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What to Know About Probiotic Enema

Medically Reviewed by Dan Brennan, MD on June 15, 2021

A probiotic enema is a procedure that has not yet been widely researched in the medical field. While there are purported health benefits that people claim to get from it, there are also risks involved. ‌

Read on to learn about the pros, cons, and risks of a probiotic enema. 

Enemas and Probiotics

Enemas.Enemas are another word for colon cleansing. The cleansing process is done by using tubes that bring water into the colon from the rectum. Enemas are done for many different reasons including detoxification, waste removal, and to clean out fecal matter.‌

Despite the many reasons that enemas are performed, research has shown that colon cleansing isn’t necessary. This is because your body already naturally cleans itself from waste substances.‌

Probiotics.Probiotics have been found by medical professionals to help with the treatment of inflammatory bowel diseases (IBD) and other types of inflammation. One study tested if probiotic enemas could help with ulcerative colitis (UC). Ulcerative colitis is a kind of IBD where you get inflammation and ulcers in your digestive tract, specifically in your large intestine (colon) and rectum. The results found that there is a possibility of improving UC, but more studies need to be conducted to see if that’s really the case. 

More research needs to be done to evaluate the full effects of probiotics before it can be known with certainty that it is safe and effective to use them. One such topic is probiotics as a treatment for stomach conditions like IBD. While taking probiotics for this is relatively common, a possible side effect of taking probiotics as a treatment for IBD is, ironically, stomach pain.

Uses for Probiotics and Enemas

Probiotics. In another study, probiotic enemas given to a group of children to treat IBD found that some symptoms did improve. More studies are needed to see if the positive results would last for the long-term.

There is also a need for more research to see if probiotics work better than anti-inflammatory drugs and if it’s necessary to administer the probiotics rectally instead of ingesting them orally.

Enemas. Two common types of enemas are retention enemas and cleansing enemas. Retention enemas are used to bring substances inside your body for absorption. Cleansing enemas are used to wash out your colon.

A probiotic enema is a retention enema. While it is common to have a probiotic enema with one particular probiotic, no one probiotic has been found to be more effective than others. However, some probiotics that have been used during enemas with positive results are:‌

  • 5-aminosalicylic acid (5-ASA) in combination with L casei
  • Lactobacillus reuteri
  • E coli Nissle 1917, or Mutaflor
  • Bifidobacterium‌

Along with these probiotics, there is a product that has been found to help with starting remission of UC, called VSL#3. It is a combination of the 8 following probiotics:‌

  • Bifidobacterium breve
  • B. longum
  • B. infantis
  • Lactobacillus acidophilus
  • L. plantarum, L. paracasei
  • L. bulgaricus
  • Streptococcus thermophilus.

While there have been positive results when testing the effects that these probiotics provide to help treat UC, more studies are needed to see if these bacteria will keep working long-term.

Choosing probiotics. It is important to keep in mind that not all probiotics will suit your medical needs. Because not every probiotic can help with a medical issue, it is important to talk to your doctor before taking probiotics.

While probiotic enemas may be able to help with remission for some people that have UC, there is no silver bullet solution to which is the most effective method of treatment. It's important to talk to your doctor to find out which types of probiotics and amount of treatment sessions would be right for you. 

Probiotics Taken Orally Versus Rectally

Probiotics are used to change luminal bacteria, or gut bacteria, to anti-inflammatory bacteria instead of ones that create inflammation in your intestine.‌

If you take a probiotic orally, it will pass through bile and stomach acid before it reaches your large intestine. Keep in mind that there will need to be enough bacteria so that probiotics are able to make a positive change with an issue, so it is important to make sure that you are taking enough.‌

You may need to take probiotics with up to billions of live cultures. Additionally, it can take 7 to 10 days of treatment for the bacteria to flourish and colonize in your gut.

When taking probiotics rectally, it may be easier for the bacteria to reach your intestines and have a good effect on your gut. One reason for this is that it does not have to go through any stomach acid or bile. The same amount of time is needed (7 to 10 days) to receive the probiotics rectally for the bacteria to colonize.‌

People often prefer taking probiotics orally because of the discomfort commonly experienced when receiving an enema. While there is more research needed, a significant difference has not been found when receiving a probiotics treatment orally instead of rectally.

The Pros and Cons of Enemas

Pros. While you may find many pros for enemas when looking, it is important to note that any pros are based on speculation. They have not been proved scientifically.

Some of these include:

  • May contribute to an increase in concentration and energy levels.
  • May promote weight loss.
  • Act as a preventative measure against colon cancer.
  • Strengthen your immune system.‌

Cons. Cons of enemas, on the other hand, have been scientifically proven.

Some of the risks of an enema include: ‌

  • Performing an enema may cause a rectal perforation if inserted wrong. 
  • Enemas have caused additional serious problems including air emboli, pelvic abscesses, and colitis. An air emboli is when a bubble gets trapped in your blood vessel and blocks it. A pelvic abscess is when you get a pocket of infected fluid and puss in your abdominal cavity (belly area). Colitis is when the inner lining of your colon is inflamed. 
  • There is no guarantee that probiotics bought commercially are the same standard as advertised on the packaging. This is because they aren’t under medical regulations since they are categorized as a food. This means that commercially-bought probiotics may not work effectively.
  • While Crohn's disease is an inflammatory bowel disease like ulcerative colitis, unfortunately, studies have found that probiotics do not make much of an effective treatment to cure it. One reason might be because the right probiotic hasn’t been found yet to effectively treat the condition. Because of this, it is not recommended to use a probiotic enema to treat Crohn's disease.

Probiotic Enema Safety

While the decision to undergo a probiotic enema is a personal decision, it is important to consult your doctor before doing so. Have especially diligent communication with your health professional if you have any health conditions including heart or kidney disease.‌

Lastly, make sure that the person performing the enema is a professional and uses sterile, disposable equipment.

Show Sources

SOURCES

Alimentary Pharmacology & Therapeutics: “Randomised clinical trial: the effectiveness of Lactobacillus reuteri ATCC 55730 rectal enema in children with active distal ulcerative colitis.”

BMC Complementary Medicine and Therapies: “Clinical trial: Probiotic treatment of acute distal ulcerative colitis with rectally administered Escherichia coli Nissle 1917 (EcN).”
Bowel Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.”

Gastroenterology & Hepatology: “Probiotics in the Management of Ulcerative Colitis.”

‌Mayo Clinic: “Is colon cleansing a good way to eliminate toxins from your body?” "Ulcerative colitis."

Mount Sinai: "Abscess - abdomen or pelvis."

ndnr Naturopathic Doctor News & Review: “THERAPEUTIC RETENTION ENEMAS: AN UNDERUTILIZED MODALITY FOR UC.”

NHS: "Air or gas embolism."

Nutrients: Side Effects Associated with Probiotic Use in Adult Patients with Inflammatory 

The George Washington University Hospital: "Colitis."

The Journal of Lancaster General Hospital: “Colon Cleansing: Medical Breakthrough or Myth?”

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