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The sigmoid colon is the last section of the large intestine that connects the descending colon to the rectum. It is so-named because it is curved like the letter “S,” which in Greek is sigma (σ).
The sigmoid colon’s function is to store fecal waste until it is ready to leave the body through the rectum and anus. Feces is stored in the sigmoid colon for seven hours or more and it is usually expelled from the body when new waste material enters the area.
7 Conditions That Cause Sigmoid Colon Problems
Things that can go wrong with the sigmoid colon include:
- Colon polyps
- Inflammatory bowel disease (IBD)
- Ulcerative colitis
- Crohn’s disease
- Colorectal cancer
- Fistulae (an abnormal connection that connects two organs or vessels that do not usually connect)
- Diverticular disease
- Volvulus (twisting of the colon)
What Are Symptoms of Sigmoid Colon Problems?
Symptoms of things that can go wrong with the sigmoid colon depend on the condition.
Symptoms of colon polyps may include:
- Blood in stool
- Diarrhea
- Constipation
- Lower abdominal pain or discomfort
Symptoms of Crohn's disease and ulcerative colitis that are similar include:
- Persistent diarrhea (may be bloody)
- Rectal bleeding
- Urgent need to have a bowel movement
- Abdominal cramps and pain
- A feeling of incomplete bowel evacuation
- Constipation (may lead to bowel obstruction)
- Weight loss
- Fatigue
- Fever
- Night sweats
- Loss of appetite
- Bloating
- Nausea
- Vomiting
Crohn’s disease can also cause symptoms in the body outside the gastrointestinal tract, including:
- Eye problems
- Mouth sores
- Joint pain and swelling
- Skin complications
- Changes in the menstrual cycle
- Osteoporosis
- Kidney stones
- Liver problems such as primary sclerosing cholangitis and cirrhosis (rare)
Additional symptoms of ulcerative colitis may include:
Symptoms of colorectal cancer include:
- Changes in bowel habits that last for more than a few days
- Constipation
- Diarrhea
- Narrowing of the stool
- Feeling the need to have a bowel movement that's not relieved by having one
- Blood in the stool
- Rectal bleeding with bright red blood
- Abdominal bloating, cramping, or pain
- Fatigue
- Weakness
- Unintended weight loss
Symptoms of fistulae may include:
- Abdominal pain
- Bowel obstruction that can be painful
- Diarrhea
- Rectal bleeding
- Fever
- Elevated white blood cell count
- Infection, including sepsis
- Poor nutrient absorption
- Weight loss
- Dehydration
- Worsening of any underlying disease
Symptoms of diverticular disease may include:
- Abdominal pain (most commonly in the left lower quadrant)
- Nausea
- Vomiting
- Constipation (may be severe)
- Fever
- Gas
- Bloating
Symptoms of volvulus may include:
- Abdominal cramping
- Bloody stools
- Constipation
- Nausea
- Signs of shock
- Vomiting
What Causes Sigmoid Colon Problems?
Causes of colon polyps include:
The cause of inflammatory bowel disease (IBD), both Crohn’s disease and ulcerative colitis, is not fully understood. Genetic factors may contribute to the development of the disease.
The cause of colorectal cancer is unknown. Risk factors for developing colorectal cancer include:
- Diet
- Tobacco smoking
- Heavy alcohol use
- Certain hereditary cancer syndromes
- A family history of colorectal cancer
The causes of fistulae may include:
- Complications of intra-abdominal surgery
- Inflammatory bowel disease (IBD) such as Crohn’s disease
- Malignant tumors
- Diverticulitis
- Vascular insufficiency
- Physical trauma to the abdomen
In Western countries, diverticular disease is thought to be caused by the classic high-fat and low-fiber diet. It may also be caused by increased pressure from constipation or increasing abdominal girth in obesity.
Causes of volvulus include:
- Malrotation
- Other medical conditions
- Enlarged colon
- Hirschsprung disease
- Abdominal adhesions following abdominal injury, infection, or surgery
How Are Sigmoid Colon Problems Diagnosed?
In addition to a patient history and physical examination of the affected area, different types of examinations and tests may be used to determine things that may have gone wrong with the sigmoid colon.
Colon polyps are often diagnosed during screening to check for colon or rectal cancer. Tests include:
- Colonoscopy
- Sigmoidoscopy
- Computerized tomography (CT) colonography (also known as virtual colonoscopy)
- Stool test
- Capsule colonoscopy
Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, tests may include:
- Stool testing
- Blood tests
- X-rays of the upper and lower GI tract
- Barium enema X-ray
- Endoscopy
- Small intestine imaging
- Tissue biopsy
Colorectal cancer is often found during screening tests. Screening for colon cancer is performed with a colonoscopy. The American Cancer Society recommends healthy adults with no risk factors start screening for colorectal cancer at age 45 (the previous recommendation was 50 years).
In addition to a colonoscopy, tests used to diagnose colorectal cancer include:
- Blood tests
- Proctoscopy
- Biopsy
- Imaging tests
Tests used to diagnose fistulae may include:
- Blood tests
- Endoscopy
- Intestinal X-rays
- Fistulogram
Tests used to diagnose diverticular disease may include:
- Blood tests
- Urine tests
- Stool test for blood
- A pregnancy test for females of childbearing age with abdominal pain
- Imaging tests
Tests used to diagnose volvulus may include:
- X-rays
- Upper or lower GI series
- Computerized tomography (CT) scans
- Flexible sigmoidoscopy
What Is the Treatment for Problems with the Sigmoid Colon?
Treatment for things that can go wrong with the sigmoid colon depends on the condition.
Some types of colon polyps may not need treatment and may go away on their own. Other polyps carry a risk of becoming cancerous and need to be removed. Surgical removal of polyps (polypectomy) is the most common treatment for colon polyps that cause symptoms or that have the potential to be cancerous.
Treatment for inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, depends on the severity of the condition and how often a patient’s symptoms flare up (worsen). Treatment may include:
- Medications
- 5-aminosalicylic acids (5-ASAs)
- Systemic or topical corticosteroids
- Immunomodulators
- Biologic/biosimilar therapies
- Janus kinase inhibitors (JAK Inhibitors) for ulcerative colitis
- Antibiotics for Crohn’s disease
- Diet changes
- Surgery
Treatment for colorectal cancer may involve one or more of the following:
- Surgery
- Ablation and embolization, used for metastases (spread) of colon cancer to the lungs or liver
- Chemotherapy
- Radiation therapy
- Targeted therapy
- Immunotherapy using immune checkpoint inhibitors
Some fistulas may close on their own if they are small and infection is controlled. When needed, treatment for fistulae may include:
- Fluid replenishment
- Electrolytes
- Restoring acid and base balance
- Reducing fluid output from the fistula
- Controlling infection
- Surgery, if there is no improvement after several months
Treatment for mild diverticular disease includes:
- Clear liquid diet for 2-3 days; progress to a soft diet as tolerated
- 7-10 days of oral broad-spectrum antibiotics if needed
- Acetaminophen (Tylenol) and antispasmodics for pain
Hospitalization may be needed for severe diverticular disease and treatment may include:
- Clear liquid diet; progress to a soft diet as tolerated
- Intravenous (IV) or oral antibiotics
- Drainage of abscesses
- Pain management
- Elective surgical resection
Treatment for volvulus may include:
- Using the sigmoidoscope to untwist the colon
- Surgery
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