The Endo Belly Problem You’ve Never Heard Of: A Redundant Colon
Last year I had a colonoscopy and endoscopy procedure. Colon cancer runs strong on my mom’s side, and my father had just died from esophageal cancer, so it felt like a smart move. Not to mention that, after my father died, I started having pretty severe pain in my upper right quadrant. I couldn’t drink coffee, take probiotics, or eat too much food without a burning sensation and pain. I felt puffy and bloated. It was scary; I wondered if the stress of my father’s passing gave me ulcerative colitis … or something worse?
So I drank the purging solution so they could scope my intestinal tract! This means you are “relieved” of all the contents in your intestines, btw. No eating solid food, just purging what’s already inside so they can have a clean look.
What did they find? Nothing important, I was told. All looks good! No ulcers, tissue samples healthy, no reason for my pain.
Except…
My (very) annoyed gastroenterologist told me afterward that my large intestine was “so long and wiggly and loopy” that it made my colonoscopy challenging. He seemed to think this was my fault. (Seriously—where do these doctors come from?). He wasn’t diagnosing me; he was complaining to me, about me. And I wouldn’t have remembered since I was still so fresh from my drowsy procedure, except it was written in my evaluation note. Again, not a diagnosis, just an offhand remark:
“Patient has a redundant colon.”
Didn’t seem like a big deal, except to annoy my gastroenterologist. But the strangest thing was that the pain in my upper third quadrant completely disappeared after the procedure. My puffyness, swolleness, and bloating too. I wondered what about the procedure could have helped it? Or, was it psychosomatic?
I put on my research glasses, dove into medical journals, and discovered game-changing information I’d never heard about: the redundant colon.
What Is a Redundant Colon?
A redundant colon (RC) is a term for a large intestine that’s longer than normal. Redundant means exceeding what is necessary or normal, and in the case of a redundant colon, these “redundancies” refer to where there is excess length—which could be at the right, middle, and/or left part of the colon and at the flexures. [1] If you look at the images below, you will see a normal large intestine to the left, following a predictable path, whereas images of a redundant colon are on the right, and you can see they don’t play by the rules. It can form extra loops, twists, and turns, making it unique to each person.
Some also call it a tortuous colon, (although this usually refers to a too-long large intestine that also has some severe twists/bends) or a more medical term: dolichocolon.
It’s generally agreed that we are born with RCs, called an inborn anatomic variant. This can help with the suspected diagnosis since your symptoms (often constipation, slow transit time, bloating/distention, perhaps some pain) would have followed you from childhood.
What are the symptoms of a Redundant colon?
Interestingly, RCs don’t always cause symptoms, and they may not be rare either. Up to a 1/3 of us have a longer-than-normal large intestine to some degree! This, I believe, is what gastroenterologists are taught when they seem to (commonly) disregard patients suffering from symptoms and barely mention RCs.
However, they can also make you incredibly symptomatic! The biggest complaints are slow transit and constipation, along with bloating, abdominal distention (does your tummy poke out even when you’re not bloated?), and pain. One study showed that while those without an RC had a took 36 hours from eating to pooping (called “transit time”). This transit time was increased for those with a RC: those with one redundancy had increased transit time by 6 hours… and 16 hours (!) for those with three to four redundancies.[2]
16 more hours of transit is a long time, my friends.
This is why some of the women I know with an RC are truly impacted (pun intended). They cannot seem to form a solid bowel movement at all, for years, instead referring to the “pelleted” state of the stool, the feeling of incomplete evacuation, the uncomfortable bloating… They never get relief. This level of constipation? it’s anxiety-inducing.
Lesser described (but perhaps not rare) symptoms may also include general weakness, headache, and “mild fever attacks suggested to be caused by a toxic condition because of fecal stasis.” [1]
I would add to this list the potential for pelvic floor dysfunction, core dysfunction, prolapse, and hernias—all pressure-related symptoms. Seriously, imagine how keeping all those extra innards inside can cause a heap of issues for some of us, as the pressurized contents only have so much abdominal room before they are pushed upwards (stomach hernia) or downwards (pelvic floor dysfunction or prolapse).
So, in all, a redundant colon can cause many issues we also refer to as “endo belly.”
A Redundant Colon and Endometriosis: 31%
While only 1.9–3% of the general population without GI complaints appear to have a redundant colon (although the numbers may vary widely!), the numbers skyrocket in those with chronic constipation—up to 30%. [1]
For bowel endometriosis sufferers, it’s significant as well: 31% of patients with rectosigmoid endometriosis (endometriosis affecting the bowel) were found to have a redundant colon. [2] And this issue may both exacerbate symptoms, and vice versa.
For example, for patients with endo and a redundant colon who underwent successful excision surgery for their bowel endometriosis, many didn’t see relief from bloating and constipation the way their peers did post-surgery. Those with a normal intestinal length did, so why didn’t they? Because their redundant colon remained a factor—its size and fermentation load continued to cause trouble.
Conversely, having a redundant colon, with inflammation, potential for bacterial overgrowths, and slow motility, may worsen endometriosis. They’re kind of like friends that are bad influences on each other. Let’s learn why
How Does a redundant colon interact with Endo?
Your large intestine differs significantly from your small intestine. It’s where fermentation happens: bacteria feast on fibers, FODMAPs, and polyphenols, producing gas. It’s also where your body absorbs water. [Both gas-making and water-absorbing are key pieces to understand as we talk treatment, so don’t disregard that important info!']
Now, add extra length to this factory. You get:
Too much fermentation → More hydrogen production, meaning bloating but also an overproduction of certain chemicals that can lead to intestinal damage and inflammation.
Too little motility → Slower transit, leading to constipation.
Pelvic pressure and pain → All that extra mass pressing down and out.
Too much water absorbed → Only drink a few cups of water today? Cool, that was absorbed in a few feet of intestines … but you have 3 extra feet to go. This is how you can get impacted stool, making the constipation soooooo much worse.
This is how you get the aforementioned symptoms. However, when this interplay of issues is doing a dance with a chronic inflammatory disease, things can get more tricky.
Dysbiosis and subsequent Inflammation
Having an RC and slow transit can contribute to something called intestinal methane overgrowth (IMO). It’s similar to SIBO, although it’s not relegated to the small intestine (hence why it’s not called SIMO). The methane-producing critter (Methanobrevibacter smithii, a type of archaea) can live anywhere in your intestinal tract, and it eats hydrogen! This means if your intestinal tract is too long (producing more hydrogen gas than is beneficial), and you have this archaeon, it can significantly overgrow and produce a heck-of-a-lot of methane.
And, methane is a gas that alters gut motility! Basically, it is a factor that causes constipation. And if you have it in excess thanks to this overgrowth, it can realllly slow things down. And as transit slows, the archaea have even more food (hydrogen gas produced by fermentation) and continue to overgrow. It’s a sick cycle.
The overgrowth of archaea also means the undergrowth of other beneficial microorganisms and the increase of inflammation-provoking chemicals produced by the archaea and bacteria, leading to the breakdown of the intestinal wall. This is where a “leaky gut” can develop and where toxins from the intestinal tract can leak out into the peritoneal cavity. I write all about the effect of leaky gut on endometriosis here.
In all, if your transit is so slow it has led to dysbiosis, the dysbiosis can impact endometriosis both directly and indirectly.
Pelvic Floor Dysfunction
I am on the left; just woke up. Friend on right, 5 months pregnant. I was joking with a side by side., but really my tummy always looked slightly distended. Can you relate?
Imagine you have an abdomen-sized shopping bag. You put 5 feet of thick rope in it, and it fits perfectly. Now shove in 3 more feet! Imagine how the seams would be bulging, the cloth spread painfully tight, the rope spilling out. Yeah, that’s similar to what happens in a human abdomen with 3 feet of extra intestine.
Of course, yours may not be three feet. It could be one foot, or perhaps 10 ft (OMG but true). But it’s not just the extra feet, right? It’s also all the fecal matter inside it and the gas being produced. It can be a lot of extra weight, even in just a little bit of extra intestine.
As I mentioned before, having too much mass in the abdomen can lead to increased intra-abdominal pressure and related issues, like pelvic floor dysfunction and core dysfunction. And yes, both of these are also associated with endometriosis!
Detoxification Issues
Your intestinal tract does a few things, but one thing it supports is detoxification. Here’s how: Your liver conjugates toxins from your blood. Then, it puts the toxins in your gallbladder in the form of bile. When you eat fat, your gallbladder “squirts” bile into the intestinal tract to help break down the fat and eliminate the toxins into the toilet. Win-win
Now, if your transit is slow, it leaves more time for the “trash,” so to speak, to be reabsorbed. And, as icing on the cake, if you have leaky gut it is MUCH easier to get reabsorbed because it literally leaks back into your bloodstream (along with LPS and bacteria). Helloooooo increased toxic load, also highly associated with endometriosis.
what to do? My Redundant Colon Journey
Getting a reduandant colon diagnosis — perhaps the least sexy diagnosis ever — was an “aha!” moment for me. I’d always joked about my belly being like an inflated balloon (distention), a problem that had followed me since childhood. Constipation had been a lifelong companion—not severe enough to disrupt my life but definitely something I had to manage. My IMO would go away… but then it seemed to pop back up. Stomach pain that occurred when I would get “backed up” a bit. I had pain in my abdomen that went away when I made absolutely sure I was having great (not mediocre) bowel movements every day.
So while I knew I couldn’t totally “fix” an RC (they don’t go into remission), it WAS something I could manage. And that’s a huge relief!
Here is what I learned from my own journey, as well as research, on how to mitigate the challenges of a too-long large intestine.
8 simple Tips for Living with a Redundant Colon
1. Consider a Diagnosis
Barium enemas can diagnose redundant colons, as well as MRIs or a colonoscopy, depending on who you are and what your doctor is up for. Of course, your GP may not even know what an RC is, so you’ll have to be referred to a gastroenterologist to talk about this all. Hopefully, yours will be less annoyed by your large intestinal length than mine.
But if you’ve been dealing with chronic constipation, abdominal or pelvic pressure, methane, etc for a long time, and to no avail, it’s worth getting a diagnosis! Then you’ll know you have a few inches to a few feet (really!) more large intestine than the average Jane. It can help you to stop seeking “root causes” that don’t exist.
I can’t tell you how much KNOWING about this issue has allowed me to relax about lingering digestive issues and simply manage them (rather than trying to totally fix them, which you really can’t with a super long large intestine).
2. Drink Plenty of Water
Since your large intestine absorbs water, staying hydrated is crucial. You need extra water to keep things moving through your longer colon. Now let’s say you have a 24 extra inches longer of large intestine, and you’re not drinking enough water to begin with… and maybe you’re drinking some coffee or alcohol on top of this.
Insert impacted, dehydrated stool. So you may need more water to function optimally!
Aim for at least 12 cups of water daily. Mineral-rich water with a pinch of sea salt and 1/4 tsp cream of tartar can help with hydration and electrolyte balance.
Start your day with 2 cups of warm water to stimulate motility.
Drink most of your water between meals rather than during them.
If you drink caffeine or alcohol, you may need even more water…
Remember, you need to drink this much water every day for the rest of your life… so make this a sustainable change in whatever way you need. Set alarm reminders if you need to, or fill up some quart jars in the morning so you know to drink all of them before the end of the day.
3. Be Cautious with Fiber
Fiber feeds bacteria, which ferments in the large intestine it to make healthy byproducts. If you have 3x more fermentation-prone bacteria, though, too much fiber can be trouble—even if it’s normal healthy fermentation!
Moreover, if you have large intestinal dysbiosis (as many of us with endo do), gram-negative bacterial overgrowths will produce inflammatory by-products that can damage the gut and create some chaos in the body (and bowel).
Once you know this, you may need to dial in a lower amount of fiber than is recommended. For example, you may feel much better eating more animal products like meat and greek yogurt, and less gas-provoking foods like kale, onions, and figs.
Conversely, you should play around with the types of fiber you ingest. Many of us with a looooong intestine feel better on a lower FODMAP diet. This doesn’t necessarily mean you should be strict—FODMAPs are super healthy! But if you eat too many you may find your belly bloats like a balloon on the regular. Play around with quantity—again, you may be better off keeping some of these foods on the minimun rather than the maximum.
And, for a last play on fiber, some “husk” type fiber can help binf things and potentially keep them moving along well. For this consider something like psylium husk, a few pills or a 1/2 tsp taken with each meal to help bulk up (and be able to draw water in) to the stool. As long as you’re drinking up that 12 cups (or more), this can really, really help some folk.
Remember, we are ALL unique in this regard, and what helps one person may or may not help you. So be patient while you dial in the specifics of fiber, and take notes with a food journal!!
4. consider Atrantil
Atantril is a supplement made up of polyphenols that helps “absorb” methane in the intestinal tract—why it’s recommneded often for IMO. And if you have a redundant colon along with bloating and constipation, I would guess you have too much fermentation going on. So rather than axe all delightful foods that feed bacteria, Atantril helps support normal digestive function.
The recommended dose is 1-2 per meal. I personally take 2 with each meal and it’s been a night and day difference. Truly, I never bloat anymore … like ever. The downside is you need to buy a lot of Atantril … but if it’s as helpful for you as it is for me, it’s worth it.
5. Use Digestive Enzymes
Digestive enzymes can help break down food more efficiently, reducing the fermentation load on your intestines. Look for blends specifically designed to tackle high-FODMAP foods or complex carbohydrates if those trigger bloating for you. There are a lot of brands out there, but some to consider may be Enzyme Gold by Enzymedica, Fodzyme, or a comprehensive blend such as Digestzymes that includes HCL (not to use if you have ulcers). Adding some digestive support can really be night or day help.
6. Supplement with Magnesium…at a higher dose than you may think necessary
Magnesium citrate is a gentle laxative that can ease constipation by drawing water into your bowels. For many, just 400mg could give them explosively loose stool. If you have a long RC, you may feel well (and actually have consistent bowel movements every morning) if you take something like 700-800/mg. To find your optimal dose, start with 200–300 mg before bed, increasing the dose gradually until you find the right amount where you have a morning bowel movement, but you don’t have diarrhea. And of course, REMEMBER to drink that extra water!!!
7. Don’t Spanx yourself in!
Tight clothing, like Spanx or restrictive waistbands, can put pressure on your abdomen and reduce motility, not to mention put pressure on your uterus and pelvic floor! This is one of the issues that can greatly affect endo pain, btw. And this is especially important to mention because many of us with RCs have a rounder belly, so we often choose to Spanx them in! Loose-fitting clothes allow your intestines to move more freely and can make a noticeable difference in how you feel, and how your bowel movements form. And, if you can get better motility, your belly won’t be as round… so make it a goal to stop corsetting yourself.
8. walk your intestines
If your intestines are bound up and immobile, helping them move can really support peristalsis. Walking is a great activity for this!! How many of us have spend some time being more sedentary than usual only to find ourselves not going so “smoothly.” In this way, we can see the importance of being more active to help the intestines move more quickly.
9. Stick to a Routine or suffer
Consistency is key when managing a redundant colon. Hydration, supplements, magnesium, and a fiber-balanced diet need to be maintained daily! Skipping just a few days can lead to impaction, leaving you constipated for days to weeks. That’s, again, why this is a lifestyle swap and not a crash diet. Every day, aim to move your body, drink all the water, take your Atrantil and enzymes with your meals, and magnesium before bed. These are all foundational tools to help keep your RC moving.
3 Advanced Redundant Colon Tips
1. Test for IMO (Intestinal Methanogen Overgrowth)
If, after implementing the above foundational strategies, you still are struggling, consider testing for intestinal methanogen overgrowth. Methane-producing archaea can worsen symptoms by slowing intestinal motility, and targeting them with specific treatments can be life-changing. However, you really need your bowels to be emptying every day (very well) in order to get rid of the IMO, you can’t just take supplements to kille them and have that stagnate in your intestinal tract. I promise, that will do more harm than good. So if you are stuck (literally and figuratively) reach out to a skilled IMO practitioner.
If you want to see if you have IMO, here is a cool tool! It’s called the Food Marble. I can’t recommend it enough.
If you can address the IMO, though, you may feel really, really good. Even with an RC ;)
2. Consider a prokinetic agent
Prokinetic drugs help support peristalsis, the movement of your intestines that gets food through the tract. If you have an RC and none of the above is helping, you can and should talk to your doc about using a support. There are also natural prokinetic agents (such as MotilPro by Pure Encapsulations or Motility Activator by Integrative Therapeutics) that are worth trying before opting for drugs with potential side effects.
3. Consider Surgery as a Last Resort
In rare cases, surgery can remove the excess sections of a redundant colon. This is typically reserved for people with severe symptoms that can’t be managed with other treatments, but it’s worth discussing with a specialist if your quality of life is significantly affected. Here is a story of one woman worth reading to see if her resounding symptoms align with yours in any way.
Takeaway
A redundant colon might not be the most glamorous diagnosis, but it’s a manageable one. Knowing what you’re dealing with can make all the difference in reducing bloating, managing constipation, and improving your quality of life—endo or not.
With a few tweaks, your long, twisty intestines don’t have to slow you down!
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1] Raahave, Dennis. “Dolichocolon revisited: An inborn anatomic variant with redundancies causing constipation and volvulus.” World journal of gastrointestinal surgery vol. 10,2 (2018): 6-12. doi:10.4240/wjgs.v10.i2.6
2] Raahave D, Christensen E, Loud FB, Knudsen LL. Correlation of bowel symptoms with colonic transit, length, and faecal load in functional faecal retention. Dan Med Bull. 2009;56:83-88.
3] Diego Raimondo,et al. “Frequency and clinical impact of Dolichocolon in women submitted to surgery for rectosigmoid endometriosis.”Journal of Gynecology Obstetrics and Human Reproduction, Volume 49, Issue 4 (2020). doi: 10.1016/j.jogoh.2020.101697.