Encyclopedia of Family Health - Vol. 15

Encyclopedia of Family Health - Vol. 15

Encyclopedia of Family Health - Vol. 15

Encyclopedia of Family Health - Vol. 15


Spastic colon is a distressing condition. It is a variant of irritable bowel syndrome, and is classified as a functional (nonorganic) disorder, but so far there has been little progress in discovering its cause.

“Spastic colon,” a term not universally approved by doctors, but widely used, is now generally recognized as one of the varieties of the functional bowel disease known as irritable bowel syndrome (see Irritable Bowel Syndrome). Doctors have found difficulty in categorizing functional bowel disease because the symptoms suffered, although genuine and distressing to the patient, are often difficult to explain in terms of conventional pathology and physiology. In 1990, a working group was set up at the 13th International Congress of Gastroenterology in Rome, and its recommendations, known as the Rome criteria, are widely accepted. One of the categories in the Rome criteria, based primarily on symptoms, is spastic colon. This condition affects women much more often than men.


The main symptom is pain. This is often sudden, sharp, severe, and piercing, and is located in the lower abdomen just above the pubis. Often, the pain is of short duration and may be associated with the passage of loose stools. There may be distension of the abdomen and a sense, after defecating, that the act has been incomplete so that the affected person feels the need to defecate again. Mucus is commonly present in the stools. Frequently, the abdominal pain will be relieved by defecating.

Diarrhea is not, however, a principal symptom of spastic colon and although it is quite common for sufferers to feel the need to go frequently to the toilet, constipation is a common feature. Spastic colon may be very persistent and chronic and can be a severely debilitating condition (see Diarrhea).

Causes of spasm

Spasm, which causes the digestive tract to contract suddenly, involuntarily, and abnormally, results in pain and distress for the person affected. Most people have experienced muscle spasm in the form of painful cramps. Common cramps are spasms of the voluntary skeletal muscles. In the case of spastic colon, however, the muscles concerned are smooth, circularly-placed muscles in the wall of the intestine that are not under voluntary control but contract because of the action of the nerves of the autonomic nervous system. The symptoms of spastic colon strongly suggest that the normal mechanisms of bowel peristalsis are disordered. Peristalsis, which is produced by organized contraction of the walls of the intestine, is necessary so that the contents of the bowel can be moved along. This is achieved by a process in which, about three times a minute and at many points along the intestine, a short segment of bowel constricts while the adjacent segment, on the side of the constriction nearer the anal end, relaxes. The effect is to force the food contents along. Peristalsis operates throughout the whole length of the gastrointestinal tract and involves the gullet and stomach as well as the small intestine and colon.

Any disturbance of the peristaltic mechanism—as when, for instance, two closely adjacent segments tighten strongly so that a length of bowel balloons between them—will produce sharp pain. It is known to medical science that the intestine is completely insensitive to touch and even to cutting or burning, but it has numerous sensory nerve endings that respond sharply to stretching. The difficulty is to discover what it is that brings about the irregularities or abnormalities in the mechanisms of contractility and peristalsis.

It is because there is a disorder of bowel function, rather than an actual structural disease that could be revealed by biopsy, that this condition is called a “functional disorder.” The term should not be interpreted, as it often is, as meaning that this is an imaginary complaint. Some research suggests the possibility that at least some cases of spastic colon, especially in black people, may be due to lactose intolerance. Lactose (milk sugar) requires the enzyme lactase for its digestion, and in its absence undigested sugar ferments in the colon, causing diarrhea and distention.

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