Length of the Adult Human Colon in Health and Constipation Measured Using Magnetic Resonance Imaging

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BACKGROUND: Quantitative data on colon length in adult chronic constipation (CC) are lacking. This study aimed to measure the length of the colon in CC, in the undisturbed state and after an osmotic laxative challenge, using magnetic resonance imaging (MRI) as compared to healthy volunteers (HV) and IBS-C patients. METHODS: Segmental and total colon length were measured by manual tracing on fasting MRI scans, retrieved retrospectively for 57 HV, 17 CC, and nine patients with irritable bowel syndrome with constipation (IBS-C). In all CC patients and 22 HV, MRI scans were also performed after an oral osmotic laxative challenge. Participants' age range was 18-75 years. KEY RESULTS: CC patients showed significantly longer colons (162 ± 6 cm) than HV (127 ± 2 cm; p < 0.01), with 10/17 being longer than the upper limit of normal. Colon length in IBS-C (129 ± 6 cm) was similar to HV. The colon in HV was able to elongate from 133 ± 3 to 148 ± 4 cm (p < 0.0001) to accommodate the macrogol challenge influx, while the CC colon could not do so (from total length at baseline 162 ± 6 to 168 ± 5 cm; p = 0.0768). CONCLUSION & INFERENCES: The study provides normative values of colon length, to which CC and IBS-C are compared. CC was associated with increased colon length and reduced capacity to elongate longitudinally, rather than radially, in response to a laxative challenge. Colon length in IBS-C was similar to HV. These measurements can improve our understanding of gut disease pathophysiology and response to treatment.

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