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A colleague of mine, an experienced pharmacist, told me that there used to be a product of activated charcoal called Charcodote, which could have been used either orally or rectally. I doubted this, as I cannot see any reason to use it rectally when activated charcoal is supposed to absorb ingested materials shortly after they were swallowed in order to reduce their absorption and systemic effects. She cannot find a reference for this (and neither can I), but insists that it could have been given rectally (she says she remembers this practice clearly, and so does the head nurse in the pediatric ward at our hospital).

Does anyone here know anything about this? The specific product doesn't matter, the question is: can activated charcoal be given rectally? If so, how does it work there and what are the indications for this route of administration?

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Yes, activated Charcoal (AC) can be given rectally. Although this is a veterinary journal, I doubt the principles are different and according to this article it's given in a liquid slurry, much like oral administration:

Enemas also have been used to decrease the colonic bacterial numbers and substrates. The following types of enemas have been recommended:

• Warm water enemas at 10 ml/kg q4-6h until signs improve, lactulose enemas at 1 to 3 ml/10 kg BW diluted 1 : 1 to 1 : 3 with warm water q6-8h

• Neomycin enemas at 15 to 20 ml of 1% solution q8-12h

• Metronidazole enemas at 7.5 mg/kg (systemic dose) mixed with water q12h

• Betadine enemas given by diluting 1 : 10 with warm water and giving 10 ml/kg q8h and flushing out with warm water after 10 to 15 minutes

• Activated charcoal enemas using the liquid suspension q8h

• Vinegar enemas made by diluting the vinegar 1 : 4 with warm water and administering at 10 ml/kg q8h

This is substantiated by the following human clinical trial involving the treatment of anal fistulas. Although I can't find historical evidence that rectal administration was a common practice in the past, it received new attention in 2017 with this study:

An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas.

The aim of this study was to evaluate the clinical effects on non-Crohn’s disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal fistulas without any concomitant medication.

It appeared to be moderately successful:

Of 28 patients included, 10 patients (35.7%) showed complete fistula healing (closed, no discharge on palpation) after 8 weeks; seven of these patients, corresponding to 25% of the enrolled patients, remained in remission for up to 31 weeks.

As I said before, I couldn't find historical evidence of rectal administration being used, but I did find an article from 1964 that seems to hint that it could have been administered other than orally in some cases. Unfortunately, the full text of the article is behind a pay wall. Here is what's freely available:

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.1964.tb05735.x

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Yes absolutely. There was a hemorrhoid treatment made of activated charcoal called Freedhem that was applied rectally. It is no longer available on the market. Also, for prostatitis, Dr. Thrash, former medical examiner of the state of Georgia, used an activated charcoal enema with success.

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  • Can and should are two very different things. Except for his marketing page, is there any evidence that this treatment is safe or even efficacious?
    – Thomas
    Sep 22, 2020 at 13:58
  • Of course charcoal can be applied rectally. It is taken orally thousands of times every day by thousands of people with gas, acid reflux, heartburn, etc., as well as an antidote for all kinds of poisons. AND when the charcoal leaves the rectum it is still the very same charcoal that went in at the other end. Charcoal is not chemically or physically changed as it passes through the GI tract. So taking it rectally or orally will benefit hemorrhoids, only taking it rectally will be more efficacious as it is more directly able to rapidly adsorb any irritants that are inflaming the hemorrhoids.
    – Chris Chung
    Sep 22, 2020 at 23:01
  • Still can't find any recent, large studies on this. Do you have any to share?
    – Thomas
    Sep 23, 2020 at 4:41
  • I am not aware of any large studies showing the benefits of charcoal specifically for hemorrhoids. But who can contradict personal experiences, and there are plenty of testimonies. Whether they are internal or external, hemorrhoids typically cause itching. Whatever is causing the itching, it is of interest that charcoal is used in hospitals in cases of pruritis [itchy skin] associated with dialysis, as well as wound healing after surgery. It is also used for a variety of allergic reactions resulting in itchiness such as insect bites, poison ivy...
    – Chris Chung
    Dec 8, 2020 at 1:01
  • Constipation or chronic diarrhea are two other common symptoms of hemorrhoids. Again, charcoal has been used for centuries to help with diarrhea and constipation. While charcoal has a binding affect and can aggravate constipation, in Europe the #1 natural antidote for constipation is charcoal combined with radish root. As long as people keep well hydrated constipation seldom is a problem. Again, many people testify that charcoal helped to regulate their bowel movements. All together charcoal can relieve several of the annoying and painful symptoms common to hemorrhoids, and other conditions.
    – Chris Chung
    Dec 8, 2020 at 1:01

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