Ask the Doctor: ‘Should I be having colonic irrigations and wellness enemas? How will I know where it’s reputable to get this done?’

“My book club – which seems to discuss mainly anything but the books we read – has recently been discussing colonic irrigations and wellness enemas. This is never something I have considered, but it seems many of the ladies in my group use these as part of their regular health and wellness routines. Is this something I should be doing and if so, how do I know where to go that is reputable?”

Answer from Professor Reza Kalbassi, Consultant in Colorectal, General & Minimally Invasive Surgery and Clinical Lead of Endoscopy Department, Beacon Hospital.

The use and benefits of regular colonic irrigation and wellness enemas are debatable. Most doctors do not advocate colonic irrigation and wellness enemas. Gut health can be achieved by improvement in diet with increase in water intake of up to two litres per day. Daily diet should include plenty of high fibre food with whole meal bread and several portions of fruit. Processed foods should be avoided and consumption of red meat reduced. Exercise and activity is encouraged. A sedentary lifestyle can lead to bowel problems such as functional bowel disorder.

Chronic constipation and difficult incomplete evacuation, i.e. obstructive defecation syndrome, are common particularly in the female population. Some patients with these symptoms try colonic irrigation for relief. These symptoms are often associated with childbirth, multiparity and difficult delivery. They are less common in men. If patients have bowel problems with symptoms of difficult or incomplete evacuation, they should discuss these with their GP and seek an early referral to a pelvic floor centre and see a specialist.

Patients will be carefully and thoroughly assessed including by colonoscopy i.e. ‘the camera’. In cases where there are findings of serious conditions such as polyps or potentially colorectal tumours, they receive urgent treatment by a colorectal surgeon or a multidisciplinary team. In those who have benign findings with symptoms of difficult incomplete evacuation, dietary adjustment and pelvic floor physiotherapy often improve and resolve their symptoms. In a small group of patients, pelvic organ prolapse such as internal or external rectal prolapse is identified on MRI pelvic floor study and surgery may need to be considered. This will be done by a specialist colorectal surgeon with interest and experience in pelvic floor surgery.

The most important issue in gut health is ensuring a good, high fibre diet, plenty of water/fluids, and exercise daily. Symptoms of chronic constipation, difficult or incomplete evacuation should be investigated by a specialist and early treatment will lead to better outcome and improvement in quality of life.

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