Colonoscopy Sheds Light

Toxic Megacolon

Toxic megacolon: extreme inflammation and distention of the colon.

Mixed feelings about a 20-year follow-up colonoscopy.

HEALTH "One in every 17 of us will have colon cancer in our lifetime," says David Ahlquist, MD, professor of medicine and consultant in gastroenterology at the Mayo Clinic. Current guidelines suggest screenings begin at age 50 or sooner if there is family history of colon cancer. [1]

Patient Story: In light of the foregoing, a colonoscopy at age 30 is unusual. Doctors must suspect there is something quite wrong. Indeed that was the case. A patient's internal organs were audibly percolating like an old Folgers coffee pot. Stools alternated between hard and soft, dark and light; sometimes even covered in mucus. Some days there was constipation; others there was diarrhea.

A stool sample was analyzed. Antacids and antibiotics were prescribed for parasites. Then it became time to look inside — north and south. Problems were found at both ends but stay focused (so to speak) on southern end for now. We'll discuss some of the potential problems before getting back to the results of our patient.

Symptoms of Colon Problems

Don't panic at the first sign of constipation but chronic constipation can be symptomatic of obstruction. Constipation may not be a secret between the individual and the toilet bowl. The confidence can be revealed in numerous ways. The symptoms herein provided could have many causes, though many may be a product of systemic bacterial putrefaction or dysbiosis: Poor appetite, loss of memory or concentration, neuritis and neuralgia, (causing reflex pain throughout the body), cold feet and hands, poor blood circulation, swelling of legs, lack of interest in life, skin problems, insomnia, depression, anxiety, headaches, irritability, nervousness, lack of sexual response, lack of endurance, disinclination for work or play, fatigue, over weight, tender or protruding abdomen, abdominal discomfort, belching or flatulence, increased body odors, bad breath, food cravings, anorexia, malnutrition, anemia, sallow complexion, brittle nails and hair, dark circles under eyes, coated tongue, high or low blood pressure, menstrual problems, sagging posture, and low back pain. [2,3]

A chiropractor may suggest a colonoscopy or lower GI examination. Here's why. Low back pain can be caused by chronic constipation. The transverse colon falls down into a U shape and impacted material lies in the middle, or it gets impacted within the splenic and hepatic flexures. This, in turn, irritates the nerves and pushes on the spine. [2]

Chronic constipation can also cause hemorrhoids, anal fissures, rectal prolapse and fecal impaction. Unfortunately, chronic constipation is increasing among youths. [4] Fortunately, most cases of constipation are temporary and can be treated with over-the-counter laxatives. [5] Don't ignore chronic colon symptoms.

The Non-Invasive Routes

Though non-invasive, virtual colonoscopy is not standard due to its limitations.

Virtual colonoscopy uses 2D and 3D imagery reconstructed from computed tomography (CT) scans or from nuclear magnetic resonance (MR) scans. Though non-invasive, it is not standard due to its limitations. Virtual colonoscopy does not allow for therapeutic maneuvers such as polyp or tumor removal or biopsy. Such radiological images have difficulty detecting lesions smaller than 5 millimeters. Since the goal is to locate cancers in their earliest stages, virtual colonoscopy has serious drawbacks. Additionally, if a growth or polyp is detected, a standard colonoscopy would still be required for biopsy. [6]

Subject to further peer-review, a new non-invasive screening test that analyses DNA for colon cancer may be on the horizon. The first clinical evaluation study enrolled 1,100 patients for at-home stool testing. The tests found 64% of precancerous tumors that were bigger than one centimeter (less than a half inch) and found 85% of cancers. (Positive results were followed with colonoscopy.) The test has the added benefit of detecting cancers on both sides of the colon — something not possible with endoscopic examination. [1]

The Procedure

A 50-year-old patient — the same one mentioned at the outset of this article — is scheduled to have a routine colonoscopy. He reflects on his first one performed 20 years ago. It's interesting how many patients avoid using the word "colonoscopy." When enlisting support for a ride, a friend is often told it's because "I'm getting a procedure" and won't be able to drive afterward. So for the sake of the modest ones, we will henceforth refer to this colonoscopy as the "procedure."

Prior to the procedure, there's a need to clear the intestines of wastes that could obstruct view of potential problems. [7] The patient had to consume about a gallon of liquid, appropriately called Go Lightly. Unprepared at the office for what eventually broke forth, he completed the regimen. Then no food or drink the day of the procedure.

In the operating room, the very capable gastroenterologist planned to have the patient sedated just enough to view the results in realtime on a video screen. The anesthesia used doesn't actually cause a patient to lose consciousness — merely experience short-term memory loss — forgetting the unpleasantness.

The first hint to anomalies were apparent as the endoscope entered the sigmoid colon. In this lightly sedated state, the gastroenterologist noted remnants of fecal matter. The patient assured the physician that the pre-op prescription was completed. It then became necessary to force the scope further. The doctor said the colon is smooth. Suddenly there was an urgent request for the nurse to administer "more medicine."

Though he recalled no pain, all involved felt sorry for the patients next in line who heard the sedated screaming.

In the recovery room, the gastroenterologist asked if the patient remembered anything in the operating room. He related the short conversation prior to "more medicine." The doctor then asked, if he recalled screaming? The patient replied with a drawn out "No," with a hint of suspicion. "Good," said the doctor. The patient was then handed his eyeglasses that fell on the floor during the procedure. The patient couldn't help but wonder what actually went on in that little room. Though he recalled no pain, all involved felt sorry for the patients next in line who heard the sedated screaming.

Curative Endoscopy

At a follow-up visit, the gastroenterologist ruled out cancer and polyps but described the condition with an unusual word. He said identified colon tigration (illustrating a tiger stripe pattern with interspaced fingers extended). In effect, it was looped and folded more like the small intestine instead of the normally three relatively straight sections of the ascending, traverse and descending colon. Folds were the reason why the colon was not completely cleared during pre-op evacuations. Areas of the colon were smooth, where they were supposed to have a uniform pattern of bulges and constrictions. In retrospect, is sounds much like spastic colon though that was not the diagnosis.

The patient optimistically asked, what caused it and was told it could have been hereditary or some autoimmune disorder. "How do we fix it?" asked the eager patient. Interestingly, the examination was somewhat curative. The scope essentially unfolded and straightened the colon out. Had he waited until 50, he would have experienced many more of the previously described symptoms.

In light of emerging DNA stool tests, this brings up another factor for gastroenterologists to consider. Each test has strengths and weaknesses. While one type may show negative results, patient symptoms may necessitate verification with an alternate detection method.

Over the next couple of decades, the patient did everything reasonably possible to take care of his colon. He was a vegetarian for several years and even performed annual colon cleanses followed by probiotics. Hopefully this has helped to restore or maintain a healthy colon. Now it's time for an age-appropriate procedure. Will it be less eventful? Certainly, no one looks forward to anything that results in adult "screaming." Yet he shares the interest of the gastroenterologist in learning the state of a once troubled colon.

Take-away tips: Many health plans recommend annual examination of the lower gastrointestinal tract beginning at age 50. Have one sooner if recommended by your physician. Cancer is one of several diseases that can affect the colon. Gastroenterologists are committed to helping you take care of your colon.

Tags: dietician, fitness, gastroenterology, gastroesophageal, hernia, nutritionist, rectum

  1. New Colon Cancer Screening Test in the Works. WebMD
  2. Death Begins in The Colon.
  3. Candida Gut Dysbiosis. The Environmental Illness Resource
  4. Chronic Constipation Appears to Be Increasing Among Kids. Action for Better Healthcare
  5. Constipation: Definition.
  6. Colonoscopy. Wikipedia
  7. Colonoscopy: The Inside Story.