by Patricia Raymond, M.D., F.A.C.P., F.A.C.G.

Question
Do you have a solution for a slow, lazy colon? Can your colon actually quit? A doctor told me it could and they would take it out and replace it with a bag! How scary. I’d never heard that and wondered if it is true.

— Sharon, Missouri

Answer
Some folks just have a sluggish colon. (We call it prolonged colon-transit time.) And the longer the stool remains in the colon, the more the colon does its job and sucks out fluid from the stool—ergo, the dryer and slower the bowel movements are.

CAUSE
If your bowel movements have been few and far between all your life, that may be just how you were wired. People like this generally don’t need treatment unless the fullness is uncomfortable or the straining makes veins pop out all over your head. Ditto for occasional constipation.

But it sounds like you may be having severe constipation, which can be a neverending feedback loop. The problem is, as more and more poo presses against your colon, its wall gets stretched thinner and thinner, and the squeeze force you can generate becomes weaker. Thus, your colon keeps getting fuller—and quite packed.

Consider my pantyhose stripped off after a long, hot day—all stretched out with little elasticity or shape. The dilated, floppy look mimics your colon after prolonged constipation.

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TREATMENT
The ultimate solution for this—done rarely—is removal of a portion of the colon, called a subtotal colectomy. This gives the stool less of a length to travel and thus less time to get all dried out and packed in. Although some people have to wear a temporary or permanent colostomy (a bag attached to the intestines through a hole in the abdomen) after the procedure, this is unlikely for someone with your condition.

Before they even consider a colectomy, most people with severe constipation respond to the simultaneous use of several prescription laxatives that work by different mechanisms, such as making the colon squeeze or pulling extra fluid into the bowels. But except for bulk-forming versions like Metamucil, don’t use laxatives (even over-the-counter ones) long-term without a health-care provider’s OK. Certain ones can cause dependency and other side effects.

I also avoid giving fiber until the bowel regimen has been established; when stools aren’t moving, the addition of fiber serves only to increase the bulk of the adobe bricks that are present (straw + “mud” = adobe).

It may take a while to hit on the right combination of meds to establish that perfect bowel pattern. Just try to be patient and work with your gastroenterologist.

Board-certified gastroenterologist PATRICIA L. RAYMOND, M.D., F.A.C.P., F.A.C.G., is a member of our print magazine's editorial board. She's practices at Simply Screening in Chesapeake, Va., is assistant professor of clinical internal medicine at Eastern Virginia Medical school and wrote Colonoscopy: It’ll Crack U Up!.

Last updated and/or approved: May 2008.
Original article appeared in September/October 2007 issue.

Comments (3)

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slow transit and mega colon
written by lisa , March 06, 2010

how long can it take for the rectum to return to its normal calibre?? on medication liquid parrafin and soduim picosulfate prescribed by diatition for slow transit constipation and mega-colon

Question to be answered
written by Leigh Ann , February 27, 2009

Thank you for this question. FYI, we're going to try to get it answered in our May/June print magazine.

Best,

Leigh Ann Hubbard
Managing Editor
James Hubbard's My Family Doctor

Sigmoidectomy and rectoplexy did not work.
written by Nancy in Santa Fe , January 29, 2009

This was an interesting article. Last year I underwent a sigmoidectomy at Arizona's Mayo clinic. I had to resort to this because I had a prolapsed rectum and elongated sigmoid.
Strangely, prior to the surgery, although I had the above conditions, I was able to sit for 20 minutes in the morning and expel all my stool, resulting in a comfortable day, every day. Now, however, I cannot pass stool at all without assisting with my finger. I take probiotics, eat a high-fiber diet and take flax seed, and exercise as per my GT's. Still no results. I have resorted to enemas, adding Bio-K probiotic to the enema, every other day. Alas! That works. Is this dangerous?