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Colon and rectum

Colon and rectum

The colon and the rectum are part of the large intestine. It is a long, tube-like organ in your abdomen that starts near the right hip, moves up to the ribs on the right side, goes across to the left side by the ribs, then down to the left hip, from where it makes an S-curve down to the anus. This last part of the colon is called the rectum. The entire colon is about 5 feet (150 cm) long!

In the colon, the inner layer of the mucosa absorbs water and nutrients from the food and drinks we have. After this process, the liquid that remains in the colon forms a semi-solid stool. As this continues to move through the colon, more water is absorbed making it completely solid. From here, the stool leaves the colon and enters into the rectum. The rectum stores the stool until defecation.

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Diverticulosis and diverticulitis

Diverticulosis is a condition in which small pouches called diverticula form in the walls of your digestive tract. This happens when the inner layer of the intestine pushes the weak spots in the outer layer of the intestine. This pressure makes them bulge forming pouches on the wall of the colon. Diverticulosis is often asymptomatic and picked as an incidental finding during CT scan or colonoscopic evaluation for some other ailments. When one or more of these diverticula get inflamed or infected, the condition is called diverticulitis. Fever, abdominal pain or cramping, bloating is some of its symptoms. Eating more fiber-based foods, drinking plenty of fluids and regular exercise may help in preventing diverticulitis.

Colonic Polyps

Colonic polyps are small clumps of cells that grow on the lining of the colon. Most colonic polyps are harmless but few have the tendency to develop into colon cancer. Obesity, smoking, family history of colonic polyps or cancer and old age (>50 years) are the risk factors. Generally, they do not showcase any symptoms but are usually found during colon cancer screening exams. Patients may have blood in the stool, the passage of excessive mucus in stool or change in bowel habits. Endoscopic removal is the best way to treat them. If the polyps are big then they cannot be removed via a colonoscopy. In such cases, laparoscopic surgery is performed. It is minimally invasive and the recovery time is good. In some patients with hereditary syndromes (like adenomatous polyposis coli), the colon is studded with hundreds of polyps and almost all of the patients end up developing colonic polyps at a later life. In these patients, prophylactic removal of the entire colon and rectum needs to be done. However, the natural passage of stool in ensured by reconstructing the passage using the small intestine.

Colorectal Cancer

Colon cancer usually starts as polyps (which are small clumps of cells) on the lining of the colon. They do not show any symptoms in the beginning stages and therefore are very difficult to diagnose. Colon cancer usually affects older people and very rarely the young. Therefore, a regular screening test in high-risk individuals is advised to stop the polyps from becoming cancerous by removing them completely. The risk of colorectal cancer can be more if close blood relatives had colorectal cancer at an early age.

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Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a group of intestinal disorders that causes chronic inflammation of the digestive tract. Ulcerative colitis and Crohn’s disease are the two kinds of inflammatory bowel diseases.

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Constipation

Constipation is a condition wherein a person finds it difficult to empty their bowel or has decreased stool frequency (<3/week). Reduced liquid & fiber intake and/or reduced physical activity are common predisposing factors. Drugs like diuretics, morphine, iron supplements can lead to constipation. Transit of contents in the large intestine is getting affected in some conditions like diabetes. Evacuation is affected in another group of conditions which are clubbed together as ‘Obstructive defecation syndrome’ (ODS). Typically, patients affected by these diseases have incoordination muscles around the anus which leads to excessive straining.

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Diarrhea

When the bowel movements are loose and watery, the condition is called diarrhea. A person suffering from diarrhea will pass stools more than 3 times a day. Diarrhea can be acute (sudden onset and short duration) or chronic (repeated episodes and long duration). Acute diarrhea is usually due to infections. Eating food contaminated with microbes and its toxins leads to diarrhea.

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