Colon hydrotherapy can be 'performed on any age group', from childhood to old age. We can distinguish between clinical applications, prophylactic use and use in preparation for diagnostic tests

1) In the clinical field benefits have been observed in various fields of medicine.

In 1933, Dr Anthony Bassler, Professor of Gastroenterology in New York, after observing over 5,000 clinical cases studies over about 25 years, asserted that "...every physician should realize that intestinal dysbiosis with toxaemia is the most important primary and contributing cause of many disorders and diseases of the human body". Colon hydrotherapy is, of course, always accompanied by education about hygiene and diet as these affect all aspects of the patient's life. Dr Bartle summed up the guidelines of proper therapy thus: "Patients must be taught how to eat, how to live, how to work and how to play. It must be impressed on them that health will not return through the simple act alone of taking medicine from a bottle. If they can be made to see that a general cleaning-up process is to be inaugurated, and that it is their duty to keep things cleaned up as treatment progresses, and after it has ended, and that the whole management of their trouble is really founded on very ordinary principles, then, with great interest, they usually cooperate quite heartily with their physician".

The main indications for colon hydrotherapy in the field of colorectal diseases are summarized in Table 1.


Table of colonic diseases

Colon hydrotherapy benefits those who suffer from chronic and persistent constipation, irritable bowel syndrome, non-acute diverticular disease, toxic colitis, terminal ileitis, abdominal distention with flatulence and bloating, bad breath, slow and difficult digestion or a feeling of gastric fullness after the ingestion of small amounts of food. Colon hydrotherapy is an almost indispensable adjunct in the radical and definitive treatment of intestinal, ano-rectal and perianal mycosis, especially if this is chronic or recurrent. It is also indicated in preparation for colonic examination and for pre- and postoperative prophylaxis. There are few contraindications and these may be temporary or absolute (Tables 2 and 3).

Table of absolute contraindications to colon hydrotherapy
Table of temporary contraindications to colon hydrotherapy

Its use in constipation and the obstructed defaecation syndrome is particularly important. The conditions under which colon hydrotherapy is effective in constipation are listed in Table 4. As there are no published, prospective controlled studies demonstrating its real benefits in international journals or on med-line, we set up an observational study based on objective and quantitative assessments of the obstructed defecation syndrome; this is also known as the iceberg syndrome because whilst the therapist is treating obvious lesions, the real causes of the disorder are often less apparent. A group of 10 patients underwent colon hydrotherapy (CHT) and another group of 10 patients underwent conventional therapy (CT) with laxatives, fibre, rehabilitation and surgery. There were 8 female patients and 2 males in each group.

A month after CHT the constipation score was reduced by 44%, whilst after CT the reduction was only 19%; the symptoms score reduced from 8 to 4.5 after CHT, from 11.2 to 9.2 after CT. Constipation had returned after 3 months in 57% and 60% of the patients treated with CHT and CT respectively. No complications or negative sequelae were observed either during or after CHT, whilst in the CT group, there were 2 cases of major complications, equivalent to 20%, both occurring after surgery and in patients with anismus and anxiety/depression. According to the study results, CHT appears to be an effective treatment for patients with constipation from obstructed defecation and causes no detectable complications, unlike CT. Obviously randomized studies on larger groups with a longer follow-up are needed to show the real efficacy of CHT (and perhaps its superiority over CT). However, in this initial investigation CHT demonstrates a positive trend, with a higher percentage of improvement in short-term symptoms as well as an absolute lack of complications. The data demonstrates that the benefits obtained are mostly temporary. However, the advantage of CHT is that it can easily be repeated and continued over time with no complications or side effects. For the future, it would seem to be important to determine the correct timing between sessions to avoid losing the good results obtained.

2) Colon hydrotherapy is suggested for purposes of relaxation and prevention, as well as for therapeutic purposes.

In general, the therapy improves a patient's state of hydration: the water absorbed during the treatment cleans the tissues at the cellular level and removes toxins promoting their elimination via the liver, kidneys, skin and lymphatic system as well as via the colon. Irrigation with hot and cold water induces relaxation and contraction of the colonic muscles, facilitating peristalsis and improving any possible colonic atony. The body continues the process of purification even after treatment. Naturally, the adoption of an appropriate diet will help to maintain the balance of the physiological bacterial flora and a more healthy colon. In general, a course of 3-6 treatments is recommended over a period of 2-3 weeks. Afterwards, we recommend maintenance therapy with cycles of 2-3 treatments every 3-6 months. The number of treatments depends on the physicians's assessment of the individual symptoms and the condition of the intestines.

3) Preparing for radiological and endoscopic examinations(Table 5): colon hydrotherapy is an excellent method of preparation for a barium enema, colonoscopy and rectosigmoidoscopy. This type of preparation eliminates the need for laxatives and provides a more thorough cleansing for the examination.

• For barium enema and colonoscopy the schedule is as follows: liquids only from midnight on the second day before the examination; the day before the examination colon hydrotherapy treatment at 14.00; on the day of the examination, colon hydrotherapy treatment at 8.00; the examination can proceed at 10.00 or 11.00.

• For rectosigmoidoscopy the following protocol is followed instead: liquids only from midnight the day before the examination; on the day of the examination, colon hydrotherapy treatment at 8.00; the examination can proceed at 10.00 or 11.00.

• A colon hydrotherapy treatment after the barium enema effectively clears the residual barium suspension from the colon, minimizing patient discomfort from any retained barium, and eliminates the problem of residual opaque matter if other radiological examinations without contrast, or upper gastrointestinal tract examinations, are performed.

• Colon hydrotherapy is also an effective way of preparing patients for surgery on the gastrointestinal tract. This colon cleansing system produces an absolutely clean surgical field and reduces the potential risk of postoperative complications due to the presence of bacteria on the laparotomy wound

Indications for colon hydrotherapy
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