ABSOLUTE CONTRAINDICATIONS

1. Abdominal Hernia including inguinal and umbilical
Defect in abdominal wall, risk of strangulation of the bowel.2. Active Fissure
Tear or crack in the anus, usually very painful when active.
Varies from small crack to open fissure that requires surgery.
3. Inflammatory Bowel Disorders – Colitis, Ulcerative Colitis, Crohn’s Disease, Diverticulosis,
Diverticulitis.
If clients are suffering with a flare-up, recent flare up, or have an unstable pattern of flare-ups there is a
risk of bleeding, tissue damage and colonics may exacerbate symptoms.
Don’t treat within 3 months of any flare up and then take into account the history over a longer period,
at least over the last year or so.
Relative contraindication exceptions. Clients who are fully in remission.
We have concluded that it is fine to treat people who have been diagnosed with inflammatory bowel
disease as long as you are satisfied that they are in a stable state of remission and, very importantly, you
feel you have the knowledge and experience to be able to decide it is safe to treat them.
It’s very tricky to be black and white with things like this, but we recognise that lots of therapists have a
long experience of treating people with IBD very successfully and without issue.
Overall, this is for you as a therapist to decide based on how you feel about things.
Always the advice is if in doubt, don’t treat. Don’t say yes if you aren’t comfortable with it.
You can always ask for advice and opinion but it’s your choice.
4. Active Rectal Fistula
Caused by an abscess‘tunnelling into the rectum ’sometimes requiring surgery.
5. Anti-Coagulants
Warfarin is administered to artificially affect and reduce blood clotting time. If the client is on Warfarin,
or a treatment dose of an injectable anti-coagulant (e.g., Daltaparin, Tinzaparin,) then it is
contraindicated. However, if they are on low dose prophylactic anti-coagulant and not being monitored
by medical staff, then fine to treat.
6. Atrial Fibrillation
Do not treat due to sudden changes in heart rate.
7. Autonomic Dysreflexia (occursin spinal injuries at or above T6)
Danger of general body spasm, particularly related to insertion of speculum.
8. Bowel Obstruction e.g., adhesions, volvulus, tumour, etc.
With a bowel obstruction no gas is passed and client would be requiring medical attention.
(Not to be confused with faecal impaction which is caused by chronic constipation.)
9. Bowel Prolapse or Rectal Prolapse
Due to weakened tissues not supporting the organs properly. Risk of making the condition worse.

© RICTAT Contraindications to treatment. Updated Dec 2025

10. Carcinoma, (Cancer) o f the colon or rectum
Risk of perforation and bleeding. Bowel is diseased and may be damaged.
11. Chemotherapy
No-one to be treated whilst receiving chemotherapy. High risk of infection due to no, or low immune
response (neutropenia). Minimum of 3 months once bloods levels to return to normal.

Reference – http://www.bnf.nice.org.uk/

12. Diabetes – Uncontrolled/Unbalanced.
Risk of hypoglycemia during a treatment. (See FAQ’s for general treatment information.)
13. Epilepsy
Do not treat unless the client has a driving licence, (or would qualify for one.) and ensure full history of
seizures is taken to allow an informed decision to be made on treatment.
14. Heart Failure
Requiring care of medical professional, ongoing monitoring, and medication. Do not treat. (On advice from
Cardiac consultant, St Bartholomew Hospital. April 2021.)
15. Hypertension (High Blood Pressure)
Uncontrolled and known not to be in normal range. Risk ofstroke or heart attack.
(See FAQ’s for more information)
16. Inflamed Haemorrhoids (Piles)
May exacerbate symptoms and cause pain and bleeding.
17. Intussusception
Do not treat as the bowel ‘telescopes’ on itself.
18. Liver function
Any condition that affects the liver and decreases its function needs to be assessed and if the client is
under the care of a medical professional. See FAQ’s for more information.
19. Neutropenia
Low or no immune system. Severe risk of infection. Do not treat.
20. POTS. Postural Orthostatic Tachycardia Syndrome.
Do not treat due to sudden changes in heart rate.
21. Pregnancy
Risk of miscarriage.
22. Prolapse of colon
Do not treat. Tissue is structurally weak and unsupported. Could make the condition worse and become a
medical emergency.
23. Prostate issues
Prostatitis or prostate cancer- do not treat.
24. Radiotherapy of abdominal area not discharged from medical care
Radiotherapy burns and damages other tissues as well as the tumour. Risk of perforation.
Do not treat for 2 years.
25. Rectal bleeding
All rectal bleeding needs investigation by GP, unless a small speck of blood on the tissue after straining to
pass a large stool.

© RICTAT Contraindications to treatment. Updated Dec 25

26. Reduced kidney function
Kidney function must be a minimum of 50% with two kidneys and 100% with only one kidney and not fluid
restricted. Or renal insufficiency which requires reduced fluid intake under the supervision of medic.
27. Tachycardia or AF
Do not treat due to inconsistent heart rate pattern.
28. Tight Sphincter
Unable to insertspeculum without pain.
29. Under medical Investigations/awaiting medical results
Do not treat or intervene if it may be perceived to interfere with test results. See FAQ’s.
30. Undiagnosed Persistent Diarrhoea
Needs professional medical investigation.

The following timelines given post-surgery/treatment are deliberately conservative and could be less with the
written support of a Medical Professional, but does not override the decision ofthe therapist not to treat ifthey
feel it is not safe or appropriate.

• Recent bowel biopsy – 3 months.
• Recent prostate biopsy made through the bowel – 3 months.
• Recent abdominalsurgery, laparoscopic or open – 6 months depending on severity of surgery and on
medical discharge with no complications.
• Recentlaparoscopic investigation – 6 weeks and on medical discharge.
• Recentsurgery of colon or rectum – 6 monthsfully discharged.
• Recent gastric band,sleeve or bypasssurgery – 6 monthsfully discharged.
• Recent gastric band removal – 6 monthsfull discharged no problems.

© RICTAT Contraindications to treatment. Updated Dec 25

RELATIVE CONTRAINDICATIONS 

The following are industry agreed relative contraindications. The suitability of the treatment remains specific to
the individual and must be assessed by a professional Colonic Hydrotherapist.

• Highly anxious,stressed or emotional client.
• Fainting (vaso-vagal attack.)
• Joint replacement (hip,shoulder, knee.)
Awareness of positioning on couch and as pain allows. NB. Hips – knees no higher than 90 degrees when
they are on their side and pillow between legs during treatment if on side, awareness of possible
dislocation.
• Severe underweight or eating disorders.
Aware of not using colonicsfor further weight loss.
• Severe anemia. Risk of fainting during a treatment.
• UTI – Urinary Tract Infection, General infections /Antibiotic Treatment
Do not treat until the course of antibiotics for the infection has been completed.
• Under medical Investigations/awaiting medical results.
Consider the nature of the conditions that the client is having tests for e.g., bowel, gynaecological, liver,
pancreas, digestive, heart. If digestive in nature, or similar, await results.
• Inflammatory bowel conditions. Fine to treat if therapist can be assured conditions are in remission. See
above (Point 3) for considerations.
• GLP’s – ensure health is within the required parameters, no contraindications are present and ensure to make
comprehensive notes of existing side effects.
• Any other illness, disease or health picture which makes the therapist judge the client is unsafe to treat.

Reference – http://www.bnf.nice.org.uk/

© RICTAT Contraindications to treatment. Updated Dec 25