Experts call for more regulation at clinics after report also shows many staff don’t wear protective aprons

Most water tanks used by colonic irrigation clinics harbour colonies of bacteria at levels that exceed those allowed in public swimming pools, an audit of the business in New South Wales has found.

The results have prompted experts to call for more stringent regulation of colonic irrigation clinics in Australia.

Colonic irrigation, also known as colonic lavage, involves inserting a tube up the rectum and flushing large quantities of water – up to 20 litres, sometimes mixed with herbal substances – through the colon. There is no evidence that it has any health benefits, and it is considered unnecessary because the digestive system and bowel eliminate waste.

Yet it has become a popular procedure offered by alternative medicine practitioners who make unsubstantiated claims that colonic irrigation can flush toxins from the body and improve health and wellbeing. There are multiple reports and studies that document the risks of colonic cleansing, including septic shock, bowel perforation, infection and death.

Sinead Flanigan, an environmental health officer at South Eastern Sydney Local Health District, led an audit of 11 colon irrigation clinics in the region – the first review of its kind in NSW.

The team collected a sample from the water storage tanks of the colonic irrigation machines at each of the businesses, with samples taken from a total of 13 tanks.

For each sample they carried out a heterotrophic plate count (HPC), which estimates the amount of live, growing bacteria in water.

There is no legislative requirement for water quality checks to be conducted for colonic irrigation.

As a guide, Flanigan used the NSW Health public swimming pool advisory, which requires the HPC in pools to be less than 100 colony-forming units per one millilitre sample.

Flanigan’s team found the HPC was higher than this level in nine of the 13 samples taken, with one sample showing more than 30,000 colony-forming units per millilitre.

While HPC does not differentiate between the types of bacteria present, it does give a general measure of water quality, and whether the filtration and disinfection systems are effective.

The audit also found that only one of the 19 staff who conducted colonic irrigation was wearing an impervious apron to protect against liquid splashes during the procedure, as required by public health regulations.

It found staff training was inconsistent, with no standard training requirements and many different institutions offering courses.

“There’s a lot that could be done in terms of our public health legislation to make it more specific to colonic irrigation clinics,” Flanigan said.

Colonic irrigation clinics fall under guidelines for skin penetration procedures such as tattooing, but Flanigan said these guidelines are too general and more can be done to improve health and safety standards.

Flanigan and the co-authors recommended the introduction of infection control guidelines specific to the procedure, education about the correct use of personal protective equipment as part of training, and microbial water sampling of water storage tanks every six months.

“I think people are also unaware that if they do encounter a problem at one of these clinics, they should be reporting it to their local council,” she said.

Ken Harvey, a public health professor, described the recommendations as “sensible and necessary”.

“There are certainly risks to the procedure, but people fall for misleading advertising from alternative health practitioners who claim the bowel is full of toxins and nasties that need to be removed for your health,” Harvey said.

“It’s all rubbish, and it’s also expensive, with some clinics charging around $100 for the procedure.

“Simply putting a tube up your rectum and squirting water up it comes with all kinds of crazy health claims on the websites for these clinics, but you never see any of them highlighting all of the risks. But colonic irrigation is just craziness.”

The results of the audit were published in the Sax Institute’s journal Public Health Research & Practice Thursday.