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Digestive Health Blog

The best colonoscopy prep: no prep! Introducing colon hydrotherapy for bowel cleansing

Updated: Dec 26, 2022




The barriers to patients choosing to follow through on completing their colonoscopy for cancer prevention have been well studied.

  1. cost

  2. fear

  3. preparation

In the US, the Affordable Care Act requires that patients not have a deductible for a preventive/screening colonoscopy. There are a few loop holes, which are in discussion at CMS to be fixed in 2023.

Modern sedation and education by advocacy groups have done a fantastic job at reducing fear through knowledge. As more people have had a colonoscopy, the word of mouth has certainly helped too. Even those who had a bad experience decades ago now agree that modern colonoscopy is comfortable. Everyone seems to agree that the prep is the worst part.


Already know a lot about bowel preps and want to skip to the section on our new colon hydrotherapy option? CLICK HERE


Why? Well, the early types of bowel purgatives required a patient to drink a gallon of terrible liquid, chugging and chugging until they were so full they would become uncomfortable and even vomit. If they didn't, the outcome at the other end was so violent for many that the humorist David Berry wrote a famous article about it. I won't link to it, because, well...things have gotten a lot better.


Next we tried pills. But LOTS of pills. Up to 40. And at the end of the day, a person would drink so much liquid with the pills they still felt uncomfortably full. We also saw not so great electrolyte side effects (that we thought we could predict but couldn't.)


Then came "half volume" preps, split between evening and morning. This was based on the amount of volume patients taking pills ingested, and did provide an improvement that is still used by many colonoscopy centers today. However, patients were often up all night, and very early in the wee hours of the morning trying to get ready. And many still had issues with fullness, nausea and even vomiting.


So, at Pearl Health Partners we thought: let's make this even better. (Some medical conditions like constipation will of course require specific preparations,) A new low volume preparation along with a number of recent studies showed that patients could prepare the morning of their procedure, over a shorter time, with better taste. We altered our colonoscopy procedure times to fit YOUR schedule, so our earliest patient undergoing same day preparation only has to arise at 5AM. The quality of these preps is fantastic, because you do the work close to the time of your procedure. We do ask that you stick to clear liquids the day before, but for many patients this fits their schedule well.


Recently, data has become robust about preparing for a colonoscopy in a way that lets patients have real food the day before an exam, food low in residue. A GI doctor created a way to make this simple, cheap and easy that we now offer to patients as an alternative. A meal kit of comfort foods is only $25, and the schedule of our favorite gentle laxative is given in small portions throughout the day prior to your procedure. 6 hours before your exam, you take a few pills to help clean out the remaining bile. We're early in our use of this preparation, but for those who have difficulty adhering to a clear liquid diet or taking drinks all at once, this is a fantastic new option: Eat Your Prep!


But being who we are, we're not through making improvements. We still want to make colonoscopy as easy and accessible as possible. And limit who needs one, and how often. (see our recent blog post about how we can, and soon will, increase selection of patients for different types of colon cancer screening tests).


Colon hydrotherapy, or "colonics", have not been endorsed by gastroenterology for a very long time. Concerns include complications, perceived benefits and care provided by non-medical providers. But times have changed. Now, there is significant research showing that colon hydrotherapy is not only safe when patients are carefully selected, and the procedure held to specific standards of practice and quality: it's very effective. When performed correctly, 97% of patients attained clean preparation for colonoscopy.


*Data from Angel of Water based program



Did you know that one recent study suggested that polyp detection is better after a hydrotherapy vs oral preparation? This is likely due to the widespread use of other types of oral preparations elsewhere which often leave difficult to clean residue. We've not seen this with our "same day" preparation, and can't state that one is better than another in our hands. But it confirms what many studies show: hydrotherapy preparations work.


And patient satisfaction is superior for same day hydrotherapy compared to any oral preparation. Discomfort is minimal and serious adverse events have not occurred in studies that meet strict guidelines on performance of the therapy.





This does not mean that any odd person can grab a garden hose and open up for business. Instead, the world of colon hydrotherapy has gone medical.


There are 2 types of colon hydrotherapy: "open" and "closed". The first uses gravity and low pressure, and is provided by one of 2 FDA approved devices (LIBBE and Angel of Water). The second uses pressure and pumps. Open hydrotherapy has been the most studied in the USA. Of the two FDA approved systems, much of the recent US data is from the Angel of Water device, marketed as HyGIeacare. As this field advances, we'll keep you updated on any differences should they arise. The systems and protocols are similar. Closed systems do have recent data from studies in Europe for colonoscopy preparation that are also encouraging.


Pearl Health Partners is proud to partner with Jill Simons to provide colon hydrotherapy to our patients as a new alternative for bowel preparation. She is a well known and busy IACT (International Association of Colon Hydrotherapy) certified Colon Hydrotherapist. Jill has been a hydrotherapist for over 20 years, longer than most in Portland. She uses the LIBBE open system with appropriate disinfection, temperature and procedural standards.


The procedure is private, located near to our center and takes about 1 hour. You will still need to adhere to a clear liquid diet, as we do not have data about the use of low residue diets yet. And we do ask that you add a few pills timed just right, similar to some other preparations.


Not all patients should undergo this technique. The following is a list of contraindications for colon hydrotherapy, many of which are also not appropriate for an outpatient procedure: cirrhosis, severe renal or cardiac disease. severe anemia, GI hemorrhage/perforation. Others make sense: fissures/fistulas, large abdominal hernia, severe hemorrhoids, recent colon surgery. However, large studies using open systems have also recently shown benefit and safety in a few categories of interest which may alter use in the near future.



But that's not all! Emerging data also shows benefit of hydrotherapy for constipation. Or consider this: have you had a tough time preparing for colonoscopy and had your procedure cancelled? What if we could "salvage" your procedure with hydrotherapy the same day? Also near and dear to our hearts, the materials evacuated during hydrotherapy are opening new doors into understanding the world of the gut microbiome. Compared to "spontaneously passed stool"...the "effluent" retrieved via a hydrotherapy procedure shows wild differences in biodiversity. You bet we are jumping into this research with both feet.


Contact us to schedule here: https://www.pearlhealthpartners.com/schedulecolonoscopy







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