What is it and is it always a disease?
The sigmoid colon is S-shaped and has a mesentery that allows it to move. With dolichosigma, it is longer than usual and forms additional loops. This feature is often found by chance during an examination for another reason, and if the stool is regular and there are no complaints, no treatment is required. A clinically significant situation is said to exist when there is chronic constipation, pain and bloating, and other causes are excluded. It is important to understand: the length of the intestine itself cannot be corrected with pills; the work is done with its emptying and the consistency of the stool.
- Lengthening the sigmoid colon with additional loops
- Often an incidental finding without complaints
- Diagnosis is only significant based on symptoms
- Medications cannot change the length of the intestine.
- The goal of treatment is regular soft stools.
Symptoms
The main manifestation is chronic constipation: stool less than three times a week, dense, with straining and a feeling of incomplete emptying. Often there is pain and distension in the left half of the abdomen, which decreases after defecation, bloating and increased gas production. Children may experience episodes of stool retention for several days, abdominal pain, decreased appetite, and sometimes stools due to rectal fullness. Long-term constipation contributes to anal fissures and hemorrhoids, and also creates a fear of defecation in the child, which aggravates the problem.
- Chronic constipation
- Hard stool and straining
- Pain and swelling on the left
- Bloating and gas formation
- Feeling of incomplete emptying
- In children - stool retention and stool loss
Diagnostics
The diagnosis is confirmed by X-ray examination of the colon with contrast: irrigoscopy shows the length and location of the loops of the sigmoid colon. Colonoscopy is needed for another task - to exclude polyps, inflammation and tumor, especially in adults over forty-five years old and when blood appears in the stool. Ultrasound of the intestines and coprogram help to assess concomitant disorders. In children, growth and weight rates are assessed and Hirschsprung's disease, in which the innervation of the intestine is impaired, is excluded; this may require special studies.
- Irrigoscopy with contrast
- Colonoscopy to rule out other diseases
- Ultrasound of the intestine
- Coprogram
- Thyroid assessment for persistent constipation
- Exclusion of Hirschsprung's disease in children
Treatment and regimen
The basis is working with nutrition and habits. You need a sufficient amount of fiber from vegetables, fruits and whole grains, a proper drinking regime, and regular physical activity. It is important to accustom yourself to the morning rhythm of bowel movements: a calm environment, a familiar time, no rush, a comfortable position with a low footrest, refusal to read or use the phone in the toilet. Laxatives are selected by the doctor, preference is given to drugs that increase the volume and soften the stool; stimulant medications are not suitable for continuous use. For children, the regime is established by a pediatrician, often with long courses of mild laxatives.
- Fiber and enough water
- Regular physical activity
- Constant time to defecate
- Comfortable position and no rush
- Mild laxatives as prescribed by your doctor
- Avoiding frequent cleansing enemas
- Observation of a pediatrician in children
When is surgery needed?
Surgical treatment for dolichosigma is rarely used and only when all conservative measures have actually been tried and have not yielded results, and constipation seriously disrupts life. A separate situation is volvulus of the sigmoid colon, which more often occurs when it is significantly lengthened and is manifested by severe pain, bloating, lack of stool and gases: this is an emergency condition requiring urgent hospitalization. The decision on elective surgery is made jointly by the gastroenterologist and the surgeon after a complete examination, including an assessment of the motility of the entire colon.
- Surgery is a last resort if treatment is ineffective
- Mandatory preliminary assessment of intestinal motility
- Sigmoid volvulus is an emergency
- For severe pain and gas retention - call 103
- The decision is made jointly by the gastroenterologist and surgeon