Nancee Lyons of Washington, D.C., now in her mid-40s, first turned to colon hydrotherapy 15 years ago after realizing her bowel habits weren't regular.

"I guess I've always had a problem with constipation, but I think it's just my body's constitution," Lyons says. "I eat healthy and eliminated red meat and pork from my diet in the early '90s, so it tells me my bowel habits are more than diet driven."

Lyons, who normally has colonics once a season, says she feels better after her sessions and doesn't have any concerns about the treatment. "I'm always amazed at what is flushed out of my system during a colonic, so I know they work," she says.

The practice of flushing the colon, or large intestine, with an injection of water has been around since ancient times. In a recent online poll, almost 15 percent of Angie's List members say they've had a colonic.

Most members, who've gone to wellness centers, spas or even a chiropractor's office for the treatment, say it was part of a body detoxification regimen or to help with weight loss. Some consumers and providers also suggest it can give major relief to gastrointestinal conditions, such as constipation, irritable bowel syndrome and Crohn's disease.

But a review in a recent issue of The Journal of Family Practice says there's no proof to back health benefit claims. On the contrary, it may even be harmful. "It is just not there," says the review's lead author Dr. Ranit Mishori of the evidence. "I will be more than happy to reconsider if anybody can provide robust scientific studies that confirm any positive effects."

Health benefits debated

Mishori, a family medicine physician at Georgetown University School of Medicine in Washington, D.C., and her colleagues looked at 20 studies that evaluated colon hydrotherapy as well as colon cleansing with products such as laxatives and tea and found they had adverse effects ranging from cramping to electrolyte imbalance and rectal perforation.

"Colon hydrotherapy is not just a gentle enema, it's a form of an extreme enema or 'enema on steroids' as I like to call it," she says, and adds it may also eliminate the good bacteria found in the intestines, which is an important part of the body's immune system. "There are no proven benefits, so why take any risks?"

Dr. Edgar Guess, a board certified physician and vice president of the National Board for Colon Hydrotherapy, says critics' claims are ridiculous. "There have been no proven cases of perforation of the colon in the U.S.," he says. "And the alteration of the normal flora of the colon by a colonic is minuscule if any. The flora in your colon is altered more by antibiotics."

Potential problems

While the alteration of normal flora during a colonic may be small and perforations rare, Mishori says, consumers should still be concerned about potential problems. She cites Texas cases where one woman died and four patients suffered injuries in 2003 following colon hydrotherapy.

The Texas Department of Health referred the cases to the state attorney general who filed six lawsuits against colon hydrotherapy providers.

The lawsuits alleged the providers advertised, sold or used colon hydrotherapy devices without physician oversight, which is required in Texas, and that providers made false claims about the benefits of those devices. In a court ordered judgment in 2005, the defendants pledged to adhere to Texas law and FDA regulations.

The FDA has only approved the use of colonic irrigation units or devices before medical procedures such as an X-ray or endoscope, and they've issued warning letters to several manufacturers for lack of FDA approval or for making unapproved claims about the devices.

FDA spokeswoman Morgan Liscinsky says individual states regulate who can operate colonic irrigation devices, but the manufacturer should be offering training to providers on how to use it.

Colon hydrotherapy basics

Colon hydrotherapy - or colonic irrigation - is centered around the belief that waste left in the colon can poison the body. During the treatment, which takes about 45 minutes to an hour, the patient lies on a table and a certified colon hydrotherapist inserts a lubricated disposable nozzle into the rectum.

The nozzle, which is attached to a long plastic hose connected to a colon hydrotherapy unit, feeds warm water into the rectum and colon. The water slowly breaks down built-up fecal matter and causes the colon to contract - flushing out the fluids and waste through a second tube.

Guess, who owns the Beverly Hills Wellness Center in California that offers colon hydrotherapy, says their clients requesting colonics most frequently complain about chronic constipation. "If you eliminate once or twice a day, it's good, but most people don't eliminate that well," says the retired ob-gyn who's performed the treatments for 45 years.

Guess' therapists do between 40 and 50 hydrotherapy sessions - which are usually an expense not covered by health insurance - each week at the rate of $95 per session.

Dr. Sharda Sharma, a highly rated general practitioner who has performed colon hydrotherapy at her Sharma Holistic Medical Center in Millburn, N.J., for more than 15 years, says most of her clients also come in for relief from constipation.

Sharma starts clients on a weekly schedule so they can experience the best results of colon elimination, she says. Each session costs $100. "My clients have better bowel function and increased energy afterwards because constipation can cause such sluggishness," she says.

But Mishori says she wouldn't recommend colonics for constipation. Instead, she says people should see their doctor if they experience any gastrointestinal problems. "There could be some very specific reasons for the constipation that need to be identified and treated," she says.

Dr. Paul Miskovitz, a highly rated gastroenterologist at Weill Cornell Medical College in New York and author of "The Doctor's Guide to Gastrointestinal Health," says he doesn't recommend colonics. But, he adds, if a patient wants to undergo them periodically, he wouldn't object as long as the proper precautions are followed.

Talk to your doctor first

Miskovitz says patients should talk to their doctor and receive a medical evaluation prior to receiving colon hydrotherapy. If they have significant colorectal disease or any other medical conditions that would contraindicate having the procedure, such as end-stage renal disease, cancer or taking antibiotics to treat diverticulitis, they shouldn't get it done.

"Colonics should also only be done in a safe and sterile fashion to avoid transmission of viral hepatitis A, B and C, as well as other harmful bacteria," he adds.

Both Miskovitz and Mishori believe a healthy lifestyle is the best way to ensure regular bowel function. "Our bodies have already been designed to rid themselves of toxins, and there is no need to assist the healthy body in doing so," Mishori says.

Miskovitz suggests a low fat, low cholesterol diet with fruits, vegetables, fiber, a multivitamin including folate and B-12, and plenty of fluids and exercise.

At highly rated Danbury Hospital in Danbury, Conn., gastroenterologists were the first in the country to offer hydrotherapy prior to colonoscopies more than five years ago as an alternative to the liquid polyethylene glycol bowel preparation.

"We wanted to have a higher percentage of people getting colonoscopies so they don't get cancer," explains Dr. Joseph Fiorito, chief of gastroenterology. "The liquid prep was a deterrent." Fiorito adds that hydrotherapy has a place for patients who can't tolerate other preps, particularly the elderly and those with medical conditions that make it difficult to reach the bathroom. "We've found very good results," he says.

Few states require physician oversight

Susan Hofer, spokesperson for the Illinois Department of Financial and Professional Regulation, says under their state law, a patient must have a doctor's order to receive colon hydrotherapy. They are one of at least a few states, including Texas, that require physician oversight.

"Once a physician determines it to be medically necessary, he or she may authorize someone who is appropriately trained and supervised to perform the procedure," Hofer says. If caught operating without supervision, Hofer adds, therapists in Illinois can be fined up to $5,000 per incident.

Proponents and some skeptics of hydrotherapy agree consumers should make sure their therapist has training through the International Association of Colon Hydrotherapy, a professional training and certification organization.

To be certified, they require a high school diploma, CPR training, completion of college-level anatomy and physiology, and a 100-hour course that includes 25 therapy sessions with clients. Florida currently is the only state that requires licensing.

Member Norman G., of Potomac, Md., who didn't want to use his last name for privacy reasons, first learned about colon hydrotherapy a half century ago when he lived in St. Petersburg, Fla. "It was widely advertised as a cure for everything," Norman says. But when he suffered constipation and couldn't find relief in 2007, he decided to give it a try.

Since then, the 82-year-old has had it done five or more times and has paid $100 each session. Although he has no concerns about safety thanks to highly rated Melissa McGlone, a certified colon hydrotherapist in Alexandria, Va., he did make sure to tell his gastroenterologist about it.

"He said he didn't recommend it regularly to patients, but there are patients for whom it worked," Norman says. "And it worked well for me."

- With additional reporting by Jackie Norris and Matthew Brady