Anne is a wisp of a woman who’s been terribly bloated and constipated for as long as she can remember. Two tablespoons of psyllium husk (soluble plant fiber that adds bulk to the stool) and one tablespoon of ground flax seed in the morning, followed by two capfuls of a polyethylene glycol osmotic cathartic (a powerful laxative), plus three stool softeners and six prunes at night—and she still has difficulty having a bowel movement. She’s had several visits to the emergency room after nearly passing out from abdominal pain. Each time, the main finding on X-ray was a colon full to the brim with stool. We take a dietary history. Impeccable: she’s quasi-vegetarian and her standard lunch is brown rice, lentils, and kale. She’s two years shy of being the age for colon cancer screening, and given the findings on X-ray, I recommend a colonoscopy to make sure there’s no obstructing lesion inside her colon.

On the day of the procedure, the anesthesiologist gets Anne nice and comfortable, and within a few minutes she’s asleep and I begin my journey through her colon. I find this procedure fascinating, even after performing thousands of them, because just as every patient is unique, so every colon is unique in its own way. Anne’s colon is an impressive maze of twists and turns and switchbacks and loops that are very difficult to navigate. After more than three times the amount of time it usually takes me to complete a colonoscopy, we are finally finished. 

The diagnosis: a voluptuous Venus colon – a twisty, looping colon that’s common in women due to some important anatomical differences: a longer colon, a wider pelvis, and lower levels of testosterone compared to men.

Anne was thrilled to hear she didn’t have colon cancer or any other worrisome condition. As it turned out, some of the positive things she was doing needed a little tweaking to help maximize their benefits. She was eating a ton of fiber, but she was doing it all at one time, which was contributing to her bloating as the bulky stools were getting stuck in the hairpin turns of her twisty colon. I had Anne modify her diet to keep her total intake of fiber the same, but spread it out throughout the day and couple it with several glasses of water to help wash it all down. As a result, she was able to stop the nighttime stool softener and osmotic cathartic.

Knowing the diagnosis was really helpful to Anne in managing her symptoms. When she felt her bowels getting backed up and started to become really bloated, she’d do a liquid diet for a day, drinking primarily green veggie juices and broth, sometimes with a couple doses of the cathartic to help clean things out. Her colon still required a lot of attention, but there were no more really bad episodes of pain or trips to the emergency room.

On occasion I’ve had to prescribe a full bowel prep for patients with a voluptuous Venus colon filled with stool, but I always recommend not letting things get to that point by doing a day or two of liquids, instead of blasting your bowels with osmotic cathartics.

A longer colon, a deeper pelvis, a less defined abdominal wall, and hormonal influences—all of these factors can conspire to constipate and bloat us. But knowing what’s going on inside can help you manage your bloat—including figuring out when to lighten up your diet to give your curvy colon a chance to decompress.

First appeared in Gutbliss (Penguin 2013).