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Practitioner protocol
Rectal Ozone Insufflation Protocol
Dosing, schedule, equipment and precautions for rectal ozone insufflation, including a slower protocol for sensitive patients.
Quick answer: Rectal ozone insufflation puts ozone gas into the rectum through a catheter inserted 3 inches, so it absorbs through the colon lining. The protocol uses 10–40 µg/mL and 200–400 mL, starting at 2 sessions a week and building to 5, with 40 gamma as the maximum. Sensitive patients follow a slower schedule.
Home method. Best done as recommended by a licensed provider who knows your health history.
What are the basics of rectal ozone insufflation?
- Concentration generally ranges from 10–40 µg/mL (setting 4–8). 40 gamma is the maximum.
- Volume ranges from 200–400 mL. If there is a severe gut concern or general sensitivity, start at the low end of the range.
Accessories required: catheter; 3-chambered bag.
Sensitive patients: for patients with known sensitivities, or who are cautious about adding new interventions, use the sensitive rectal insufflation protocol below.
What dose and schedule are used for rectal ozone insufflation?
| Weeks | Frequency | Amount | Flow rate | Strength |
|---|---|---|---|---|
| 1–2 | 2x per week | 200 mL | 1/4–1/2 LPM | 17–34 gamma |
| 3–4+ | 5x per week | 200–400 mL | 1/4–1/2 LPM | 17–35 gamma |
The weeks column is how long to stay on that regimen. Start extremely slowly with these applications. It is a powerful modality. If you know you are sensitive, cut the starting points in half and slowly work your way up.
What are the best tips when using rectal ozone insufflation?
- Ideally done after an enema, colonic or bowel movement.
- Insert the catheter only 3 inches to allow absorption into the portal vein. If you feel pressure, push the catheter in or pull back gently and the gas will flow.
- Keep positive pressure on the bag or syringe while administering; releasing it may cause backflow into the bag/syringe.
- It absorbs into the colon lining quickly, so there's no need to hold it longer than 20–30 seconds. A bowel movement or flatulence afterward is normal and doesn't mean it didn't work. See what's normal after a session.
How do you do rectal ozone insufflation, step by step?
Equipment
- Oxygen tank
- Oxygen regulator (usually comes with the generator)
- Ozone generator
- Ozone bag
- Catheter
Preparation
- Connect the ozone generator to the regulator on the oxygen tank with the silicone tubing: one end on the regulator's barb outlet, the other on the generator's oxygen inlet.
- Plug in the generator, but don't turn it on yet.
- Open the clamp on the ozone bag's tubing and screw the tubing into the generator port, finger tight.
- Set the generator to the desired concentration (ug/mL). Use the strength from the dosing schedule above (10–40 µg/mL, setting 4–8; 40 is the maximum).
- Turn on the generator, open the oxygen regulator, and pinch the bag at the 200 mL line. Let that portion fill, stopping before it gets tight.
- With 200 mL collected, turn the regulator to 0, turn off the generator and clamp the bag.
Administration
- Attach a catheter to the clamped tube of the filled bag.
- Insert the catheter 3 inches into the rectum (lubricant is fine).
- Roll up the bag steadily to release the gas. Some mild discomfort is normal at first. Remove the catheter while keeping the bag rolled up so no gas escapes into the air.
- There's no need to hold the gas longer than 20–30 seconds.
What are the precautions for rectal ozone insufflation, and who should avoid it?
- Rectal insufflation is a powerful systemic application.
- If there's a "Herx," stop for 4–7 days, then restart at half the gamma and time, and titrate back up over a timeframe set by the practitioner. Vitamin C, glutathione and others are often used to help prevent a Herx.
- Mucus in the stool may mean the application is too strong. Reduce strength and volume until it stops.
- Avoid doing an IV and a rectal ozone session on the same day.
- A Herx can show up as excessive fatigue, rash, lymph drainage, and/or fever or chills.
- If there is cramping, bloating or real discomfort, lower the dose and frequency to a tolerable level.
- For most people it takes up to 4 weeks of regular sessions to notice a change. Consistency is important.
Contraindications
Talk to your provider first. They will evaluate uncontrolled hyperthyroidism, G6PD deficiency, bleeding disorders and pregnancy.
Sensitive patients: rectal insufflation protocol for sensitivity
Reviewed by: Mandy Dell, DCN, and Thomas Levy, MD
Concentration (µg/mL) × volume (mL) = dose in µg (divide by 1,000 for mg).
| Time | Concentration | Volume | Setting on machine/oxygen | Total dose |
|---|---|---|---|---|
| Day 1 | 10 | 5cc | ~2 or 3 | 50mcg |
| Day 4 | 15 | 10cc | ~3 or 4 | 150mcg |
| Day 7 | 15 | 15cc | ~3 or 4 | 225mcg |
| Day 11 | 20 | 20cc | ~4 or 5 | 400mcg |
| Day 14 | 30 | 25cc | ~6 | 750mcg |
| Day 17 | 30 | 30cc | ~6 | 900mcg |
| Day 20 | 30 | 35cc | ~6 | 1050mcg |
| Day 23 | 30 | 40cc | ~6 | 1200mcg |
| Day 26 | 30 | 45cc | ~6 | 1350mcg |
| Day 29 | 30 | 50cc | ~6 | 1500mcg |
| Day 32 | 30 | 55cc | ~6 | 1650mcg |
| Day 35 | 30 | 60cc | ~6 | 1800mcg |
If tolerated well at the final dosage, the patient may proceed with caution to 120cc (two full 60cc syringes) at a concentration of 30 (about setting 6 on the generator) every 2–3 days.
If after one month, two syringes are tolerated well, the patient may proceed with caution to a typical cycle: 5 days on, 2 days off.
Upon patient improvement and demonstrated tolerance, they may proceed with caution to the typical protocols.
Learn more
Background, benefits and research: Rectal ozone therapy, full article. Comparing routes: Comparing home ozone therapies.
Related protocols: Ozone Ear Insufflation Protocol, Vaginal Ozone Insufflation Protocol, Ozone Limb Bagging and Cupping Protocol.
Other protocols
For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.
