Inactive colon
Inactive colon: Excerpt from Professional Guide to Diseases (Eighth Edition)
Inactive colon, also known as lazy colon, colonic stasis, or atonic constipation, is a state of chronic constipation that, if untreated, may lead to fecal impaction.
Causes
Inactive colon usually results from some deficiency in the three elements necessary for normal bowel activity: dietary bulk, fluid intake, and exercise. It’s common in bedridden people because of their inactivity and is generally relieved with diet and exercise. Other possible causes can include habitual disregard of the impulse to defecate, emotional conflicts, chronic use of laxatives, or prolonged dependence on enemas, which dull rectal sensitivity to the presence of feces.
Signs and symptoms
The primary symptom of inactive colon is chronic constipation. The patient commonly strains to produce hard, dry stools accompanied by mild abdominal discomfort. Straining can aggravate other rectal conditions such as hemorrhoids.
Diagnosis
A patient history of dry, hard, infrequent stools suggests inactive colon. A digital rectal examination reveals stool in the lower portion of the rectum and a palpable colon. Proctoscopy may show an unusually small colon lumen, prominent veins, and an abnormal amount of mucus. Diagnostic tests to rule out other causes include upper GI series, barium enema, and examination of stool for occult blood from neoplasms.
Treatment
Treatment varies according to the patient’s age and condition. A higher-bulk diet, sufficient exercise, and increased fluid intake commonly relieve constipation. Treatment for severe constipation may include bulk-forming laxatives, such as psyllium, or well-lubricated glycerin suppositories; for fecal impaction, manual removal of feces is necessary. Administration of an oilretention enema usually precedes removal; an enema is also necessary afterward. For lasting relief from constipation, the patient with inactive colon must modify bowel habits.
Special considerations
In many cases, patient education can help break the constipation habit.
❑ Advise the patient to drink at least 8 to 10 glasses (2 qt [2 L]) of liquid every day because fluids help keep the intestinal contents in a semisolid state for easier passage. This is particularly important for an older patient. Stimulate the bowel with a drink of hot coffee, warm lemonade, iced liquids — plain or with lemon — or prune juice before breakfast or in the evening.
❑ The patient should add fiber to the diet with foods such as whole grain cereals (rolled oats, bran, shredded wheat, brown rice, whole wheat bread, and oatmeal) to contribute bulk and induce peristalsis. However, too much bran can create an irritable bowel, so check labels on foods for fiber content (low fiber — 0.3 to 1 g; moderate fiber — 1.1 to 2 g; high fiber — 2.1 to 4.2 g). Increase the bulk content of the diet slowly to prevent flatulence, which can be a transient effect of a high-bulk diet. Include fresh fruits with skins as well as raw and coarse vegetables (broccoli, brussels sprouts, cabbage, cauliflower, cucumbers, lettuce, and turnips) in the diet for additional bulk.
❑ The patient should moderate his consumption of fat-containing foods, such as bacon, butter, cream, and oil; although these foods will help to soften intestinal contents, they sometimes cause diarrhea.
❑ Instruct the patient to avoid highly refined foods, such as white rice, cream of wheat, farina, white pastries, pie or cake, macaroni, spaghetti, noodles, candy, cookies, and ice cream.
❑ The patient should incorporate moderate exercise, such as walking, into his daily routine.
❑ Advise the patient to avoid overusing laxatives and to maintain a regular time for bowel movements (usually after breakfast). Autosuggestion, relaxation, pleasant reading material, privacy, and use of a small footstool to promote thigh flexion while sitting on the toilet may be helpful. The patient should respond promptly to the urge to defecate. If he worries about constipation, explain that a 2- to 3-day interval between bowel movements can be normal.
❑ The patient should take bulk-forming laxatives, such as psyllium, with at least 8 oz (240 ml) of liquid. Juices, soft drinks, or other pleasant-tasting liquids help mask the gritty texture of these laxatives.
❑ Advise the patient against overusing enemas. Frequent use of sodium biphosphate, in particular, is to be avoided because its hypertonic solution can absorb as much as 10% of the colon’s sodium content or draw intestinal fluids into the colon, thereby causing dehydration.
ELDER TIP If an older patient with inactive colon is hospitalized, help him move to a bedside commode for bowel movements because using a bedpan causes additional strain. However, if he must use a bedpan, have him sit in Fowler’s position or sit on the pan at the side of his bed to facilitate elimination. Occasional digital rectal stimulation or abdominal massage near the sigmoid area may help stimulate a bowel movement.
Alert If the patient has a history of arteriosclerosis, heart failure, or hypertension, constipation and straining may induce Valsalva’s maneuver, thereby causing a vagal effect, in which the heart rate slows or stops entirely.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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