What Can Go Wrong with the Sigmoid Colon?

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:

• Rectal pain 
• Dehydration

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

Causes of colon polyps include: 

• Lifestyle 
  • Diet high in fat and red meat, low in fiber 
  • Smoking
• Obesity
• Aging 
• Family history and genetics

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

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

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