Motility Disorder of the Colon and Rectum

Introduction:

The primary function of the colon is to store food residues and absorb water. About five gallons of fluid is dumped into the colon every day, the main function of the colon lies in the absorption of the extra water from food. Most fluid is reabsorbed and this prevents us from becoming dehydrated. This process takes time and 95 % of contractions of the colon are non-peristaltic. These contractions of the large intestine mix the contents back and forth but not in a forwarding direction. This is the pattern of motility and the residue of food remains in the colon for about 30 hours, along with lots of healthy bacteria. This bacteria and its amount depend on diet and antibiotic intake by the individual.

What Is a Motility Disorder of the Colon and Rectum?

The colon is the last major organ of the gastrointestinal tract. The colon plays a crucial role in regulating the frequency of defecation and consistency of stools. Colonic motility depends on the integrity of central and autonomic nervous systems, gut wall innervations and receptors, gastrointestinal hormones, and circular smooth muscle. Propagating motor complexes on the colon is stimulated by increased intraluminal pressure generated by bulky fecal content.

There are two primary symptoms of colonic motility dysfunction: intermittent abdominal cramping and altered bowel habits. Other additional symptoms include urgency, the feeling of incomplete evacuation, straining, the passage of mucus, bloating and feeling of abdominal distension, and postprandial exacerbation of symptoms.

What Are the Disorders of the Colon and Rectum That Cause Motility Dysfunction?

The disorders of the colon and rectum that affects motility include:

• Chronic Diarrhea - Loose, watery stools that persist for weeks.

• Colon Cancer - Cancer of the colon and rectum that begins with non-cancerous polyps.

• Appendicitis- A condition in which the appendix becomes inflamed and fills with pus causing severe pain.

• Colonic Dysmotility- A disorder that is caused by abnormal contractions of the intestinal muscles.

• Diverticulitis- Inflammation and infection of one or more small pouches that occurs in the gastrointestinal tract.

• Crohn’s Disease- Chronic inflammatory bowel disease that affects the lining of the digestive tract.

• Fecal Incontinence- An inability to control bowel movements that cause an unexpected leak of stools.

• Achalasia- A rare disorder that makes it difficult for food and liquid to pass through the esophagus.

• Intestinal Obstructions- A gastrointestinal condition that results in preventing the digested material from passing through the bowel.

• Polyps- Small lump of cells that forms around the rectum or colon.

• Rectal Prolapse- A condition that results when part of the large intestine slips outside the anal area.

• Ulcerative Colitis- Inflammation of the innermost lining of the colon and rectum forming ulcers.

• Irritable Bowel Syndrome- An intestinal disorder that causes wind, diarrhea, discomfort, pain, and constipation.

• C.difficile Infection- Infection that occurs due to inflammation caused by the bacteria Clostridium difficile.

What Are the Signs and Symptoms of Motility Disorders of the Colon and Rectum?

The signs and symptoms of motility disorders are:

• Abdominal swelling, distention, or bloating.

• Blood in stools.

• Abdominal pain.

• Diarrhea.

• Fatigue.

• Gas.

• Fatigue.

• Fever and chills.

• Nausea with or without vomiting.

• Inability to defecate or pass gas.

Other symptoms that affect the general health of the individual are:

• Depression (mood disorder that causes a persistent feeling of sadness and loss of interest)

• Loss of appetite.

• Anxiety (feeling of dread, fear, and uneasiness).

• Overall weakness.

• Malnutrition.

• Skin and hair conditions.

• Unexplained weight loss.

How Is Diagnosis Done for Motility Disorders of the Colon and Rectum?

The diagnosis of the symptoms and severity of the disorders is done by taking a detailed medical history and doing a physical examination. These tests also help in developing treatment plans for the disorders, and these tests include:

• Blood Tests: A blood test is done to check for abnormal values of blood.

• Barium Enema: It is a lower GI test. Barium sodium is placed in the colon, and X-rays are taken.

• Barium Swallow: It is an upper GI test. Barium solution is asked to swallow that coats the inner lining of the esophagus, and the stomach and X-rays are taken.

• Colonoscopy: A flexible thin tube with a lightheaded camera is inserted in the colon, and this helps in finding colon polyps, tumors, ulcers, and any signs of bleeding or inflammation. This test also helps in the screening for cancer and helps in taking biopsies for external examination.

• Breath Tests for Lactose: A simple, invasive method of assessing absorption. A nutrient that contains radioactive material is used in the test.

• Capsule Endoscopy: This test gives an enhanced view of the lower gastrointestinal tract that can’t be visible in a traditional colonoscopy.

• Sigmoidoscopy: Procedure to examine the rectum and area of the colon and rectum.

• Ultrasound: Helps in the detection of intestinal tumors.

• MRI: Magnetic resonance imaging helps in capturing detailed images of the affected colon and rectum.

• CT Scans: Computed tomography is used to image diseased organs by using radio waves and Computer technology.

• Radionuclide Imaging: Typically used in the detection of gastrointestinal bleeding. A radioactive substance is injected into the vein, and images are taken.

What Is the Treatment Provided for Motility Disorders of the Rectum and Colon?

Treatment of motility disorders is based on the following simple measures that help in reducing a few symptoms:

• Exercise.

• Avoid smoking.

• Avoid foods that trigger the symptoms.

• Over-the-counter medications include prokinetic agents, opioid antagonists, antidiarrheals, cholinergic agonists, and antibiotics. The most useful drugs in treatment are Neostigmine, Metoclopramide, Bethanechol, Cisapride, and Loperamide.

• Increase fiber intake.

• Maintaining a healthy weight.

Some conditions are treated by advanced treatment measures, and even surgery is recommended in some cases.

• Rectal prolapse surgery.

• Colon and rectal surgery.

• Polyp removal.

• Sacral nerve implants to prevent accidental stool leakage.

Conclusion:

The symptoms of motility disorders of the colon and rectum are common problems that result due to gastroenterology and issues occurring either as primary or secondary to other underlying diseased conditions. Common problems like irritable bowel syndrome, diverticulosis, and chronic constipation are included in these conditions. Although the individual has abnormal colonic and rectal motility is more complicated as a consequence of dysregulation of the brain-gut axis resulting in altered intestinal motility and visceral hypersensitivity.