Could an Enema Really Cure Acne?
Does taking an enema for acne really make sense? The fact is, enemas are more likely to result in increased blemishes than decreased blemishes, and they taking enemas too often can cause other health problems1.
- Enemas help treat constipation, but they can actually make acne worse.
- The reason enemas and colon irrigation used to be recommended for acne treatment is the now disproved idea that food could rot in the colon.
- In hundreds of millions of colonoscopies, doctors have never found evidence for the old auto-intoxication theory.
- Colon health, however, is still important to the health of the skin.
- Adding probiotics to the colon trains the immune system to fight acne bacteria with less inflammation.
- Pimples begin to clear up first, usually after taking probiotic supplements or eating yogurt every day for about two weeks.
What Is An Enema?
An enema is a procedure using water to remove fecal matter. A squeeze bulb or squeeze bag filled with liquid is attached to a hose that ends with a syringe, and the syringe is inserted into the anus. In North America and Europe, the syringe is usually lubricated, but in Latin America and Asia, it usually is not. Liquid is squeezed from the bulb or bag into the rectum, and the user clinches butt cheeks while getting in position over the toilet. When pressure on the anus is released, the enema fluid and fecal matter are expelled.
There are several reasons enemas are used as a legitimate medical procedure. One is to loosen the stool so it is easier to have a bowel movement. This requires “holding time,” so the enema fluid can loosen and soften the stool. The cheeks of the buttocks have to be held tight for up to an hour while the stool is liquified. The net effect of this procedure is similar to using an osmotic laxative, such as Milk of Magnesia.
Another reason to use an enema is to stimulate the bowels2. This used to be done by adding castille soap to the enema solution, but the problem with adding soap to the enema solution is that it not only stimulates bowel movement, it inflames the colon. Adding mineral oil to the enema also stimulates bowel movement, but can cause griping, ejection of small amounts of feces that can stain the user’s undergarments for up to 36 to 48 hours after the enema.
Enemas used to be used as preparation for colonoscopy or colon surgery3, but this use has fallen out of favor with most gastroenterologists. The reason doctors don’t order enemas as often as they once did has to do with the anatomy of the colon.
The colon twists and turns as it descends to the anus. Because of the colon’s shape inside the human body, enemas remove far more fecal matter from the right side of the colon than from the left side of the colon. When the gastroenterologist needs to do a colonoscopy to look for a problem on the left side of the colon, or to perform surgery on the left side of the colon, removal of fecal matter is usually accomplished from the top down, by drinking large amounts (up to several gallons, that is, 10-12 liters) of laxative solution over a period of up to 48 hours. Often, preparation for colonoscopy or bowel procedures does not involve enemas at all.
What Benefit Could Enemas Have for Acne?
Enemas for acne have usually been justified by the claim that acne is a result of toxins, and enemas remove toxins. Ironically, some of the solutions used to “detoxify” the colon, such as hydrogen peroxide, can cause severe skin reactions on the face, and coffee enemas have even resulted in deaths4.
The theory behind the use of enemas in fighting acne is a nineteenth-century idea called auto-intoxication. In the era before the colon could be directly observed in living people, a Russian physician named Ilya Illich Mechnikov popularized the idea that food could rot in the colon and release toxins that are visible in the skin. “Colonic irrigation” with enemas became (and remains) popular as an easy treatment for the alleged disease. But as early as 1919, doctors already knew that food does not rot in the colon the same way it might rot in the garbage can, even when constipation is severe.
The idea that food rotting in the colon could cause outbreaks in the skin also turned out to be false5, but that did not mean that there is no relationship between colon health and fighting acne. Instead, the connection turned out to be that what you add to your colon fights inflammation in your skin6, not what you flush away from your colon.
Probiotic Bacteria and Acne
In the 1930’s, two American doctors, John H. Stokes and Donald M. Pillsbury, discovered a relationship between healthy, probiotic bacteria in the colon and both acne and depression. During the 1920’s, American doctors had started noticing that depression and acne occur at the same time. This probably should not have been a surprise, since acne is depressing.
However, doctors also noted that probiotics they were trying as a treatment for depression also cleared up acne. Brewer’s yeast, as hard as it may be for some people in the twenty-first century to believe, became a common prescription for acne, and it worked. Yogurt, which contains Lactobacillus bacteria, was not commonly available during that era, but it worked even better.
It was over 70 years before American physician Whitney P. Bowe and Canadian dermatologist Alan C. Logan explained why probiotic bacteria in the colon have such a beneficial effect on the skin7. In acne, it turns out, inflammation is not caused by acne bacteria. Redness, itchiness, and swelling are actually caused by the action of the immune system on the skin, as it tries to reduce the number of bacteria in a pore.
The immune system also tries to get rid of brewer’s yeast bacteria and Lactobacillus bacteria from yogurt when they arrive in the colon, but it quickly learns that inflammation is not necessary to keep the colon healthy in the presence of these bacteria. The lesson is transferred to the immune system in the skin, and pimples aren’t quite as red, or itchy, or inflamed, and there is less hardening of sebum to trap acne bacteria in whiteheads or blackheads.
Maintaining healthy, probiotic bacteria in the colon clears up the skin. Flushing them away as if they were toxins, however, harms the skin.
How to Use Probiotics to Clear Up Acne8
The most effective way to take probiotics is by taking a product like Alive!, mixed with juice and taken once a day, or by taking probiotic capsules between meals. These supplements contain large numbers of helpful bacteria that survive passage through stomach acid. More helpful bacteria reach the colon when you take supplements than when you eat yogurt.
But if you would prefer to eat yogurt, eat it with meals, but not when the meal includes soup, which lengthens the time food stays in the stomach, or when you have eaten bitter foods, which increase the production of stomach acid. Small amounts of yogurt several times of day are better than a cup of yogurt eaten in one serving.
You can, if you wish, also eat cakes of brewer’s yeast, available in your grocer’s dairy case. They are more palatable when added to smoothies.
Probiotics won’t clear up your skin overnight, but you should see results in one to two weeks. Taking an enema, however, means you have to start all over providing probiotics for your colon and skin health.
- Adverse effects after medical, commercial, or self-administered colon cleansing procedures. Ncceh.ca. 2019.
- Portalatin M, Winstead N. Medical management of constipation. Clin Colon Rectal Surg. 2012 Mar;25(1):12-9.
- Yıldar M, Yaman İ, Başbuğ M, Çavdar F, Topfedaisi H, Derici H. A new approach in bowel preparation before colonoscopy in patients with constipation: A prospective, randomized, investigator-blinded trial. Turk J Surg. 2017 Mar 1;33(1):29-32.
- Niv G, Grinberg T, Dickman R, Wasserberg N, Niv Y. Perforation and mortality after cleansing enema for acute constipation are not rare but are preventable. Int J Gen Med. 2013 Apr 26;6:323-8.
- Chen TS, Chen PS. Intestinal autointoxication: a medical leitmotif. J Clin Gastroenterol. 1989 Aug;11(4):434-41.
- Stewart TJ, Bazergy C. Hormonal and dietary factors in acne vulgaris versus controls. Dermatoendocrinol. 2018 Feb 22;10(1):e1442160.
- Kober MM, Bowe WP. The effect of probiotics on immune regulation, acne, and photoaging. Int J Womens Dermatol. 2015 Apr 6;1(2):85-89.
- Bowe WP, Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? Gut Pathog. 2011 Jan 31;3(1):1.
To be your most trusted ally in your pursuit of clear, healthy skin.