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Enlarged Colon

Enlarged Colon

The colon is a significant part of our digestive system and is concerned with some very important functions. An enlarged colon or megacolon refers to a dilated colon. It can manifest into several complications, some of which can be really serious.
Chandramita Bora
Last Updated: Feb 28, 2018
A fact that draws experts on the edge of their seats: A healthy colon consists of 5 to 20 pounds of fecal matter; however, a toxic colon -- what is also known as megacolon -- can have as much as 40 pounds of accumulated waste. You might want to consider this one, as well: A survey conducted by the National Institute of Health, delivers that over 4.5 million Americans, more often than not, are victims of constipation.

The colon is a part of the large intestine, and can be divided into four parts -- the ascending colon, transverse colon, descending colon, and sigmoid colon. It is the last part of the digestive system, and its basic functions are absorption of water and salts from semi-digested foods and wastes, storage of waste products until they are expelled from the body, maintenance of water balance, as well as absorption of certain important vitamins. The entire colon can be approximately 1.5 meters long, and this is where the intestinal bacteria can flourish and carry out the process of fermentation of unabsorbed substances. The colon can occasionally become enlarged and dilated. An enlarged colon or megacolon can be a congenital condition or it can be developed through the course of time.

Causes of Megacolon
Megacolon, a.k.a. megarectum, refers to the abnormal dilation of the colon. Therefore, it is considered enlarged if the cecum is more than 12 cm (generally, the diameter should be 9 cm), the rectosigmoid region is more than 6.5 cm, and the ascending colon is greater than 8 cm. This dilation, in clinical terms, is generally categorized into three forms: acute megacolon, chronic megacolon, and toxic megacolon.

Colon enlargement can take place due to an inflammation or infection. Megacolon refers to an abnormal dilation of the colon, which is a part of the digestive system. It can result from any kind of nerve damage, Parkinson's disease, use of narcotics (as narcotic painkillers leads to intestinal pseudo-obstruction). Many a time, colon enlargement occurs due to constipation, in which the feces gets accumulated in the colon and eventually dilates it.

A few other conditions that cause enlargement of the colon are:
Ulcerative colitis
This is a type of inflammatory bowel disease (IBD) which affects the lining of the large intestine (colon).

Chagas disease
It damages the nerves that control the digestive organs (colon, being a part of it), and the heart. This eventually leads to organ damage.

Hirschsprung's disease
This disease is also termed as aganglionic megacolon, which is a congenital condition that develops during the early stages of fetal development. It is characterized by the absence of certain nerve cells, known as ganglion cells in the colon. If along with enlargement the colon gets infected, then it leads to toxic megacolon.

Crohn's disease
This disease is also a type of inflammatory bowel disease, and it results in swelling and dysfunction of the intestinal tract.

Probable Symptoms
Enlargement or dilation of the colon can impair the peristaltic movement of the bowel, which can eventually cause feces to accumulate and become hard inside the colon. This might lead to the development of fecaloma or a stone-like structure. Due to fecaloma, if the colon gets infected, i.e., toxic megacolon develops, then symptoms like the following might be experienced.
Abdominal pain
Severe constipation
Rapid heart rate
Abdominal tenderness
Abdominal distention

Diagnostic Measures
  • Abdominal X-ray
  • Complete blood count
  • Blood electrolytes\
  • Colonoscopy
  • Anorectal manometry
Treatment Options
The appropriate treatment option for the condition is determined by the underlying cause(s).
For stable cases, non-surgical options are employed:
  • For restoring bowel movement, physicians usually recommend the use of laxatives and bulking agents, along with a diet that is rich in fiber.
  • For toxic megacolon, medications like corticosteroids and other anti-inflammatory drugs are used.
  • Anorectal and nasogastric tubes are used for bowel disimpaction and decompression.
For severe cases, surgical options are employed:
  • Colectomy - removal of the entire colon
  • Ileorectal anastomosis - tying of the remaining ileum and rectum segments
  • Total proctocolectomy - removal of rectum, colon, and sigmoid
  • Ileostomy - creates an opening from the ileum through the abdominal wall, to perform as an anus
  • Ileoanal anastomosis - colon and rectum are removed, but the anus and anal sphincter are intact
The best way to prevent colon enlargement is to control the risk factors. The risk of developing an enlarged colon can be effectively managed with some simple ways like following a diet containing sufficient fiber. This can prevent constipation and ensure regular bowel movement. Similarly, reducing the use of narcotics as well as early treatment and management of inflammatory bowel diseases can also help in preventing the development of megacolon and toxic megacolon.

Disclaimer: This article is for informative purposes only, and should not be used as a replacement for professional medical advice.
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