Long Colon and Its Impact on Constipation: Surgical Options Explained

Long colon leading to constipation?

Hello, doctor.
I have a condition of elongated colon and a twisted sigmoid colon.
I have visited Chang Gung Memorial Hospital in Kaohsiung, and the doctor recommended a total colectomy.
I would like to ask, is it absolutely necessary to perform a total colectomy? Is it possible to leave a portion of the colon? Wouldn't a total colectomy lead to diarrhea, making life inconvenient? I have been suffering from chronic constipation and severe hemorrhoids.
Two months ago, I had surgery for my hemorrhoids, and now every time I have a bowel movement, it is extremely painful at the moment of passing stool, almost like anal fissures.
It feels unbearable and is truly painful.
I take softening laxatives daily, but they don’t seem to help.
If I don’t have a bowel movement for a day, it becomes very difficult to go.
Will a total colectomy lead to any long-term complications? I am very worried.
Should I really undergo this surgery? I would appreciate your help in clarifying my concerns.
Thank you.

Xiao Ye Zi, 40~49 year old female. Ask Date: 2011/07/24

Dr. Lin Zhiguang reply Surgery

Hello, if you have been suffering from chronic constipation for a long time and have not responded to several years of medication, a total colectomy may be an effective option.
Typically, the rectum is preserved while the colon is removed, and the small intestine is connected to the rectum.
The significant reduction in the length of the colon usually yields good results, and since the rectum is retained, diarrhea is generally not severe.
However, this is a major surgery, and aside from the risk of poor anastomotic healing (5-15%), the main complication is intestinal adhesions, which do not necessarily occur and are usually infrequent.
It is important to rule out psychological issues, as some individuals may experience stress, anxiety, or sedentary lifestyles, and sometimes addressing these habits can lead to improvement.
As for discomfort from hemorrhoids, it is generally temporary and tends to improve within one to two months.
If needed, I can also perform this surgery laparoscopically, which results in smaller incisions.

Reply Date: 2011/07/24

More Info

Understanding the implications of a long colon and its associated conditions, such as tortuous sigmoid colon, can be quite complex. Your situation, characterized by chronic constipation, severe hemorrhoids, and the recommendation for a total colectomy, raises several important considerations.

Firstly, it is essential to understand that a long colon, particularly with tortuous segments, can lead to significant functional issues. The twisting and elongation of the colon can impede the normal passage of stool, resulting in constipation and the straining you experience during bowel movements. This straining can exacerbate hemorrhoids and lead to painful conditions such as anal fissures, which you have described as feeling like a "crack" during bowel movements.
The recommendation for a total colectomy, which involves the surgical removal of the entire colon, is a significant one. While this procedure can alleviate the symptoms associated with a long and tortuous colon, it is not without risks and potential complications. After a total colectomy, patients may experience changes in bowel habits, including diarrhea, urgency, and the need for dietary adjustments. The removal of the colon means that the body will have a different mechanism for stool formation and absorption, which can lead to a more liquid stool consistency.
However, it is important to note that total colectomy is not the only surgical option available. Depending on the specifics of your condition, including the degree of tortuosity and the overall function of your remaining bowel, a partial colectomy or other surgical interventions may be appropriate. For instance, if the tortuous segment of the colon can be resected while preserving a functional portion, this may alleviate your symptoms without the need for a total colectomy.
Before making any decisions, it is crucial to have a thorough discussion with your healthcare provider. Ask about the potential benefits and risks of both total and partial colectomy, as well as the possibility of alternative treatments. It may also be beneficial to seek a second opinion from a colorectal surgeon who specializes in functional bowel disorders. This can provide you with a broader perspective on your options and help you make an informed decision.

In addition to surgical options, there are non-surgical interventions that may help manage your symptoms. These can include dietary modifications, such as increasing fiber intake, hydration, and possibly the use of medications that promote bowel motility. Working with a dietitian or a gastroenterologist can provide you with tailored strategies to improve your bowel function and reduce discomfort.

In summary, while a total colectomy is one potential solution for your long colon and associated symptoms, it is not the only option. A careful evaluation of your specific condition, along with a discussion of the risks and benefits of various surgical and non-surgical approaches, will be essential in determining the best course of action for your health and quality of life. Remember, you are not alone in this journey, and seeking support from healthcare professionals can help you navigate these challenging decisions.

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