What is rectal ozone application?
As defined in the Ozone Application Guideline (opens in a new tab) of the Ministry of Health of the Republic of Türkiye, rectal insufflation is “the procedure in which ozone gas at a suitable dose and volume produced by a medical ozone device is administered by the rectal route using ozone-resistant, single-use sterile materials.”
The procedure requires no venous access. It may therefore be considered for patients whose veins are difficult to find, or for whom taking blood is not deemed appropriate; the decision on suitability still rests on the indication and the clinical situation.
Only physicians who hold the relevant certificate may perform the procedure, and only at premises authorised by the Ministry.
When is the procedure considered?
For the guideline’s indication list, see the Major Ozone Therapy page.
That indication list also includes bowel-related conditions (ulcerative colitis, Crohn’s disease), and the guideline further states that ozone may be applied in a supporting role in conditions such as colitis, proctitis and fistula. In these areas the rectal route may be considered on clinical grounds; the decision is made at the end of the examination.
Appearing in the indication list does not mean that the procedure will treat that disease.
In which patients is the procedure not performed?
The patient groups in whom the procedure cannot be performed under the Ozone Application Guideline are listed below:
- Patients with glucose-6-phosphate dehydrogenase enzyme deficiency
- Patients with uncontrolled hyperthyroidism (Basedow-Graves type)
- Pregnant patients
- Patients with malignant hypertension
- Patients with active and heavy bleeding
- Patients with profound thrombocytopenia
- Patients in the acute phase of conditions such as cerebral haemorrhage and heart attack
- Patients with acute alcohol poisoning
In the following patients, additional caution is required:
- In patients with a bleeding or clotting disorder
- In patients with a chronic condition (because of general medication interactions)
- In patients receiving intravenous copper or iron treatment
- In patients with haemochromatosis
In accordance with the guideline, the procedure is performed with the opinion of the relevant specialist physician in patients under 18 years of age, in oncology patients (with the opinion of the specialist physician primarily responsible for the treatment), in patients of advanced age and in patients during an acute flare of a chronic condition.
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- Active rectal bleeding
- A known mass or narrowing
In these situations, the procedure is planned subject to the physician’s assessment:
- An active anal fissure, haemorrhoid crisis, abscess or fistula
- Recent anorectal surgery
- An active flare of inflammatory bowel disease (the opinion of the relevant specialist physician is sought)
- A planned colonoscopy or similar procedure
How is the procedure performed?
- Assessment and the decision on suitability. A detailed history is taken; the physician asks about bowel habit, anorectal complaints and previous procedures.
- Information and consent. The physician explains the procedure, the method of application and the possible side effects, verbally and in writing; the information form is completed and signed.
- Preparation. The procedure takes place in conditions that respect privacy.
- The procedure. The medical ozone device produces an ozone-oxygen mixture at a suitable dose and volume, which is administered by the rectal route using ozone-resistant, single-use material.
- Observation. The patient is kept under observation after the procedure; vital signs are recorded.
All materials used are single-use and ozone-resistant. The device and the materials must be registered in the Product Tracking System. The area where the procedure is performed is well ventilated.
How long does it take, and how many sessions are needed?
The number of sessions and the interval between them are determined according to the person, the indication and the outcome of the assessment; a definite number cannot be given in advance. At each session the vital signs, the technique used and the side effects observed are recorded in the patient’s file.
What should you do before and after the procedure?
Before: in accordance with the guideline, come to the session having eaten a light meal. At the session, report:
- A list of all the medicines and supplements you use
- Your known allergies
- Your pregnancy status
Your physician will tell you whether any preparation to empty the bowel is needed before the procedure.
After: there may be a short-lived sensation of gas, bloating and a need to go to the toilet. Recommendations specific to you are given in writing at the end of the procedure.
Risks and side effects
Those that may be related to rectal application: bloating and a sensation of gas in the abdomen, a temporary feeling of discomfort, an increased need to go to the toilet, irritation in the anal area and, rarely, minor bleeding.
The side effects reported by the guideline for ozone applications:
- Low or high blood pressure
- Low or high blood sugar
- Particle reactions
- Itching at the application site
- Insomnia
- Gastritis
- Palpitations
- Dizziness
Rarely seen: air embolism, intraocular haemorrhage.
If side effects continue after the session, a further assessment is made and, if necessary, the procedure is discontinued.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Bleeding after the procedure
- A high fever
- Progressively increasing pain and tightness in the abdomen
- Increasing pain, swelling or discharge in the anal area
In the event of sudden and severe abdominal pain, an inability to pass wind or stool together with nausea and vomiting, bleeding that does not stop, marked dizziness, fainting or altered consciousness, go directly to the emergency department.
Frequently asked questions
What does rectal ozone application involve?
As defined in the guideline, ozone gas at a suitable dose and volume produced by a medical ozone device is administered by the rectal route with ozone-resistant, single-use sterile materials. Venous access is not required.
Why is this route preferred over the venous route?
The route of application is chosen according to the indication, the state of the patient’s veins and the clinical assessment; rectal application does not require venous access. The physician decides which route is suitable.
Will rectal ozone eliminate my disease?
No; no such statement may be made. The Ministry of Health guideline states this explicitly. The procedure is performed with the aim of supporting treatment that is already under way, and only where it is considered suitable after the physician’s assessment.
Is rectal ozone application uncomfortable?
There may be a brief sensation of gas, bloating and a need to go to the toilet. These sensations vary from person to person and usually pass quickly. The procedure takes place in conditions that respect privacy.
I have haemorrhoids; can the procedure be performed?
While a haemorrhoid crisis, an anal fissure, an abscess or a fistula is active, the procedure is assessed by the physician. Please mention your anorectal complaints at the beginning of the consultation; the decision on suitability is made at the end of the examination.
How many sessions are needed for rectal ozone application?
A definite number of sessions cannot be given in advance. The number of sessions and the interval between them are determined according to your indication and the outcome of the assessment.
Is rectal ozone performed during pregnancy?
No. The guideline lists pregnancy among the situations in which it cannot be performed. If you suspect that you may be pregnant, please say so at the beginning of the consultation.
Sources
- Ministry of Health of the Republic of Türkiye, General Directorate of Health Services, Ozon Uygulama Kılavuzu, Ankara, June 2025. https://ekutuphane.saglik.gov.tr/Yayin/697 (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği, Official Gazette 28 April 2026 / 33237 (this repealed the regulation dated 27 October 2014, number 29158, Art. 19). https://www.resmigazete.gov.tr/eskiler/2026/04/20260428-2.htm (opens in a new tab)
