Be good to your colon and it will be good to you

Written By Dr. Jason Goldman

While many people are embarrassed to talk about their colon, understanding how to maintain GI health is important for many reasons. The most obvious function is to concentrate waste material into stool, which is then passed out of the body. Recent studies suggest that the bacteria we have in our intestines contribute to how the body and immune system function. Certain key nutrients are produced by bacteria in our GI tract and we could not function normally without them. Unfortunately, many people do not take care of their health, especially their colon, and this can lead to serious problems. It is never too early to be good to your colon so it will be good to you.

There are too many diseases to review in regards to the colon for the scope of this article, but I will touch on a few significant ones that my patients have asked about. One of the most serious conditions of the colon is cancer. This is a disease when cells continue to grow without stopping, leading to a mass that can spread throughout the body. Colon cancer starts and develops in a predictable manner. The first step is the formation of a precancerous polyp or adenoma which eventually becomes a cancerous tumor that can invade into the colon wall and spread to other parts of the body. Most colon cancers, except in high risk patients, will develop after age 50. A simple procedure, called a colonoscopy, will allow a doctor to look inside the colon, detect and remove any precancerous lesions and help to prevent colon cancer. Everyone needs to have a screening colonoscopy by age 50, if not earlier, based on risk factors. The importance of the screening colonoscopy can never be overlooked and is always worth mentioning.

I was recently asked by a patient about a condition she had called rectal prolapse. In the normal function of the body, the anal sphincter will open and close to allow the passage of stool out of the body. In some cases, the anal sphincter will weaken and allow the rectum to push through the anal sphincter to protrude outside the body. This is an uncommon condition and usually occurs more in woman over age 50 in the setting of chronic constipation. It can occur in other situations where there is trauma or weakening of the anal sphincter. It is unclear why some people develop prolapse and others don’t but it is believed that constant straining will increase the chances of prolapse.

There are several problems with prolapse that need to be addressed. The first is the discomfort it can cause the patient. The usual complaint is feeling a ball sticking out of the rectum. This can make it difficult to have bowel movements and be quite uncomfortable. In addition, the longer the rectum is prolapsed, the more likely it is to cause nerve damage of the pudendal nerve. This nerve is what controls the strength of the anal sphincter. Without this control, fecal incontinence, the inability to hold stool, can result. Patients with fecal incontinence will have frequent and uncontrolled bowel movements. In some cases, the rectum is prolapsed for such an extended period of time that ulcers can form and it can bleed. In severe cases, the rectum can be incarcerated, or stuck, outside the body. This is a surgical emergency as the tissue can die from loss of blood flow. With prompt intervention, a severe and life threatening condition can be avoided. While it is uncommon, rectal prolapse can be a minor annoyance to a major condition.

While potentially serious, it can be treated. In many cases, the rectum will go back into the body without any intervention. If this does not happen, surgery may be required to reattach the rectum to its proper position within the body. There are many different surgical approaches but the main point is that surgery can be done to correct the problem. If left untreated, the prolapse can become much larger and more pronounced over time. If severe enough, the rectum can literally fall out while standing and lead to permanent incontinence, as well as other complications described above. The best treatment is to prevent prolapse in the first place. Eating a high fiber diet and preventing constipation will decrease risk of prolapse. Avoiding trauma to the anal sphincter will lessen the chance of weakening the muscle tone. Trauma can include anything that stretches the anal sphincter beyond its normal limits or function. It will open and close normally during a bowel movement but repeated stretching of the muscle, usually by insertion of foreign objects, can potentially lead to prolapse. If you think you may be suffering from rectal prolapse, it is important to seek medical care and consult with your physician.