Sheila Shea MA

The Hydrotherapies: Colon Hydrotherapy, Colemas and Enemas

Many people want to understand these 3 forms of hydrotherapy: colon hydrotherapy, colemas and enemas. “Hydro-” means water and all three are a form of water therapy. Each introduces water into the colon or large intestine and allows water and waste to exit. In each therapy, water has the potential to reach the cecum or beginning of the ascending colon.

The ascending colon is the beginning of the large intestine and is located in the lower right quadrant of the abdomen. The ileo-cecal valve connects the cecum, or lower portion of the ascending colon, to the ileum of the small intestine. The appendix is in the lowest portion of the cecum below the ileo-cecal valve.

Colon size is approximately 1 gallon in volume. This varies depending on the size and condition of the individual colon. The amount of water needed to cleanse the colon may be equal to but is most often less than the amount of water the colon holds. Water and massage stimulate the muscle response called peristalsis before the entire tract is filled. Sometimes elimination happens by the stimulation not just by water volume. The key is to get the muscles working.

The water pressure with each type of intestinal hydrotherapy is less than one to two pounds per square inch (psi). Most often, it is less than one-pound psi.

The water moves in and around the contents of the colon and helps soften, loosen, rinse and hydrate them. The muscles respond to the water and to abdominal massage if it is used. Peristalsis, or the involuntary expansion and contraction of the intestinal muscles, can be strengthened each time the muscles respond. The large and small intestines of many people are impacted, dehydrated, in spasm and gaseous. The large and small intestines may have extra length, coiling or redundancy, adhesions and locked or lethargic muscles. Hence, the water does not go the entire length of the colon immediately or easily. With whatever system is used, people work on getting the contents out little by little. The hydrotherapies fill the large intestines and in most cases are prevented from entering the small intestines by the ileocecal valve, the one-way gate between the large and small intestines.

Following are descriptions of the 3 hydrotherapies.

Colon Hydrotherapy
Colonics, colonic irrigation, colon therapy, high colonic and entero-lavage are synonyms for colon hydrotherapy and occasionally the terms are used interchangeably.

Colon Hydrotherapy uses equipment to introduce water into the large intestines or colon and release waste and water. Two kinds of equipment exist. One is the “closed-tube” system. The other is the “open-basin” system. I will refer to them as the Closed and Open systems. The water source for both the closed-tube and open-basin may be either water pressure or gravity depending on the manufacturer and company.

Water filters are used with both types of equipment. Equipment can have from two to six filters. Two to four filters are installed for the hot and cold water lines. UV light and activated carbon/charcoal filters are also used additionally with some equipment.

Water temperature is controlled with the temperature gauge. The water is generally kept close to body temperature. Water can be used at warmer and cooler temperatures for additional therapeutic effects. Water pressure is controlled on the “pressure” systems and is monitored with a pressure gauge.


New machines range in price from $4,500 to $12,000.

The cost for a session ranges from $75-$200.

Closed-tube Pressure Colon Hydrotherapy System
With the closed-tube pressure system, the water pressure can be adjusted for each inflow. This means water enters the colon very slowly or potentially less than 1/2 psi (pound per square inch).

The time of one session ranges from 20-60 minutes.

The speculum is the instrument that is inserted into the anus that allows the water to flow in and out. The speculum for the pressure machine is 3/4″ in diameter and 6” long. The speculum is inserted 2-3 inches into the colon. Smaller speculums exist for children and smaller anuses. One larger speculum exists and is slightly larger than the standard.

The water line attaches to a T joint on the top of the speculum. The waste line is joined at the end of the speculum. The water and waste line are separate and approximately 3 feet in length. The other ends of the water and waste line are attached to the equipment. The water line connects to the incoming water line on the equipment and the waste line attaches to an illuminated glass viewing tube.

The waste goes out the speculum into the disposable waste line to the illuminated glass viewing tube that allows observation of what is eliminated. The equipment empties into the sewer system after it passes through the viewing tube.

The water flows in only. When the client has a feeling of fullness in the abdomen or when the therapist judges it appropriate, water and waste material are allowed to exit. The recipient remains on the treatment table throughout the process. The sessions consist of a series of inflows and outflows that are accompanied by abdominal massage.

Volume of Water:

Studies show the range of water to be from two to six liters or quarts that are introduced into the colon during a colon hydrotherapy session. Some individuals take up to 40 ounces on one inflow. The majority of people do not exceed 70 ounces on one inflow. The upper range on one inflow can be 110 ounces. This is usually reached after several treatments and only then by 20% of the people.

Position of Recipient:

The standard position for colon hydrotherapy sessions is resting on the back with knees bent and feet on the table. Alternate positions include lying on the right and/or left side or rotating through all 3 positions.

Open-basin colon hydrotherapy system
With the open-basin system, the table on which the client rests has a basin set into it. The equipment is plumbed to the sewer system from the bottom of the basin. The client’s hips are at the edge of the basin so intestinal waste may fall easily into it. Water comes from a gravity tank system and/or a pressure system set in a cabinet at the foot or side of the table. Tubing connects the tank with the speculum. The equipment is designed so that either the therapist or the recipient may administer the session.

Water pressure is regulated. The maximum pressure is 1.4 psi in gravity mode and 3 psi for pressure flow. The therapist or the recipient may regulate the pressures below these levels.

The speculum for the open-basin system is narrower than a pencil in diameter and 4 – 10” long. It goes into the anus about 2 – 4″. The speculum stays in during the entire session. Its narrowness and flexibility allow the water to flow in and out at the same time. The water and waste are expelled around the tube and into the basin. The recipient can also choose to retain water in the colon during the session.

During this kind of system and the colema, the water is flowing continuously in and out. Most likely, not more than two to three liters/quarts is in the colon at any one time. More information is needed.

Position of Recipient:

The standard position for colon hydrotherapy sessions is resting on the back with knees bent and feet on the table. For the open-basin system, the client remains in this position to accommodate the basin. The therapist can monitor the waste that comes out. The client is able to see the waste coming out depending on the system.

The open-basin works especially well with spina bifida, elderly clients, paraplegics and quadriplegics or any other population that has loose sphincters muscles. It also works well for those with intense constipation, dehydration, impaction and/or urgency.:


In both kinds of systems, the therapist may use abdominal massage, acupressure, lymphatic drainage, reflexology, hot rocks and other techniques to help loosen waste material and promote muscular response.


Most tubing and speculums come in germicidal packs and are disposed of after each session. Auto-claving and/or germicidal solutions are used with tubing and speculums that are not disposable. Sanitizing the viewing tube and/or tanks between sessions is also a necessary part of sterile technique.

Both systems involve plumbing of water and waste lines according to code. Most equipment is FDA approved. Some equipment has the waste line empty into the commode.

Administration of Sessions:

A professional therapist administers the colon hydrotherapy session. Some equipment is designed to allow the client to self-administer once they are familiar with the process.

The therapist is present during the entire session with a closed pressure instrument.

The presence of the therapist in the open-basin system is necessary to fill tanks if present, monitor water volume and administer optional massage and/or monitor the session and results.


In her book Stay Young & Healthy Through Internal Cleansing, Millan Chessman quotes the story of a man with severe and long-term psoriasis. His wife wrote this note:

“Bob took one colon cleansing every day for 6 weeks and diligently ate nothing but raw vegetables, fruits, grains, nuts, beans and legumes. He began to see the sores going away. At the end of 6 weeks, Bob had no psoriasis.”

A colema is done with equipment that includes a 5 gallon bucket, a colema board with an opening and protective shield at one end, tubing and speculum. The opening in the board sits on top of the toilet and a chair or other device supports the other end. A person rests on the board on their back with their buttocks positioned at the edge of the opening and against the shield.

The 5-gallon bucket is placed at the foot of the toilet on top of the tank, on a table or on a shelf nearby. The tubing goes from the bucket to the backside of the shield to attach to the speculum. The speculum for the colema is the same as for the open-basin system. It is narrower than a pencil in diameter and 4-12” long. It goes into the anus about 2″. The speculum stays in during the entire session. Its narrowness allows the water to flow in and out at the same time. The water and waste are expelled around the tube and into the basin. The client can also choose to retain water in the colon during the session.

The water enters the colon via gravity not by water pressure. The bucket outlet is not more than 1-2’ higher than the anus and the water pressure is maximally 1 pound-per-square inch (psi).

The set-up is similar to the open-basin colon hydrotherapy equipment however; no machine or plumbing is necessary.

Water temperature varies with each individual. It is usually close to body temperature.

Volume of Water:

During the open-basin colon hydrotherapy system and colema, the water is flowing continuously in and out. I would imagine the same inflow volume would hold true. Probably not more than two to three liters/quarts would be in the colon at any one time. More information needed here.

Purified water is best for the colemas.

The instructions for the boards come with information on disinfecting them after use.

Colemas are self-administered. The recipient is encouraged to use abdominal breathing techniques and self-massage of the abdomen to aid in the cleansing.


“I was very toxic when I started. It seemed like I was getting nowhere before investing in a colema board. There was just too much. I did them once daily and after 3 weeks, the stuff was coming so fast, I had to do them twice daily. It helps to remove toxins caught up in the system.”

The enema is administered with a bag or bucket ranging in volume from 1 1/2 to 4 quarts. Standard enema bag size is two quarts. Volume of water used is determined by measuring the amount remaining in the bag after the enema. Some enema containers are clear plastic and note volume in centiliters and ounces.

Douche and hot water bags purchased at most drug stores and supermarkets double as an enema bag. The bag comes with a few feet of hosing and a small 3-inch pencil-thin speculum that is inserted a few inches into the anus. A small clasp near the speculum end of the hosing allows the recipient to regulate the water flow and pressure.

The bag may be hung on a shower rod, towel rack or hook. The higher the elevation, the greater the water pressure. Water pressure should not exceed 1 psi.

Purified water is best to use in the enema container.

Enema positions vary. Generally, the recipient is kneeling with the upper torso and/or face resting on the floor called the knee-chest position. Some individuals rest on their back with knees bent and feet on the floor. Others begin the process on their left side, moving to their back and then to their right side. Nursing training generally has the recipient lay on their left side. Gerson therapy has the recipient lay on their right side to receive the enema.

Some people feel enemas do not reach as far as the cecum, the beginning of the ascending colon. Others are highly successful in filling the entire colon. Mainly, people need to practice enemas to improve getting the water to the ascending colon and practice breathing through peristaltic waves to allow water to flow in. Learning to take a good enema is like learning any other skill. It takes time and practice.

Enemas can be combined with yoga, breathing, and abdominal massage for best effect. Using a combination of an enema, yoga postures, breathing and abdominal massage enables the water to get all the way around to the ascending colon. The massage, breathing and postures are also helpful in stimulating peristalsis so that the muscles work to expel all the waste and enema water.

People who tend to have spasms in their intestines can take a little warm water and/or abdominal massage and/or tincture of valerian, orally and/or rectally, to help relieve the spasm. Smaller amounts of water are taken in the beginning. After each release on the toilet, more water is taken in via the enema. This situation is also true for any others who have difficulty retaining water or getting water into and around the intestines.

Enemas are usually self-administered however; a family member, partner, nurse or friend can also give them.

High Enemas:

Enema tubes are available from 14 to 36 inches long. They are attached to the enema speculum. The flexible and long enema tube is slowly reeled into the colon by hand. The goal is to reach the transverse and hopefully the top of the ascending colon. As you can tell, this is a sensitive process. Experience and gentleness are important for administration. Some suggest having a professional administer the high enema.


“A good quality colon tube (Fr 28 – 30) can usually be inserted its full 30 inch length quite comfortably after a rather routine 1-1/2 to 2 quart enema. When the fluid enters that deep into the bowel, one can usually get a good cleanse back as far as the cecum with out a lot of discomfort.”


Enema bags range in price from $13-$200+. The larger 4 quart bags can cost as much as $150.


Number of Sessions for the Hydrotherapies
The number of sessions can vary from once to several times daily, weekly, monthly or annually for extended periods. It depends on the condition and goal of the person.

Some people are detoxifying so strongly they need enemas, colemas or colonics from once to three times daily. For example, individuals with parasite infestations, chronic constipation, environmental illnesses and various degenerative disorders might take several enemas or colemas daily or colon hydrotherapy sessions daily for several months, even as long as several years.

Some people are so impacted, dehydrated and/or tense they require two to three weekly for one to three weeks until intestinal waste begins to break up and flow through. Some people have a breakthrough with muscle tone, peristalsis and elimination between three to twenty sessions.

Six sessions once a week for six weeks generally can create a good cleansing beginning.

Some individuals take the intestinal hydrotherapies weekly to cleanse and tonify the intestinal tissue. Others use them occasionally to correct temporary constipation, reduce flu symptoms, relieve gas, while traveling or recovering from traveling, or motivate lifestyle change.

Note: It is important to be aware of proper hydration as well as electrolyte and flora supplementation while using intestinal hydrotherapies.

All therapies used above are types of colon hydrotherapy. Some people find the colema to be the most helpful. Some find the enemas are their preferred method of cleansing. Some prefer to work with a professional therapist and take colon hydrotherapy sessions.

A person can use enemas and colemas while taking a series of colon hydrotherapy sessions. Many of my clients take enemas or colemas between colon hydrotherapy sessions because they are so toxic and need frequent cleansing or are following a cleansing program.

The enemas and colemas are useful because people can self-administer. They are a great form of self-help. They are also relatively inexpensive, the only cost being the enema bag or colema board.

Other uses for colon hydrotherapy include restoring muscle tone, stimulating lymph, calming the nervous system, relieving and restoring the immune and endocrine system, re-positioning the intestines, hydrating, warming or overcoming hypothermia, jump-starting the GI tract, assisting during a life-style change, drug detoxing, pre-surgery, before a barium x-ray, endoscopy, sigmoidoscopy or colonoscopy, eliminating parasites, releasing toxic emotions and counter-acting the effect of pain killers on peristalsis.

I want each person to feel free to explore and experiment to find what they like and what works best in different situations. The truth is that it requires time, energy, perseverance, discipline, trial and error, practice and a sense of humor to cleanse effectively and thoroughly. People must also work with diet, fluid, exercise, herbs and attitude to help promote the loosening of waste. It takes a long time to cleanse the GI tract, heal the walls and restore peristalsis.