What is Melanosis Coli?
Melanosis coli, a condition initially recognized by Andral and Cruveilhier in 1830, is when lipofuscin, a specific kind of cell waste, collects in the inner lining of our large intestines. The name might sound like it’s related to melanin, the pigment in skin and hair, but this isn’t the case.
This condition occurs mainly due to the use of some types of laxatives, specifically derived from senna and rhubarb plants. These laxatives pass through the colon and trigger cell death in the colon’s lining, eventually darkening the colon’s color. It’s typically diagnosed with a procedure called a colonoscopy, which gives doctors a detailed view of the colon.
Generally, stopping the use of laxatives can resolve melanosis coli. Importantly, there is no evidence suggesting that melanosis coli increases the risk of colon cancer.
What Causes Melanosis Coli?
If you use laxatives for a long time, specifically from a group known as anthranoids, you can develop a condition called Melanosis coli. Senna glycosides (commonly known as senna) are the main laxatives that cause this.
As the laxative travels through your intestinal tract, it stays inactive until it reaches your large intestine. Once in the large intestine, the laxative activates, damaging the lining of the intestine and causing cells to die, a process known as apoptosis.
As these cells die, they produce a dark pigment called lipofuscin, which builds up and lines your large bowel. Eventually, these dead cells are absorbed by immune cells known as macrophages. Melanosis coli can develop in just a few months of regular laxative use.
Risk Factors and Frequency for Melanosis Coli
People of all ages who misuse laxatives by using them excessively over time may develop a condition called melanosis coli. This condition is generally seen in individuals over the age of 45, but younger people can also be affected. The chance of developing melanosis coli increases with age and occurs equally in males and females. It’s worth noting that this condition has also been observed in patients suffering from chronic colitis, a type of inflammatory bowel disease (IBD), even if they don’t misuse laxatives.
Signs and Symptoms of Melanosis Coli
Melanosis coli usually does not cause any symptoms and is found by chance during a procedure called a colonoscopy that is usually performed for other reasons. Health practitioners will normally ask for a detailed history of laxative use, primarily those containing a substance called anthraquinone, such as senna or cascara. This is because these laxatives can also be found in herbal supplements and teas that are available without a prescription. When examined during a colonoscopy, melanosis coli appears as black coloration on the lining of the large intestine.
Testing for Melanosis Coli
The assessment of melanosis coli, a condition characterized by a dark pigmentation in the inner lining of the colon, is done through a procedure called colonoscopy. This involves using a long, flexible tube with a small camera on the end to look at the inside of your colon. Medical experts will take tissue samples from your colon to exclude the possibility of “true melanosis”. This is important as true melanosis may be connected to more serious conditions like Peutz-Jegher Syndrome, a genetic disorder that can increase a person’s chance of developing certain types of cancer.
Unfortunately, regular laboratory tests or imaging scans are not helpful in diagnosing melanosis coli. One key characteristic of this condition is that it is typically most intense at the start of the large intestine, known as the cecum, and lessens as it travels down the colon.
Treatment Options for Melanosis Coli
The recommended treatment for melanosis coli condition is to stop using laxatives. Once laxative use is discontinued, the condition typically improves over the course of a year.
What else can Melanosis Coli be?
Before diagnosing melanosis coli, doctors must first eliminate the possibility of other conditions. One such condition is Peutz-Jeghers syndrome. This is an inherited disorder that causes numerous non-cancerous growths (polyps) in the gut and distinctive dark spots on the skin and mucous membranes. It may appear similar to melanosis coli. Patients with Peutz-Jeghers syndrome have a significantly higher risk (15 times greater) of developing colon cancer compared to the general population. Therefore, it’s crucial to rule out this syndrome before diagnosing melanosis coli.
What to expect with Melanosis Coli
The outlook is very good for these patients. Melanosis coli, a condition where the colon appears dark, usually disappears once the use of the laxative causing the issue is stopped. However, this can take up to one year. Be aware that constipation might return when you stop taking the laxative.
Possible Complications When Diagnosed with Melanosis Coli
Research has found a link between melanosis coli, a condition that darkens the lining of the colon, and the formation of polyps in the colon. However, there’s no definitive proof that this increases the chance of colon cancer. Some studies suggest melanosis coli might be connected to colorectal adenomas, which are benign tumors.
Continuous use of stimulant laxatives can lead to an imbalance of electrolytes. This happens because when food and liquid pass too quickly through the intestine, absorption of water and nutrients is affected. Low potassium levels are the usual result, and this can be life-threatening.
Common Side Effects:
- Imbalance of electrolytes (due to rapid transit of food in bowel)
- Lack of nutrition and water reabsorption
- Potassium imbalance (can be fatal in severe cases)
Preventing Melanosis Coli
When dealing with constipation, remember that the use of laxatives should only be a short-term solution. A healthy bowel routine is vital for a good quality of life, and it’s not ideal to rely on laxatives like senna. It is recommended to maintain a diet rich in fruits, vegetables, whole grains, and legumes, which provides the necessary fiber to bulk up your stool and prevent constipation. Staying properly hydrated is crucial for having healthy bowel movements as well.
Keep in mind that certain things can trigger constipation. For example, coffee, energy drinks, fried foods, too many carbohydrates, alcohol, red meat, and artificial sweeteners. Regular physical activity also helps stimulate bowel movements, helping the rhythmic motion, known as peristalsis, that carries stool through the digestive system. A good sleep routine is also beneficial, as it helps your body keep your bowel health in check.
