Tortuous Colon and IBS

A tortuous colon, also known as a redundant colon, is an abnormally long colon that cannot fit inside the body without twisting or looping. This often causes constipation and other gastrointestinal problems because digested food takes longer to travel through the colon (a.k.a. large bowel or large intestine). Other rare complications include bowel obstruction.

While many people with tortuous colon are asymptomatic (without symptoms), some require a high-fiber diet, fiber supplements, and/or laxatives to reduce the chances of constipation. Medications may also be prescribed to reduce pain and cramping.

This article describes the symptoms, cause, and diagnosis of tortuous (redundant) colon as well as the various treatment options. It also explains how tortuous colon differs from irritable bowel syndrome (IBS), a gastrointestinal disorder with many of the same symptoms.

Types

Some doctors may use the terms tortuous colon and redundant colon interchangeably, as is done throughout this article. Others make a distinction, identifying them by subtle differences:

• Tortuous colon: A colon that has an excessive amount of sharp bends
• Redundant colon: A colon that has an excessive amount of loops
  

Most of the time, neither are a serious health problem. In addition, they do not increase your risk of getting colon cancer.

Symptoms of Tortuous Colon

Most people who have a tortuous colon have no symptoms. They learn that they have this condition after a healthcare provider discovers it while performing a medical test or procedure, or treating another issue.

In some cases, though, it can contribute to the following problems such as:

• Abdominal pain
• Abdominal cramps
• Bloating or swelling of the abdomen (distention)
  
• Constipation
• Excessive passing of gas
• Fecal impaction, when a mass of dried stool get stuck in the rectum

Complications

Bowel obstruction is a rare, but potentially serious complication associated with tortuous colon. It can occur when the loops in the colon twist so much that they block the digestive path—a condition known as colonic volvulus.

Symptoms of a bowel obstruction include:

• Severe lower abdominal pain
• Excessive abdominal swelling/distended abdomen
  
• Nausea and/or vomiting
• No bowel movement for longer than three days
• Passing stool with blood or mucus

Get immediate medical assistance if you experience any of these symptoms.

Causes

There are a variety of reasons why a person might have a tortuous colon. Some people are born with it, and there may even be a genetic predisposition for the condition.

The colon can also become elongated and twisted as a result of a diet low in dietary fiber, chronic constipation, frequent hard stools, and straining to eliminate.

In some cases, the cause can't be identified.

Treatment

An elongated or twisted colon is generally only treated if it is causing symptoms.

Otherwise, good digestive habits and responding promptly to urges to have a bowel movement are recommended.

Self-Care Treatment

If you're experiencing symptoms of gas, bloating, abdominal pain, or constipation, address each of these symptoms as needed.

For abdominal pain relief, you may want to use a heating pad or hot water bottle on your abdomen where the pain seems to be coming from.

Eating a high-fiber diet and drinking lots of water may help ease constipation.

A low-FODMAP diet may help to ease symptoms of gas and bloating, although there's no research that its effectiveness for a tortuous colon specifically. (FODMAPs are fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are particular types of carbs that the intestine has a hard time absorbing.)

Medical Treatment

There is no one specific treatment protocol for a tortuous colon.

Your healthcare provider may work with you to come up with a management plan for any chronic digestive symptoms that you may be experiencing, and this may include the use of prescription medications or over-the-counter products.

Options include:

• Antispasmodic medications, which discourage the muscle contractions that cause abdominal pain and cramping
• Fiber supplements to bulk up and soften stool
• Laxatives, medications that make stools easier to pass
• Constipation medications
• Antidepressants for pain relief

Tortuous Colon vs. IBS

Many of the symptoms of a tortuous colon are similar to those of irritable bowel syndrome (IBS). By definition, IBS is diagnosed when there is no structural abnormality (or visible inflammation or injury). Thus, IBS and tortuous colon are considered two separate health conditions.

It is possible that a tortuous colon may be identified as you go through diagnostic testing for IBS. It's also possible that your doctor may lump your symptoms under the same IBS umbrella.

Although there's no firm research on the matter, having constipation-predominant IBS (IBS-C) may raise your risk of developing a tortuous colon. Even still, tortuous colon is uncommon.

Colonoscopy Alternatives

A colonoscopy is an essential procedure for colon cancer screening. A long tool with a light at the end, called an endoscope, is inserted into the rectum and threaded all the way through the entire colon until it reaches the cecum. This is where the small and large intestine meet.

During this procedure, your doctor can view the health of your large intestine and remove any abnormal tissue, such as polyps. This tissue can then be tested for the presence of cancer cells.

A tortuous colon can make this procedure challenging. The twists, loops, and/or sharp angles of the intestine can make it hard to get the endoscope all the way through the colon.

Doctors have some alternative screening options in these cases.

Double-Contrast Barium Enema (DCBE)

In the past, a double-contrast barium enema was most frequently used as an alternative to traditional colonoscopy for a tortuous colon.

In this procedure, a liquid formulation containing barium is inserted into your rectum. Then, a series of X-rays are taken of your lower abdomen. The barium serves as a contrast agent, or a substance that helps highlight the structures of interest on the scans so that they are easier to distinguish.

Next, the barium is allowed to drain out, air is pumped into your colon through your rectum, and further X-ray images are taken.

One of the reasons why the DCBE has fallen out of favor is that research has shown that it's not that good at identifying the presence of abnormal tissue within the large intestine.

Virtual Colonoscopy

The virtual colonoscopy, also known as computed tomography colonography (CTC), offers another alternative to traditional colonoscopy for a tortuous colon.

In this procedure, you must still undergo the bowel-emptying prep that is required in a traditional colonoscopy before the day of the test.

Prior to the CTC, you'll be asked to drink a liquid that contains a contrast dye. A short, thin tube will be inserted that will pump air into your colon. Then, you'll undergo a series of X-rays.

Like the DCBE, this procedure is limited in its ability to detect small growths in the colon. If there is evidence of any, you'll still have to undergo a follow-up traditional colonoscopy.

Summary

If your colon measures longer than five feet, it will contort itself so that it can fit into your abdomen. The extra loops and bends that form result in a condition known as tortuous or redundant colon.

You may have some digestive discomfort such as constipation and cramping, but often there are no issues. In most cases you can manage the symptoms with over the counter and at-home remedies.

If you do suffer from severe digestive problems, though, you should see a doctor to determine if these are due to an unusually long colon.