Thirty years ago, I underwent a bowel examination that should have provided an important clue to a medical problem that would continue to trouble me for decades.
Before the examination, I had been given Picolax, a powerful bowel-cleansing preparation intended to empty the intestines before an endoscopic examination.
Unfortunately, it hadn't worked properly.
During the examination, the surgeon made what seemed at the time to be a throwaway remark. He told me that I had convoluted bowels, and that this was why the Picolax had failed to clear my bowel adequately and not, as he had presumed, because I hadn't taken the Picolax correctly, for which he had apologised.
And that, as far as I was concerned, was that.
Nobody explained that convoluted bowels could represent a recognised anatomical variation associated with medical problems. Nobody discussed what it might mean for my future bowel health or whether I needed to take particular precautions.
Over the following 30 years, I continued to experience bowel difficulties. Yet, despite consultations with GP practices, the surgeon's observation was never raised with me again. I now wonder if his diagnosis was passed on to my medical practice?
The Discovery I Made Myself
Eventually, while carrying out my own research, I came across information about convoluted bowels.
To my considerable surprise, I discovered that the term could refer to a recognised medical condition, often described as a redundant colon or dolichocolon.
Essentially, this means that the colon is longer than usual and may form additional loops.
For some people, this causes no problems whatsoever. For others, however, it can be associated with chronic constipation, abdominal discomfort, bloating and difficulties with normal bowel movements.
Suddenly, the surgeon's remark from three decades earlier took on an entirely different significance.
I began wondering why nobody had explained this to me at the time, and why my GP practices had never mentioned it during the intervening years.
I had spent decades struggling with a problem that might have been better understood much earlier.
My Wife, a Century-Old Medical Book and a Breakthrough
Fortunately, my wife is a qualified nurse.
She has the professional knowledge and experience to understand medical information and, importantly, the determination to investigate problems rather than simply accept that nothing can be done.
In trying to help me, she consulted a medical book that was more than 100 years old.
The information she found helped her approach my bowel difficulties from a different perspective.
Together with her nursing knowledge, it led to a practical approach involving lactulose and dietary changes.
Lactulose is an osmotic laxative that draws water into the bowel, softening stools and making them easier to pass.
Combined with adjustments to my diet, it has finally helped me manage the bowel difficulties that had caused so much trouble over the years.
What an extraordinary situation: after 30 years of medical consultations, the breakthrough came through my wife's nursing experience, my own research and information from a book written more than a century ago.
Why Wasn't I Told?
This is perhaps the most frustrating aspect of the entire experience.
The surgeon clearly recognised that my bowel anatomy was unusual. He even connected it with the failure of the Picolax preparation.
Yet I was never given an explanation of what that observation might mean.
I appreciate that medicine has changed considerably over the past three decades. I also recognise that not everyone with a redundant colon experiences constipation and that my symptoms could have had several contributing causes.
Nevertheless, surely an observation that might have implications for a patient's future health deserves more than a passing comment?
Had I understood the significance of convoluted bowels 30 years ago, I could have asked more informed questions, discussed possible treatments and perhaps avoided some of the difficulties I subsequently experienced.
Can Older Medical Books Still Teach Us Something?
I believe there is another important lesson in this experience.
We live in an age of remarkable medical advances, sophisticated diagnostic equipment and increasingly effective treatments.
But that doesn't mean older medical literature has nothing to offer.
Some observations about human anatomy, digestion and bowel function were made long before today's medical technologies existed.
Of course, historical medical advice must always be assessed against current scientific evidence. Some treatments recommended a century ago would be inappropriate or even dangerous today.
However, the fact that my wife found useful information in such an old publication demonstrates why medical history should not automatically be dismissed.
Lactulose itself is a modern treatment, introduced long after that book was published. It was the older information, interpreted alongside modern nursing knowledge, that helped inform her approach.
What Should Other People Do?
If you suffer from long-standing constipation or other persistent bowel difficulties, my advice is to ask questions.
Find out whether there might be an underlying explanation for your symptoms.
If you have previously undergone a colonoscopy or another bowel investigation, consider asking whether any unusual anatomical findings were recorded.
And if a doctor mentions something you don't understand, ask them to explain it.
Dietary changes and laxatives can help many people with constipation, although treatment needs to be tailored to the individual. Increasing fibre, for example, can sometimes worsen bloating and discomfort in people with slow bowel transit.
Lactulose is not suitable for every situation and can itself cause wind and bloating. (But some wind might well be a worthwhile sacrifice if the Lactulose works?)
Anyone with persistent constipation should discuss appropriate treatment with a healthcare professional.
Thirty Years Is a Long Time to Wait
I am delighted that my bowel problems are now being managed much more successfully.
But I remain deeply disappointed that an observation made by a surgeon three decades ago was apparently never followed up or properly explained to me.
My experience has reinforced two beliefs.
Firstly, patients deserve clear explanations of medical findings, even when those findings are made incidentally during an examination.
Secondly, we should never underestimate the knowledge, dedication and resourcefulness of qualified nurses.
In my case, my wife helped achieve something that years of medical consultations had failed to accomplish.
And it all began with a throwaway remark from a surgeon 30 years ago, a remark whose significance I only discovered through my own research.
Further Information
NHS – Constipation: https://www.nhs.uk/conditions/constipation/
NHS – Lactulose: https://www.nhs.uk/medicines/lactulose/
Guts UK – Digestive health information: https://gutscharity.org.uk/
This article relates my personal experience and should not be regarded as a substitute for medical advice.
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