Convoluted Bowels: How a Surgeon’s Throwaway Remark Led to 30 Years of Unnecessary Suffering

An update from That's Health

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.

Convoluted Bowels. What they are, how to treat them

Being told that you have a “convoluted bowel” as I was some years ago, can sound rather alarming. In many cases, however, the term refers to a tortuous or redundant colon, a large bowel that is longer than usual and consequently has additional bends, twists or loops.

For some people it causes few problems. For others, the additional journey through the colon can be associated with slower movement of waste and recurrent constipation.

While you cannot change the basic shape of your bowel through diet, there are practical steps that may make constipation easier to manage.

Aim for consistency rather than crisis management

For someone who regularly experiences constipation, the objective should ideally be to keep stools comfortably soft and relatively easy to pass rather than waiting until severe constipation develops.

Adequate fluid intake is important, particularly when increasing dietary fibre. Regular physical activity can also help stimulate normal bowel function, and it doesn't necessarily mean vigorous exercise. Walking and simply avoiding very long periods of inactivity can be beneficial.

Fibre can help, but more isn't always better

Increasing fibre is standard advice for constipation, but it is worth doing gradually.

Good sources include oats, fruit, vegetables, wholegrain foods, pulses and linseed. Fruits such as kiwifruit, pears, plums and prunes can be particularly useful additions to the diet.

However, suddenly consuming large amounts of bran or other coarse fibre isn't necessarily helpful for everyone. It can sometimes result in considerably more wind, bloating and abdominal discomfort.

People with chronic constipation may therefore find it useful to experiment gradually rather than simply adding as much fibre as possible.

Make breakfast work for your bowel

Our digestive system has a useful mechanism called the gastrocolic reflex.

Eating causes the stomach to expand, which sends signals encouraging the colon to move its contents onwards. The response can be particularly noticeable after breakfast.

This makes the period shortly after breakfast a good opportunity to establish a regular toilet routine.

Try allowing yourself five or ten unhurried minutes on the toilet around 15–30 minutes after breakfast. Don't force things if nothing happens and avoid prolonged straining.

A small footstool can also help. Raising the feet so that the knees are slightly higher than the hips creates a more favourable position for opening the bowels. Leaning slightly forwards can help too.

And when the natural urge to open your bowels does arrive, try not to ignore it repeatedly.

What about laxatives?

Occasional constipation can often be managed through lifestyle measures or short-term treatment. Recurrent constipation is different.

If constipation is happening frequently, particularly when you have already been diagnosed with a tortuous or redundant bowel, it's worth discussing a long-term bowel-management plan with your GP or pharmacist.

There are several types of laxative.

Osmotic laxatives such as macrogol (polyethylene glycol or PEG) work by increasing the amount of water retained in the bowel, helping to produce softer stools. Other options include bulk-forming and stimulant laxatives.

Which treatment is most appropriate will depend on the individual, their symptoms, other health conditions and any medicines they are taking. Some commonly prescribed medicines can themselves contribute to constipation, so a medication review may also be worthwhile.

Keep a bowel diary

A simple diary for a couple of weeks can provide surprisingly useful information.

Record when you have a bowel movement, the consistency of the stool, whether you needed to strain, any bloating or abdominal discomfort, and any laxatives or other treatments you used.

The Bristol Stool Chart can make this particularly easy. Types 1 and 2 indicate hard stools associated with constipation, while types 3 and 4 are generally considered more desirable.

Taking this information to a GP can provide a much clearer picture than simply saying, “I get constipated quite often.”

Know when constipation needs medical attention

Although constipation is extremely common, persistent or changing bowel symptoms shouldn't automatically be blamed on a convoluted bowel.

Seek medical advice if constipation is recurrent or isn't improving, or if you experience symptoms such as blood in your stools, unexplained weight loss, persistent abdominal pain or bloating, unusual tiredness or a significant change in your normal bowel habits.

Severe or worsening abdominal pain and swelling accompanied by vomiting and an inability to pass either stools or wind requires urgent medical assessment, as these can be symptoms of a bowel obstruction.

For people living with recurrent constipation, perhaps the most useful conversation to have with a GP is a simple one:

“Can we develop a regular bowel-management plan that helps me prevent constipation rather than treating it once it has become severe?”

Living with a convoluted bowel may mean paying a little more attention to bowel habits than most people need to. But establishing a regular routine, finding the right balance of fibre and fluids, remaining active and getting appropriate medical support can make constipation much easier to manage.

That’s Health note: This article provides general health information and is not a substitute for individual medical advice. Anyone experiencing persistent or concerning bowel symptoms should consult an appropriate healthcare professional.