired knowledge and experience, not covered in the syllabus, is expected. Prospective students must meet the following criteria:

  • They must be fully qualified medical doctors or certain RGNs with current registration or registered within the last 5 years OR
  • They must have successfully completed a 2-year full time or 3-year part-time course in a substantial body-based therapy or therapies, including in-depth anatomy and physiology (physiology is particularly important covering the digestive, endocrine, neurological and circulatory systems) and clinical practice time and hold verifiable certification to this effect.
  • If the therapy does not involve physical contact, a short contact therapy course will be required."


Postgraduate Colon Hydrotherapy Course

Roger Groos, together with Dr Milo Siewert, MD, DC (Founder and honorary president of ARCH), lecture at postgraduate courses in colon hydrotherapy held at The College of Naturopathic Medicine.

Qualified practitioners with clinical experience can undertake an intensive two-module 9-day course at CNM which will enable them to register, obtain insurance and practice as a colon hydrotherapist on successful completion.

About the author

Roger GroosRoger Groos, BSc, DHM, MACH,RCT, originally studied biology, then re-trained in Holistic Medicine and has practised colon hydrotherapy for more than 20 years. Working naturopathically, he combines dietary therapy, colonics, the use of herbs, reflexology and lymphatic drainage to treat a broad range of health problems.


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