Colon hydrotherapy—also known as colonic irrigation —is the removal of waste from the large intestine using temperature-controlled water. In 2008, the Washington Court of Appeals affirmed a ruling by the Department of Health (DOH) in Yow v. The Department of Health Unlicensed Practice Program, that colonic irrigation constitutes the practice of medicine.
2009 Department of Health Sunrise Review. According to a January 2009 sunrise review by DOH, colon hydrotherapy is performed using colonic irrigation systems. Colonic irrigation systems are devices regulated by the federal Food and Drug Administration (FDA) that require a prescription. The FDA recognizes colonic irrigation systems for colon cleansing when medically indicated. The sunrise review found the practice of colon hydrotherapy was within the scope of practice of allopathic physicians, osteopathic physicians, and naturopaths. Colon hydrotherapy may be delegated by these professionals to other licensed professionals in certain circumstances. DOH evaluated a proposal to establish certification for colon hydrotherapists and found the unregulated practice of colon hydrotherapy can harm or endanger health and safety, but the public does not need an assurance of professional ability because the procedure is already regulated under the scope of practice of other health professions, and certification would not be the most cost-effective means of providing public protection.
2020 Department of Health Report. The 2019-2021 operating budget included a proviso that directed DOH to work with stakeholders to review other states' requirements for practicing colon hydrotherapy and produce recommendations for implementing a colon hydrotherapy certification program in Washington State. The report was released to the Legislature in October 2020. According to the report, many practitioners currently working as colon hydrotherapists in Washington State do not hold a health care credential that allows them to perform colon hydrotherapy. The report recommended education and standards of practice requirements, as well as the following three credentialing options:
Colon hydrotherapist is established as a new certified profession under the Board of Naturopathy (board). Colon hydrotherapy is defined as the performance of enemas or colonic irrigation. Beginning July 1, 2022, a colon hydrotherapist is certified to perform colon hydrotherapy when they meet examination, education, and training requirements established by the board. The education and training requirements, at a minimum, must address proper technique, use of appropriate equipment, and safety and consent procedures. The board may recognize accreditation or certification by a professional organization with standards that are equivalent or more stringent than the board's requirements as satisfying certain board certification requirements.
In order to practice colon hydrotherapy, a colon hydrotherapist must affiliate with at least one licensed naturopath and only perform colon hydrotherapy on patients who have been referred to the colon hydrotherapist by an affiliated naturopath and in accordance with the plan of care delegated from the affiliated naturopath to the colon hydrotherapist. The colon hydrotherapist must submit the names of all their affiliated naturopaths to the board on a schedule established by the board. A colon hydrotherapist may practice in a location other than the naturopath's office.