Fecal Mythology

The following may be NSFW and contains possible abuse memory triggers.

Defecation is the great equalizer. Everyone drops trou from time to time. Seriously, everyone. Members of the kingdom animalia, which includes the popular girls in high school, dictators, presidents, attorneys, doctors, supermodels, and Michael Stipe, all need to download some brownware evacuate our bowels occasionally. Even me! It’s the result of metabolism. Speaking only for myself, I tend not to think about this metabolic process much unless I’m sick. However, there are people, at least in Western societies, who fetishize the functioning of their colons and perform all sorts of fascinating rituals to rid themselves of evil feces. Which is exactly why I became an anthropologist. Other people are weird.

Even weird people are complex, and the lines of colonic fetishism for health vs. sexual reasons sometimes overlap. People who enjoy insertive anal stimulation may seek out colonic therapies to achieve orgasm. Klismaphiliacs in particular receive “...arousal from introducing liquids into the rectum and colon via the anus.”  Google “enemarotica” for more on this. Of course not all of colonic health fetishization is explicitly sexual.

Alternative colonic health practices all look like purification rituals to me. Proponents imagine a discredited concept called auto-intoxication in which feces stagnate in a closed system continually leaching poisonous substances into the bloodstream. The basic premise is that feces are inherently evil toxic and performing extreme colon cleansing rituals will get rid of the devil toxic stuff, ushering in “true” health and purity. And lower BMI. And cure asthma. And cure halitosis. And improve body odor. And really, who doesn’t want to smell like honey?

On one end of the colonic health spectrum is eating fiber and self-administering laxatives and enemas to assist or achieve ease of elimination. Near the other end is commercial colon hydrotherapy. Here’s a description of that process:

“...a colonic irrigation [also called hydrotherapy] is a procedure where a jet of water is inserted into the colon through the rectum and the whole colon is physically washed for hours with warm streams of water. The procedure takes two to four hours...”

The very latest fad is a bit of an outlier, fecal microbial transplantation, which I’ll get into in a minute.

There are medically valid reasons for some practices like colon cleansing enema, such as prior to a colonoscopy under the direction of a medical doctor. There is a great deal of potential for harm from the rogue practice of commercial colonic hydrotherapy. People have died from this from a wide variety of fatal practitioner errors including improper sterilisation of equipment. The most common complication seems to be bowel perforation, where there is improper insertion or the pressure from the hydrotherapy ruptures the colon, flooding the abdominal cavity with fecal slurry. This is often fatal. Shooting water, or herbal water, or coffee water into your colon under pressure is not a benign undertaking.

The new holy grail of alternative colonic ritual is fecal microbial transplantation (FMT), for which PubMed lists a number of studies supporting its use for a very specific bacterium which causes severe diarrhea. Dr. Mark Crislip describes the process as it occurs under close medical supervision:

The best therapy, best being the highest cure rate, for C. difficile is the stool transplant [...] The stool of a spouse (although it should be parents or children) is pureed and given either down a nasogastric tube or as an enema. Efficacy is almost 100%. There are worries about disease transfer, as some infections are spread by the fecal-oral route [...] most spouses, unlike other relatives, probably share most infections anyway.

As Crislip said in his lovely Quackcast episode 86 on the subject, most spouses have fecal-oralled, intentionally or otherwise, and are therefore unlikely to introduce a novel infection. In other words, the donor in this scenario is a close relative who is likely to be microbially compatible with the recipient.

Contrast that with a naturopath (not an actual medical doctor) in Portland who has taken FMT well beyond the evidence of safety and efficacy for C. difficile. From Willamette Week:

Portland naturopath Mark G. Davis, who opened the Bright Medicine Clinic four months ago, is using fecal microbial transplantation for other health problems, including autoimmune disease, eczema, asthma, multiple sclerosis and depression.

“What makes me unique,” Davis says, “is that I’m doing it for other ailments.”[...]

Davis needs “clean” excrement from a donor who hasn’t taken antibiotics or been sick recently. He dilutes the sample in saline, filters the slurry and injects the liquid into the patient via enema.

Note the stress on purity. The donor is a thirteen-year-old boy whose fecal microbial population has never been tainted eradicated by oral antibiotics. He is “pristine.” And his pristine fecal slurry is harvested and inserted into unrelated adults. It’s not clear from the article whether or not this boy has been tested for bloodborne pathogens like HIV or what-have-you that might infect his sample if there is any rectal tearing during elimination. It’s also not clear to me whether he’s been vaccinated against vaccine-preventable diseases, although if his parents refused antibiotics, it’s highly probable that they also refused routine childhood vaccinations. Purity might not mean what this particular naturopath thinks it means.

I recently attended a lecture about human microbial ecology. Oral antibiotics are like rototilling and turning over the soil of intestinal flora. They wipe out the good with the bad. Individual microbial populations are astonishingly diverse, even among relatives. However, our personal microbial ecology evolves over time regardless, and our microbial populations are closely compatible with those who live with us in the same house. There is a great deal of pseudoscience centered around colonic health. I asked about the portland naturopath, and there is cause for concern about introducing novel infections and introducing microbes that are incompatible with an individual’s body chemistry.

The use of a non-relative child donor in the case of the Portland naturopathic FMT protocol skates a bit close to the line between purported health vs. possible sexual reasons for seeking FMT for me. Paying a “pure” child for his feces, liquefying them, and then introducing the slurry into the rectum and colon via the anus seems awfully dubious to me. It reminds me of the myth, prevalent in sub-Saharan Africa, that raping a child will cure HIV. Just like the unrelated child-donor FMT, it’s all pre-scientific ideology about using purity as a sword against evil.


Naturopath Mark Davis emailed me with this response:

Hi Terrie,

  I just read your article "Fecal Mythology" from last month, and since you mention me, I thought I'd write you a quick note.  I'm sorry that you got your information from the Willamette Weekly article; the author decided to write a piece that emphasized the weird and left out the scientific.  I use the Fecal Microbiota Transplantation Workgroup standards to screen my donors (including the 13 yo boy) for HIV, syphilis, viral hepatitis, C diff, and a litany of other stool pathogens.  The list of "other conditions" she said I'm treating (autoimmune disease, eczema, asthma, multiple sclerosis and depression) are from a list on my website of conditions that could theoretically respond to FMT.  I spoke with the WW article's author at length about the conditions I am actually treating, primarily ulcerative colitis and irritable bowel syndrome--conditions which have some support in the literature, and which some medical doctors in the US and abroad are also using FMT--but she chose not to mention them at all.  Not having an acute illness while being a donor or having used antibiotics in the past 6 months are simply another part of the Fecal Microbiota Transplantation Workgroup protocols.  I don't know if any of my patients are ritualizing the FMT process, but I only take on patients who have a complaint that I think may respond to FMT.  They don't always respond, unfortunately, but I'm doing my best to make a reasoned medical judgement as to who will.



Cultural Relativism Disclaimer:

I am comfortable discussing sex in the abstract, but I won’t publicly discuss my own quirks. As long as all participants are adult, consenting, and safe, I say go for whatever it is that makes you feel amazing. Even though I think your kinks are beyond the pale, I will try not to judge. Except when what you are doing is actually dangerous and/or exploitive.

I am not a medical doctor and this article is not intended as medical advice beyond encouraging the reader to seek the advice of an actual medical professional.

This article was originally published at the Anthropologist Underground blog