Large Intestinal Disorders

Large Intestinal (colonic) Disorders

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The large intestine is also called the colon or large bowel, and it is mainly concerned with the storage of waste matter (faeces), but also does some things that help the body such as provide a supply of vitamin k and absorbs fluid. It also breaks down very tough foods that can not be absorbed from the small intestine - called fibres. Fibre breakdown provides another small supply of energy. The last part of the large intestine is mainly concerned with storage of waste product which has been fermented and has had much of the water removed from it, making it more solid. At a convenient time the waste product is passed out of the body as a bowel motion (also called a stool). If something is wrong with the large intestine it often shows as diarrhoea and / or pain in the tummy (abdomen). the lining of the intestine may also bleed in certain conditions and blood can then sometimes be seen in the toilet. The appearance of blood in the bowel motion or seen in the toilet should always be taken seriously and advice from a doctor should be sought.
Irritable bowel syndrome (IBS)
Lower abdominal pain
Constipation
Flatulence (wind)
Bloating
Diarrhoea
Colitis
Crohn’s disease
Ulcerative colitis
Diverticulitis
Polyps
Cancer

People with this condition suffer intermittent abdominal pain and an alteration in bowel habit. There can either have predominantly constipation, diarrhoea or a mixture of the two. The condition is characterised by an intermittent course, with symptoms coming and going with periods or relative normality in between. It is unusual for patients to be disturbed from their sleep by the symptoms of IBS which tends to disappear when they are sleeping. IBS does not lead on to any life threatening conditions but can be very inconvenient and disrupt normal day to day activities, even preventing people from working properly and taking part in social activities. IBS is often caused by intolerance to certain foods.

Lower abdominal pain is most commonly the result of constipation, irritable bowel syndrome or food intolerance. When is affects large area and is not localised to a particular region it is most likely to be caused by irritable bowel syndrome. Sudden bouts of abdominal pain which occur out of the blue are often a sign of infection, these are usually food poisoning related or a viral infection which are self limiting in most cases.

This commonly affects females in their younger years but can affect anybody at any time. It may be part of an irritable bowel syndrome, when there is also pain present. Constipation usually arise from the slow passage of waste materials along the large intestine and this is called slow transit constipation. It is also possible that there is a problem in the lower aspect o the bowel which prevents the normal expulsion mechanism from working properly, this is called an evacuatory disorder. This is less common than slow transit but is important to recognise as the treatment are different. Any change in bowel habit can be the sign of a more serious underlying disease and if persistent should be discussed with the local doctor.

Lower bowel wind or flatulence can be very inconvenient and cause social embarrassment and on occasions result in significant abdominal pain. It is the result bacterial action in the large bowel or a result of swallowing too much air which then passed down the intestines and out of the bottom end. Patients with irritable bowel syndrome tend to notice wind more then usual

Colonic bloating is usually caused by gas in the colon and felt by the person as a generalised feeling of swelling over the abdomen associated with discomfort. It is often worse in the mornings and some notice that it is increased by eating certain foods.

This occurs when the contents of the intestine are prevented from travelling any further and become blocked. This often results in distension of the intestine above the level of blockage and pain results from the attempts of the intestine to overcome the blockage. This type of pain usually occurs in waves and is often called “colic”. Obstruction is a serious problem and needs to be treated on an urgent basis in the hospital.

The term is usually used to describe a change in bowel habit that includes the passage of more frequent and looser bowel motions. The commonest cause is infection, but many people experience transient diarrhoea as part of the irritable bowel syndrome which affects over 20 % of the population in developed countries. When diarrhoea persists it may be a sign of an underlying disease that required treatment and therefore medical advice should be sought.

In this condition irritation and ulcers are found in the intestinal tract and can occur in any part from the mouth to the anus. These irritations (inflammations) are recurrent and cause a chronic relapsing problem. The ulcers are occasionally quite deep and can rarely these cause abnormal passages between loops of intestine or from the intestine to the skin and these are called fistulas.

This is another form of irritation of the lining of the intestine but only affects the large bowel. It is affects either all the large intestine or just portions of it, and always starts at the very bottom part (the rectum) and works its way up the bowel in a continuous manner.

Some people have small pockets that poke out through the wall of the large intestine, these are called diverticula. When these pockets become irritated (often by bowel motion getting trapped in them) they cause pain, fevers and often diarrhoea. This is called diverticulitis and is either treated with antibiotics or surgery to remove the portion of bowel that is affected.

It is quite common for small areas of the lining of the bowel to grow too quickly and cause little mushroom like growths in the large bowel called polyps. The term polyp refers to the shape of the growth rather than its nature and is used to describe similar “mushroom” shaped abnormalities elsewhere in the body (such as nasal polyps) which are not necessarily caused by the same type of problem. Some colonic polyps- called adenomatous polyps- have an increased chance of turning into cancer. These are always removed from the bowel, usually at the time of a colonoscopy (a telescopic examination of the bowel). When polyps are found it is usual to arrange follow up colonoscopies to check for more polyps in the future. Sometimes polyps cause bleeding and blood can be seen in the bowel motion, other times they may cause an alteration in bowel habit, but usually they do not cause any obvious symptoms and are therefore quite difficult to detect.

Large bowel cancer often arises from colonic polyps that have not caused any symptoms and have therefore remained undetected and allowed to grow and slowly develop into cancer. The cancer will then grow and will eventually cause symptoms, either due to pain, bleeding or a change in bowel habit, in most cases. Bowel cancer is one of the commonest cancers to affect people in developed countries but is much less common in Africa. This difference may partly be due to differences in diet, with Africans eating more roughage which may have a protective effect on the bowel. The treatment of bowel cancer depends upon how advanced the cancer is but usually involves and operation and chemotherapy.

Irritation and ulcers of the lining of the large intestine so that it becomes sore and often bleeds is called colitis. This can be the result of infections such as salmonella or E.coli. Sometimes when the cause of the colitis can not be determined and nevertheless, the colitis keeps coming back, it is termed chronic idiopathic inflammatory bowel disease. This type of colitis is divided into two main sorts – Ulcerative colitis and Crohn’s disease. There is a third type which has some of the features of the other two – called indeterminate colitis. Colitis usually needs treatment by a specialist gastroenterologist.

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