The dense sigmoid colon is palpated. Intestinal palpation: features of the procedure and its tasks

Date: 23.09.2020

The sigmoid colon is located in the lower part of the left flank and in the left iliac region. Its direction is oblique: from left to right and from top to bottom. It crosses the left umbilical line (lin. umbilico‑iliaca) almost perpendicular to the border of the middle and outer third of it.

The patient lies on his back, breathes through his mouth, his arms are extended along the body, the abdominal muscles are relaxed. This position of the patient should be in the study of the entire intestine and stomach. The doctor sits to the right of the patient facing him.

The right hand is given such a position that the II-V fingers are closed and half-bent (the tips of all fingers should be on the same line). The right hand is placed flat on the left iliac region so that the fingertips are located over the expected projection of the sigmoid colon. The hand should lie so that the back of the fingers is facing the navel. With a superficial movement (without immersion) during a deep breath in the abdomen, the hand is displaced medially and a skin fold is formed in front of the fingers. After this, the patient is asked to exhale and, taking advantage of the collapse and relaxation of the anterior abdominal wall, immerse the fingers of the right hand deep into the abdominal cavity until the fingertips come into contact with the posterior abdominal wall. The immersion of the fingers should be carried out at the site of the formed skin fold and should not be fast, ahead of the relaxation of the muscles of the abdominal wall. At the end of expiration, the fingertips slide along the posterior abdominal wall in the direction of the iliac spine and, at the same time, roll over the sigmoid colon (Fig. 68).

At the moment of sliding fingers along the intestine, its diameter, consistency, surface, mobility, pain and rumbling phenomenon are determined. In the second method of palpation of the sigmoid colon, the palpating hand is initially set so that the palmar surface of the hand is directed towards the navel. On inhalation, a skin fold is created towards the navel. On exhalation, the hand plunges to the posterior wall of the abdominal cavity, and then the nail surface of the fingers slides in the direction of the iliac spine, rolling through the sigmoid colon (Fig. 68).

Fig.68. Palpation of the sigmoid colon in two ways (top view).

In a healthy person, the sigmoid colon is palpable in the form of a painless, dense, smooth cylinder 2-3 cm wide, which does not growl at hand, has passive mobility within 3-4 cm.

The sigmoid colon is part of the colon and passes into the rectum. For the diagnosis of diseases of the sigmoid colon, the method of palpation is often used. It consists in probing the organ and determining obvious defects. It is violations in the structure that indicate the presence of a disease or problem. There are several techniques for palpation, each of which is used in different cases.

Appointment of palpation of the sigmoid colon

Palpation is prescribed to patients as one of the simplest and most effective diagnostic methods. With the help of such a study of the sigmoid colon, many symptoms characteristic of diseases are revealed. By touch, you can determine the size, density, surface condition. Each of these landmarks allows you to make a correct diagnosis and pinpoint the problem.

Methodology

There are several techniques for palpation. In addition, during such an examination, it is necessary to adhere to the basic rules in order to obtain a reliable result and not harm the patient:

Probing the organ is carried out with three fingers (usually the index, middle and ring fingers).
The fingers must be placed parallel to the sigmoid colon, and they should be moved transversely.
It is possible to press on the organ only synchronously with the phases of respiration.

Palpation is necessary in 4 stages:

Set your fingers correctly.
While inhaling, pull the skin into a fold.
When exhaling, press on the organ and press it against the posterior abdominal wall.
Wait for the moment of complete exhalation and run your fingers across the intestine.

Palpation of the large intestine begins with the sigmoid colon.

The main parameters that must be assessed during palpation are the thickness of the sigmoid colon, the distance along which it is probed, the consistency, the state of the surface, how easily and how far it can be displaced. You should also pay attention to the presence of pain during the examination and rumbling. These symptoms are basic for some diseases.

The first version of the method

The most common and frequently used. Palpation is based on the location of the organ - the left side of the iliac region is examined obliquely ascending and from outside to inside. The left hand must be placed on the wall of the peritoneum transverse to the navel and the anterior upper part of the iliac spine parallel to the axis of the sigmoid colon. The palm goes to the ilium. The desired segment is located approximately in the middle part of the organ. The fingers are slightly bent. Next, you need to slightly shift the skin to the navel and, with each exhalation, slowly move your hand until it comes into contact with the posterior abdominal wall. This is done in 2-3 breaths. On the next exhalation, a sliding movement is made along the back wall in a lateral direction by 3-6 cm. If a person does not have congenital anomalies, the sigmoid colon will be under the fingers.

To obtain the necessary information, the mobility of the colon must be maintained. It should be moved outward so that it is pressed against the compacted surface of the iliac region. To extract the maximum information from the inspection, it must be carried out 2-3 times. When the middle of the organ is determined, it should be probed 3-5 cm up, and then shifted lower. This is how a section 12–25 cm long is studied.

In a healthy state, the sigmoid colon feels like an elastic cylinder, which is 2–2.5 cm in diameter. This cylinder is quite dense, but not hard, has a smooth surface without bulges. Also, in the normal state, the organ can be displaced by 3-5 cm (maximum - 8 cm). If a person has a congenital short mesentery, he can practically not move. Be sure to check if rumbling occurs. When probing, peristalsis should not be felt and pain should occur. The compaction of the sigmoid colon can vary depending on the feces contained in it, therefore, for accurate results, the intestines are cleaned.

When filled with feces, the thickness of the intestine increases.

There are situations when, during palpation, it is not possible to feel the sigmoid colon in a standard place. This is most likely due to congenital elongation of the mesentery and its displacement. Inspection in such conditions is carried out a little differently. You must first find the prerectal part of the organ. It is located above the transition to the small pelvis. Next, you should move along the ascending along the colon and thus find the rest. You can also use this method - with your left hand, press to the right of the midline below the navel. Under pressure, the intestine will return to its correct position.

The second version of the methodology

In this technique, the location of the fingers of the right hand is the same as in the first. The only difference is that the fingers are set further from the middle of the plane, and the palm is placed on the gastric wall. The fold of skin gathers again towards the navel. Next, the fingers are immersed in the peritoneum and a sliding transition is made along the back wall to the ilium. The palm does not move, all movements are made by bending the phalanges of the fingers. This variant of palpation is more suitable for women, since they have a more plastic structure of the peritoneal walls.

The third version of the methodology

Palpation in this technique is performed with the edge of the hand (oblique palpation). Fingers are directed towards the patient's head. The palm is placed transverse to the navel and the anterior superior iliac spine, that is, it is located in the direction of the axis of the colon. The skin fold moves to the navel, the hand deepens to the posterior wall of the abdominal cavity. Movements are made only under the exhalations of a person. Next, a sliding movement outward is made. The edge of the hand moves along the organ and thus extracts data about its state. If during such an examination a person has a strong involuntary contraction of the muscles in the region of the peritoneal wall, one should use the "damp" technique - slightly press down on the wall in the region of the right iliac fossa.

What diseases can be detected by palpation?

On palpation, the doctor can detect a number of diseases.

Palpation helps to identify many symptoms and prevent further development of diseases. There are some signs that indicate problems:

If the large sigmoid colon has a diameter of up to 5-7 cm, this indicates a decrease in its tone. The causes may be defects in innervation, persistent inflammation, overflow due to prolonged stagnation in the rectum (spasm, hemorrhoids, swelling). The walls of the organ thicken with an increase in the size of the muscles, the accumulation of uncharacteristic cellular elements, if a cancer develops or polyps occur. Also, the intestine is wide and elongated due to a birth defect, or it changes its shape due to mechanical obstacles.
When the sigmoid colon has a thin, pencil-like shape, it means that it has recently been cleared of stool (diarrhea, enema) or a spasm occurs. This condition is observed in disorders of innervation and chronic inflammatory processes.
Excessive compaction occurs if the muscles contract with strong spasms, with an increase in the intestine in volume under the influence of inflammatory processes; if the rectum narrows, there are cancers, there is an accumulation of feces.
The intestine becomes too soft if it loses its tone due to a deficiency of essential substances. Then it is palpable as a ribbon 2-3 fingers wide.
Tuberosity manifests itself during spasms with constipation, stagnation of feces, which transforms into stones, the occurrence of neoplasms on the walls, fibrous cords along the perimeter of the sigmoid colon. On palpation it will be very dense to the touch.
When strong muscle contractions are felt during palpation, density changes over time, an acute inflammatory process and impaired fecal excretion should be suspected.
The sigmoid colon moves easily and far if a person has a congenital anomaly, that is, an elongated mesentery, or prolonged constipation.
If completely static, this indicates a congenital short mesentery, an inflammation of the peritoneum that covers the intestine, a cancer with metastases to neighboring tissues.
During palpation, pain is felt when the intestine and its mesentery are inflamed.
If rumbling, bursts are noted in the sigmoid colon, it means that gases and fluid secreted from inflamed tissues accumulate in it. Occurs with problems with the small intestine.

If a person has one of these signs on palpation: thickening of the intestinal walls, tuberosity, excessively dense structure, it will be necessary to clean the intestines with an enema and repeat the procedure. So you can determine whether any pathological processes are really observed in the intestine or whether it is just constipation. Do not neglect bowel cleansing - this will help to detect real diseases.

After superficial palpation of the abdomen, the abdominal organs accessible with deep palpation are examined, determining their position, size, shape, texture, surface condition, and pain. In this case, additional pathological formations, in particular, tumors and cysts, can also be detected.

The conditions for the study are the same as for superficial palpation of the abdomen. To reduce the tension of the abdominal muscles, you need to ask the patient to slightly bend the legs at the knees so that the soles are completely on the bed. In some cases, palpation is additionally carried out with the patient in an upright position. To clarify the boundaries of individual organs, along with the palpation method, percussion and auscultation are used. In addition, in order to identify pain in the projection of organs that lie deep in the abdominal cavity and are inaccessible to palpation, penetrating palpation is used. In patients with ascites, balloting palpation is used to examine the abdominal organs.

One of the most important conditions for deep palpation of the abdominal organs is the knowledge of their projection on the anterior abdominal wall:

left hypochondrium: cardia of the stomach, tail of the pancreas, spleen, left flexure of the colon, upper pole of the left kidney;
epigastric region: stomach, duodenum, body of the pancreas, left lobe of the liver;
right hypochondrium: right lobe of the liver, gallbladder, right flexure of the colon, upper pole of the right kidney;
left and right lateral areas (abdominal flanks): respectively, the descending and ascending sections of the colon, the lower poles of the left and right kidneys, part of the loops of the small intestine;
umbilical region: loops of the small intestine, transverse colon, lower horizontal part of the duodenum, greater curvature of the stomach, head of the pancreas, hilum of the kidneys, ureters;
left iliac region: sigmoid colon, left ureter;
suprapubic region: loops of the small intestine, bladder and uterus with their increase;
right iliac region Key words: caecum, terminal ileum, appendix, right ureter.

Usually observe the following sequence of palpation of the abdominal organs: colon, stomach, pancreas, liver, gallbladder, spleen. The study of the organ, in the projection of which tenderness was revealed during superficial palpation, is carried out last in order to avoid a diffuse protective reaction of the muscles of the abdominal wall.

When feeling the colon, stomach and pancreas, a method is used, developed in detail by V.P. Obraztsov and called the method of deep, sliding, methodical, topographic palpation. Its essence is to, on exhalation, penetrate the brush into the depths of the abdominal cavity and, sliding the fingertips along the back wall of the abdomen, feel for the organ under study, after which, rolling over it with your fingers, determine its properties.

During the study, the doctor puts the palm of his right hand on the anterior abdominal wall in the area of the palpable organ so that the tips of closed and slightly bent fingers are in line and parallel to the longitudinal axis of the part of the intestine being examined or the edge of the palpable organ. The greater palea is not involved in palpation. During the study, the patient should breathe evenly, deeply, through the mouth, using diaphragmatic breathing. In this case, the abdominal wall should rise on inspiration, and on exhalation - fall. After asking the patient to take a breath, the doctor moves the skin of the abdomen forward with the fingertips of the palpating hand, forming a skin fold in front of the fingers. The supply of skin obtained in this way facilitates the further movement of the hand. After that, on exhalation, taking advantage of the lowering and relaxation of the anterior abdominal wall, the fingers are smoothly immersed deep into the abdomen, overcoming the resistance of the muscles and trying to reach the posterior wall of the abdominal cavity. In some patients, this can be done not immediately, but within a few respiratory movements. In such cases, during inspiration, the palpating brush must be held in the abdomen at the achieved depth in order to penetrate even deeper with the next exhalation.

At the end of each exhalation, the fingertips slide in the direction perpendicular to the length of the intestine or the edge of the organ under study, until it comes into contact with the palpable formation. In this case, the fingers should move along with the skin underlying them, and not slide along its surface. The discovered organ is pressed against the back wall of the abdomen and, rolling across it with the fingertips, a palpation is carried out. A fairly complete picture of the properties of the palpated organ can be obtained within 3-5 respiratory cycles.

If there is tension in the abdominal muscles, it is necessary to try to cause their relaxation in the palpation zone. For this purpose, the radial edge of the left hand is gently pressed on the anterior abdominal wall away from the palpable area.

The colon is palpated in the following sequence: first the sigmoid colon, then the cecum, ascending, descending and transverse colon.

Normally, in the vast majority of cases, it is possible to palpate the sigmoid, cecum, and transverse colon, while the ascending and descending colons are palpated intermittently. On palpation of the colon, its diameter, density, nature of the surface, mobility (displacement), the presence of peristalsis, rumbling and splashing, as well as pain in response to palpation are determined.

Sigmoid colon located in the left iliac region, has an oblique course and almost perpendicularly crosses the left umbilical-awn line on the border of its outer and middle thirds. The palpating brush is placed in the left iliac region perpendicular to the course of the intestine so that the base of the palm rests on the navel, and the fingertips are directed towards the anterior superior spine of the left iliac bone and are in the projection of the sigmoid colon. The skin fold is displaced outward from the intestine. Palpation is carried out by the described method in the direction: from the outside and from below - inside and up (Fig. 44).

You can use another method of palpation of the sigmoid colon. The right hand is brought in from the left side of the body and positioned so that the palm lies on the anterior superior spine of the left iliac bone, and the fingertips are in the projection of the sigmoid colon. In this case, the skin fold is displaced inside from the intestine and palpated in the direction: from the inside and from above - outwards and down (Fig. 45).

Normally, the sigmoid colon is palpable for 15 cm in the form of a smooth, moderately dense cord with a diameter of the thumb. It is painless, does not growl, sluggishly and rarely peristaltes, easily shifts on palpation within 5 cm. When the mesentery or the sigmoid colon itself (dolichosigma) is lengthened, it can be palpated "significantly more medially than usual. Cecum is located in the right iliac region and also has an oblique course, crossing the right umbilical-awn line at the border of its outer and middle thirds almost at a right angle. The palpating brush is placed in the right iliac region so that the palm rests on the anterior superior spine of the right iliac bone, and the fingertips are directed towards the navel and are in the projection of the caecum. On palpation, the skin fold is shifted medially from the intestine. Palpate in the direction: from the inside and from above - outwards and down (Fig. 46).

Normally, the caecum has the shape of a smooth, soft-elastic cylinder with a diameter of two transverse fingers. It is somewhat expanded downwards, where it blindly ends with a rounded bottom. The intestine is painless, moderately mobile, growls when pressed.

In the right iliac region, it is sometimes possible to palpate also terminal ileum, which from below obliquely flows from the inside into the caecum. Palpation is carried out along the inner edge of the caecum in the direction from top to bottom. If the ileum is reduced and accessible for palpation, it is defined as a smooth, dense, movable, painless cord 10-15 cm long and no more than a little finger in diameter. She periodically relaxes, emitting a loud rumbling, and at the same time, as it were, disappears at hand.

Ascending and descending colon located longitudinally, respectively, in the right and left lateral regions (flanks) of the abdomen. They lie in the abdominal cavity on a soft base, which makes them difficult to palpate. Therefore, it is necessary to first create a dense base from below, to which the intestine can be pressed when it is felt (bimanual palpation). For this purpose, during palpation of the ascending colon, the left palm is placed under the right lumbar region below the XII rib in the direction transverse to the body so that the tips of closed and straightened fingers rest against the outer edge of the long muscles of the back. The palpating right hand is placed in the right right flank of the abdomen transversely to the course of the intestine so that the base of the palm is directed outward, and the fingertips are 2 cm lateral to the outer edge of the rectus abdominis muscle. The skin fold is displaced medially to the intestine and palpated in the direction from the inside to the outside. At the same time, the fingers of the left hand press on the lumbar region, trying to bring the posterior abdominal wall closer to the palpating right hand (Fig. 47a).

When feeling the descending colon, the palm of the left hand is advanced further behind the spine and placed transversely under the left lumbar region so that the fingers are outward from the long muscles of the back. The palpating right hand is brought in from the left side of the body and placed in the left flank of the abdomen transversely to the course of the intestine so that the base of the palm is directed outward, and the fingertips are 2 cm lateral to the outer edge of the rectus abdominis muscle. The skin fold is displaced medially to the intestine and palpated from the inside to the outside, while pressing with the left hand on the lumbar region (Fig. 47b).

The ascending and descending colons, if they can be felt, are mobile, moderately firm, painless cylinders about 2 cm in diameter.

Transverse colon palpated in the umbilical region simultaneously with both hands (bilateral palpation) directly through the thickness of the rectus abdominis muscles. To do this, the palms are placed longitudinally on the anterior abdominal wall on both sides of the midline so that the fingertips are located at the level of the navel. The skin fold is shifted towards the epigastric region and palpated from top to bottom (Fig. 48). If the intestine is not found at the same time, palpation is repeated, slightly shifting the initial position of the fingers first above and then below the navel.

Normally, the transverse colon has the shape of a transversely lying and arched downward, moderately dense cylinder with a diameter of about 2.5 cm. It is painless, easily shifted up and down. If it was not possible to feel the transverse colon, palpation should be repeated after finding the greater curvature of the stomach, which is located 2-3 cm above the intestine. At the same time, it must be borne in mind that with severe visceroptosis, the transverse colon often descends to the level of the pelvis.

In the presence of pathological changes in the colon, pain in one or another of its departments can be detected, as well as a number of other signs characteristic of certain diseases. For example, local expansion, compaction and tuberosity of the surface of a limited area of the colon most often indicates its tumor lesion, although sometimes it can be caused by a significant accumulation of solid fecal masses in the intestine. Uneven beaded thickening and thickening of the wall of the colon or terminal ileum are observed with intestinal granulomatosis (Crohn's disease) and its tuberculous lesion. The alternation of spastically contracted and swollen gas areas, the presence of loud rumbling and splashing noise is characteristic of diseases of the colon of inflammatory (colitis) or functional origin (irritable bowel syndrome).

In the presence of a mechanical obstacle to the movement of fecal masses, the overlying part of the intestine increases in volume, often and strongly peristaltizes. Causes of mechanical obstruction can be cicatricial or tumor stenosis of the intestine or its compression from the outside, for example, during the adhesive process. In addition, in the presence of adhesions and colon cancer, the mobility of the affected area is often significantly limited.

If there is local pain in the abdomen, but the palpation of the intestine located in this section does not cause pain, this indicates a pathological process in neighboring organs. In patients with ascites, the presence of even a small amount of free fluid in the abdominal cavity significantly complicates palpation of the colon.

Small intestine usually not available for palpation, because it lies deep in the abdominal cavity and is extremely mobile, which does not allow it to be pressed against the posterior abdominal wall. However, with an inflammatory lesion of the small intestine (enteritis), it is sometimes possible to probe its loops swollen with gas and making splashing noise. In addition, in patients with a thin abdominal wall, deep palpation in the umbilical region makes it possible to detect enlarged mesenteric (mesenteric) lymph nodes in case of inflammation (mesadenitis) or cancer metastases.

Methodology for studying the objective status of the patient Methods for studying the objective status General examination Local examination Cardiovascular system Respiratory system Abdominal organs

When palpating the abdomen, the intestines are palpated from below as a rigid tube (namely, only the sigmoid intestine), this is constant, does not go away at all. The sigmoid colon is as hard as a tube. I think you understand.

The stool is most often not formed, it is mushy, not liquid, it is lumpy, creamy, with wateriness. There is no pain. But like for a long time there were pains in the bottom of a stomach or belly. I go to the toilet as if not with ease, the feces seem to be difficult to go.

I also have neurosis, phobic anxiety disorder, hypochondria.

From the tests, I passed a coprogram - excellent, a general blood test - excellent, a biochemistry blood test (alt, ast, bilirubin, protein, urea, creatinine, amylase) - everything is fine, I also passed oncomarkers REA, AFP, CA everything is fine. Passed FGDS - gastroduodenitis, and did an ultrasound of the abdominal cavity - diffuse changes in the pancreatic perenchyma, bending of the bile duct, signs of intrahepatic holistasis.

I can’t do a colonoscopy because of the main diagnosis of neurosis.

What could it possibly be? Very worried. Thanks in advance for your replies.

After receiving the answer, do not forget to rate ("rate the answer"). I am grateful to everyone who found it possible and necessary to rate the answer!

God bless you never have a reason to go to the doctor! And if you have to, then do not delay.

Psychotherapy. Teaching sanogenic thinking. Osteopathy. Homeopathy. Reflexology. Sale of devices for home treatment - Tuning fork, DeVita-RITM, DeVita-AP.DeVita-Cosmo. DeVita Energy. Functional food. Weight correction. Postcard "Longevity". Razumrud -2. Detensor therapy.

Yours sincerely, General Director of the Research and Production Institute of Public Relations "Health Image"

Other options (congenital anomaly, oncology) are excluded by your description of the disease.

Yes, srk can be like that. Yes, such a long spasm. And not only in the sigmoid colon. In other departments it is simply impossible to probe.

Treatment of inflammation of the sigmoid colon, its symptoms and diagnosis

The intestinal canal is divided into several sections, each of which perform its specific function. The digestive system is responsible not only for the digestion of food, but also for immune function. One of the important sites is the sigmoid colon. What is it and why is it needed? Let's figure it out.

Reasons for the development of pathological processes

In appearance, the sigmoid colon resembles the Latin letter sigma. The length of the sigmoid colon is about sixty centimeters. Its main function is to digest food, absorb water and saturate the body with it. Also, the formation of fecal masses occurs in it.

Where is the sigmoid colon located? This site is located on the left side in the retroperitoneal space. In the female half of the population, it is located directly behind the uterine cavity. In men, the sigmoid colon is located behind the bladder.

This type of intestinal tract is considered one of the largest. The unusual shape allows you to hold moving food, so that it is digested and formed into feces. From the sigmoid colon, the mass passes into the rectum, from where it exits.

Often in practice there is a disease such as sigmoiditis. It is characterized by the development of an inflammatory process, which occurs due to stagnation of feces and the ingress of an infectious agent as a result of injury to the mucous membrane.

The causes of the development of the disease in the sigmoid colon are:

violation of blood flow in the pelvic organs;
dilation of venous vessels;
diseases of the rectum in the form of fissures in the anus, proctitis, paraproctitis, Crohn's disease;
colibacillary type infections, dysentery, dysbacteriosis in the intestinal canal;
malnutrition, lack of vitamins and minerals, lack of foods that are rich in fiber;
sedentary lifestyle;
persistent constipation;
deterioration of digestive peristalsis;
diseases of the digestive system in the form of duodenitis, cholecystitis, enzyme deficiency;
pathological processes in the prostate gland;
chronic diseases in women;
increased pressure on the intestine during the period of bearing a baby;
surgical interventions on the abdominal cavity;
injury to the abdomen.

If a person has encountered at least one of the above reasons, then it is worth visiting a doctor for a consultation and further examination. The sooner an ailment is detected, the easier and faster it will be cured.

Types of sigmoiditis

The inflammatory process in the sigmoid intestine can have an acute and chronic course.

The acute process is characterized by vivid symptoms. It develops against the background of injury or ingestion of infectious agents.

The chronic course proceeds sluggishly. Most often characterized by a disorder of the intestinal canal and dysbacteriosis.

Often, sigmoiditis is divided according to the nature of the damage. These include:

catarrhal form. This type of disease is the easiest. The inflammatory process affects only the surface layer of the epithelium;
erosive form. Often observed as a result of untreated catarrhal sigmoiditis. With such a pathology, erosions form on the mucous membrane. When food is digested, bleeding occurs;
ulcerative form. This type of disease is considered the most severe. It is characterized by the formation of ulcers on the mucous membrane. Moreover, their number can be several, and also have different depths and localization. Often manifested due to ineffective treatment of erosive sigmoiditis.

Usually patients ignore the catarrhal type of sigmoiditis, since symptoms do not always occur. It is much harder to cure the ulcerative form.

Symptoms of the disease

Symptoms and treatment depend on the course and form of the disease. The sooner the patient detects unpleasant signs and turns to a specialist, the more the treatment process will pass without complications.

Symptoms of sigmoiditis are manifested in the following:

painful sensations. Pain in the sigmoid colon is intense, and localized on the left side;
development of spasms. Can give to the left leg and lumbar region;
bloating;
liquefied stools of a frequent nature. Feces have an unpleasant odor. There may be blood or purulent impurities;
signs of intoxication in the form of blanching of the skin, weakness;
nausea and vomiting.

These signs characterize the disease in the acute period.

If the sigmoid colon has been damaged for a long time, and the disease has acquired a chronic course, then the disease will manifest itself:

in alternating diarrhea and constipation;
in a feeling of fullness in the abdomen;
in painful sensations that occur during the emptying of the intestinal canal.

Inflammation of the sigmoid colon of this type leads to a deterioration in the digestion and absorption of food. If the disease is not treated for a long time, then the person loses weight, lacks nutrients. The long presence of feces in the sigmoid region can lead to the development of allergic reactions. Chronic sigmoiditis is characterized by periodic exacerbations and remissions.

Methods for diagnosing the sigmoid colon

Inflammation of the sigmoid colon is quite difficult to diagnose. Often sigmoiditis is confused with another disease in the form of acute appendicitis. If the sigmoid colon begins to hurt, then it is urgent to consult a specialist.

He will listen to the patient's complaints and palpate the abdomen. An experienced doctor will immediately be able to determine the location of the inflammatory process and prescribe an appropriate examination.

To identify inflammation of the sigmoid colon, you need:

donate blood for analysis;
pass feces;
conduct an x-ray;
perform an irrigoscopy using a contrast agent;
perform sigmoidoscopy.

During the diagnosis, it is necessary to determine the cause of the manifestation of the disease. If the diagnosis is erroneous, then the sigmoid colon will not be able to fully carry out its functions.

Features of the treatment of the sigmoid colon

Treatment of sigmoiditis is considered a difficult and rather lengthy process. It requires the patient to comply with all the recommendations of the doctor. The treatment process is based on diet and medication.

Nutrition for sigmoiditis

If the intestines are affected, the sigmoid colon will not be able to fully digest food and absorb water. As a result, the feces will stagnate or come out with undigested pieces of food.

In acute cases, food should be sparing. It means eliminating irritating foods from the diet.

Treatment of sigmoiditis with a diet excludes the consumption of foods that are rich in carbohydrates and fats. This process leads to inhibition of digestion and the development of fermentation.

From the diet are completely excluded:

fresh pastries and bread;
fatty, fried foods;
meat and sausages;
soups and cereals with milk;
strong meat broths;
fish and canned food;
caffeinated and alcoholic drinks;
marinades, spices, seasonings, smoked meats.

For seven days, the menu should consist of vegetable broth and cereals. As a drink, you can use green tea, infusions of berries, decoctions of wild rose. Also in the diet should include baked apples.

Gradually, the menu can be expanded. But the emphasis should be on preventing congestion in the sigmoid colon and the appearance of constipation.

Medical therapy

If the sigmoid colon is affected, the location of the pain sensation will be on the left side. An unpleasant feeling may occur during or after eating, when emptying the intestinal canal.

To get rid of this, the patient is prescribed treatment, which includes:

painkillers and antispasmodics;
antibacterial medicines in the form of Doxycycline, Tetracycline, Phthalazole;
means of an adsorbing nature in the form of Smecta or Neo-smectin;
enveloping and astringent type medicines. These include:
Almagel;
drugs with anti-inflammatory properties.

Treatment of sigmoiditis also involves the restoration of intestinal microflora. For this, the patient is prescribed probiotics in the form of Acipol, Bifidumbacterin. The duration of treatment therapy is from seven to fourteen days.

Alternative methods of treatment of inflammation of the sigmoid colon

You can restore the work of the digestive organ with the help of folk remedies. They are used as adjunctive therapy to reduce inflammation and stop diarrhea.

There are several effective recipes.

In equal proportions, herbs are taken in the form of sage, mint, St. John's wort. Herbal collection is poured with a cup of boiled water and infused for thirty to forty minutes. Then it is filtered.

The finished product should be taken up to three times a day, one hundred milligrams, thirty minutes before eating.

Second recipe.

Mint, motherwort and nettle are mixed in the same ratio. The mixture is poured with a cup of boiled water and infused for about forty minutes. Then it is filtered.

It is necessary to use the medicine up to four times a day for sixty milliliters. The duration of treatment is three weeks.

Third recipe.

To make the solution, chamomile, sage and calendula are taken. It is poured with a mug of boiled water and infused. Then it is filtered and cooled to a temperature of 37 degrees.

The solution is injected into the intestinal canal and held for at least ten minutes. It is necessary to carry out these manipulations before a night's rest for fourteen days.

When the first signs appear, you should immediately consult a specialist.

The information on the site is provided for reference purposes only. Do not self-medicate. At the first sign of disease, consult a doctor.

Sigmoid colon is hard

Along with excessive mobility, one can encounter the opposite phenomenon - limitation of mobility or almost immobility of the sigmoid colon. This, as a rule, with the exception of rare cases of congenital short mesentery, occurs when the intestine is fixed by an inflammatory process of the outer lining of the intestine, leading to the development of adhesions between the intestine and the posterior wall of the abdominal cavity (perisigmoiditis).

In such cases, attempts to move the sigmoid colon in one direction or another are not only unsuccessful, but sometimes cause severe pain in the patient due to the tension of the adhesions.

Following mobility, attention is paid to the thickness and consistency of the palpable intestine. Sometimes the sigmoid colon is palpated in the form of a thin, dense consistency of a strand as thick as a pencil or even thinner. Often, with a similar palpation picture, the patient experiences pain during palpation. These properties are due to spasm, which, for example, can be established in spastic colitis; this is very characteristic of dysentery. It should be pointed out that sometimes during palpation the sigmoid colon can be felt either of the usual width, or of a thinner and at the same time more dense consistency. It depends on the peristaltic movements caused by repeated movements.

Thicker than normal, the sigmoid colon occurs primarily when it is filled with feces and gases. If the contents of the intestine are liquid and at the same time there is an accumulation of gases, then rumbling or splashing is felt on palpation of the intestine. Splashing on palpation is one of the objective symptoms of the band, however, it should be remembered that it also happens in patients who, shortly before palpation, were injected with liquid through the rectum, for example, a cleansing enema, etc.

If stool masses stagnate in the sigmoid colon for a long time, then as a result of partial absorption of the liquid by the intestinal wall, they harden significantly and give the palpable intestine a significant density. In some cases, such dense fecal masses appear to be heterogeneous and form, as it were, calculi - the so-called fecal stones (scybala). On palpation of the sigma containing fecal stones, the intestine is palpated hard and bumpy-beaded. The same intestine is found in the tuberculous process, severe ulcerative colitis, or, finally, in a neoplasm. It is not difficult to distinguish these relatively innocent fecal stones from a neoplasm or process in tuberculosis by probing the intestine a second time after a previously made cleansing enema.

Thickening of the intestine may also be the result of the development of the pericolytic process. Then, if the process has not yet stabilized, the sigmoid colon is not clearly contoured in the form of a wider motionless cylinder of pasty consistency, painful on palpation; in addition, an infiltrate is palpable in the left iliac region.

Finally, with intestinal atony in general and in particular with atony of the sigmoid colon, the latter is palpable in the form of a wide soft ribbon with a transverse diameter of up to 2-3 fingers. A particularly significant expansion of the palpable intestine occurs when it is damaged by a neoplastic process, tuberculosis, or with intestinal polyposis. Naturally, in these cases, the consistency of the probed segment also changes.

The severe pain felt by the patient during palpation is in most cases due to the inflammatory process in the intestine itself and especially in its serous membrane. First of all, significant pain occurs in dysentery, ulcerative colitis, advanced proctosigmoiditis. Sometimes this soreness can be caused by an inflammatory process of the peritoneum in the circumference of the intestine, the starting point of which in women is the genital area.

Interesting medical articles.

Diseases of the sigmoid colon can be inflammatory (acute intestinal infections, ulcerative colitis, pseudomembranous colitis) or non-inflammatory in nature (cancer, polyps, malformations, etc.).

Difficulties arise in the diagnosis of inflammatory diseases, since the clinical picture is quite similar. The changes found in the sigmoid colon are nonspecific and can be a manifestation of both nonspecific colitis and acute intestinal infection.

The defeat of the sigmoid colon rarely occurs in isolation, more often it is part of an extensive process that affects other parts of the intestine.

Most pathological changes in the sigmoid colon are manifested by the following symptoms:

pain in the abdomen, which is more often dependent on food intake and is non-localized;
change in stool (constipation, diarrhea);
the presence of pathological contents in the feces (blood, mucus);
intoxication syndrome (fever, loss or lack of appetite, weight loss).

Diseases of the sigmoid colon

Dolichosigma

It is an anomaly in the development of the large intestine, its sigmoid part. It manifests itself in the form of lengthening of the intestine without a decrease in its diameter and is not accompanied by a change in the muscular wall of the sigmoid colon. It is diagnosed in 30% of the population and does not manifest itself clinically. Dolichosigma is detected in most cases in childhood, when the child is examined for constipation.

There are several clinical forms of dolichosigma:

latent form. It is discovered by chance during the examination, it is not clinically manifested by anything.
pain form. Disturbed by pain in the abdomen, more often in its left half without irradiation.
The dominance of constipation in the clinic. Dolichosigma is the cause of constipation in 25-40% of children. On palpation, fecal stones are felt in the abdomen, hard to the touch.
mixed form.

Symptoms of dolichosigma appear when intestinal motility changes, when the evacuation function is disturbed and intestinal contents stagnate. Appears bloating, rumbling, abdominal pain, constipation. Against the background of congestion, intestinal dysbacteriosis develops, inflammatory changes that require urgent examination and treatment.

Diverticulosis

A diverticulum is a protrusion of the intestinal wall. The presence of multiple diverticula is designated by the general term. The main reason for the development of this condition is the weakness of the intestinal wall, which, under the influence of various factors, begins to protrude.

Risk factors for diverticulosis include the following:

frequent constipation in history;
long-term use of laxatives;
, which is accompanied by bloating and flatulence;
excess body weight;
inflammatory processes in the intestine.

The course of this disease can be uncomplicated and complicated. In some people, diverticula are not clinically manifested, so a person is not always aware of their presence in the intestine.

The main symptoms of uncomplicated sigmoid diverticulosis include:

pain in the abdomen without a clear localization, appear after eating;
constipation, which can be replaced by diarrhea;
rumbling, bloating (flatulence);
color of feces without features.

A complicated course is said to be in the case when the evacuation of intestinal contents from the diverticulum is disturbed, inflammation develops - diverticulitis. It is manifested not only by symptoms from the sigmoid colon (pain, bloating, rumbling, etc.), but also by the appearance of signs of an inflammatory process: body temperature rises, mucus or blood appears in the feces, diarrhea becomes constant, abdominal pain intensifies, changes. On palpation, the abdomen is painful in the projection of the diverticula on the anterior wall of the abdomen.

In extremely severe cases, diverticulitis leads to bleeding, the development of strictures (narrowing), perforation (violation of the integrity of the intestinal wall), intestinal obstruction, abscess, and can be fatal.

Polyps of the sigmoid colon

A polyp is a pedunculated tumor that grows from the intestinal wall. Polyps of the sigmoid colon, rectum, and stomach are most common. The true cause of the formation of polyps has not been fully established. Most polyps are asymptomatic. Glandular polyps are considered as a precancerous disease.

Adenocarcinoma of the intestine in 95% of cases develops from a benign polyp. In the presence of a plural number of polyps, the term "polyposis" is used, which in some cases is familial, therefore, hereditary polyposis syndromes are distinguished (Gardner's syndrome, Peutz-Jeghers, Turco, etc.).

Clinically manifested by cramping abdominal pain, mimic the clinic of incomplete intestinal patency. A characteristic symptom of polyps is a strip of blood on the stool. The nature of the stool often remains unchanged. In an uncomplicated course, abdominal distension is rare.

Cancer of the sigmoid colon

The clinical picture of cancer depends on the stage of the malignant process, the structure of the tumor and the prevalence of the process. Of all malignant bowel processes, sigmoid colon cancer is detected in 25% of cases.

There is a triad of symptoms that are characteristic of the localization of the tumor in the sigmoid colon and the descending colon:

The appearance of pathological discharge from the anus, which may not be associated with the act of defecation. The discharge may be mucous, purulent or bloody.
Intestinal disorders (diarrhea and constipation, urge to defecate -), which may alternate.
Formation of intestinal obstruction.

A person is concerned about cramping or aching pain in the left lower abdomen, which can spread to the groin, back. There are frequent urge to defecate, constipation or diarrhea. Blood impurities are detected in the feces. On examination, a tumor of a certain size is already detected by palpation of the abdomen.

At the same time, symptoms of severe anemia, general intoxication (fever, lack of appetite, weight loss, etc.) join the symptoms of damage to the sigmoid colon. Early stages may be asymptomatic.

A feature of tumors of the sigmoid colon is the early development of intestinal obstruction and bleeding.

Sigmoiditis

- this is inflammation of the sigmoid colon, which occurs with inflammatory diseases of known etiology - acute intestinal infections (, etc.) and unclear etiology (ulcerative colitis, deep cystic colitis, etc.). Very rarely manifests itself without the involvement of other parts of the large intestine.

Common symptoms include abdominal pain, changes in the nature of the stool, loss of appetite. In acute intestinal infections, the clinical picture will have a number of features that depend on the characteristics of the pathogen.

In all forms, the sigmoid colon is affected. Diarrhea and bleeding in ulcerative colitis are the main symptoms, tenesmus, cramping abdominal pain before defecation, fever, and weight loss are also disturbing.

Other diseases

nonspecific ulcerative colitis;
diffuse familial polyposis.

Diagnostics

If at least one of the above symptoms appears, you must first contact a general practitioner or gastroenterologist. According to the results of the survey and the initial examination, a person is assigned additional methods for examining the sigmoid colon:

. It is possible to examine the rectum and the lower part of the sigmoid colon with a sigmoidoscope. Using this method, the mucous walls of the intestine are examined, polyps, tumors, and erosive processes are detected. Biopsy material may be taken.
. A long advanced endoscope is used, which allows you to examine all parts of the large intestine, unlike a sigmoidoscope.
. It is used to accurately determine the location of the tumor, its size, the presence of pathological formations that displace the intestine. Using this method, an inflammatory process in the sigmoid colon is detected.
. A more informative method compared to computed tomography in cancer search. High resolution allows to detect neoplasms of the sigmoid colon without the introduction of contrast agents, accurately determines the size of tumors, the presence of metastases in other organs and tissues.
. The method is based on x-ray examination of the intestine with a contrast agent. With the help of irrigography, it is possible to determine developmental anomalies, the shape of the intestine, its length, peristalsis, the presence of pathological formations, the presence of obstruction, erosion.

Therapeutic measures

Treatment of any disease is carried out in three directions:

etiological treatment. It is aimed at eliminating the cause of the disease.
pathogenic treatment. It is aimed at eliminating the pathological mechanisms at the heart of the disease.
symptomatic treatment. Designed to manage symptoms.

To implement these areas, medical and surgical methods of treatment are used.

Surgical methods include:

Resection of the intestine (removal of the intestine).
Endoscopic removal of polyps.

Surgical treatment is primarily used in the treatment of polyps and cancerous processes; there is no full-fledged drug replacement. Chemotherapy is prescribed as an adjuvant treatment.

Prevention

Compliance with a number of preventive measures can significantly reduce the risk of developing diseases of the sigmoid colon:

personal hygiene reduces the risk of developing acute intestinal infections;
food rich in fiber provides, reducing the frequency of constipation;
timely diagnosis and treatment of diseases of the sigmoid colon;
physical activity contributes to the normal functioning of the entire gastrointestinal tract;
timely removal of polyps.