Colon Stricture: Symptoms, Types, Causes and Treatment

Colonic strictures—also called colon strictures or colonic stenoses—are a narrowing of the large intestine that can have a significant impact on digestive health and quality of life. While rare, these strictures can stem from a variety of causes, present with a range of symptoms, and require a tailored approach to treatment. This comprehensive article explores the key symptoms, the different types, causes, and the treatment landscape for colon stricture, synthesizing evidence from clinical research and case studies.

Symptoms of Colon Stricture

When the colon narrows, the passage of stool becomes difficult, leading to a range of symptoms that can vary in intensity and onset. Recognizing these signs early is crucial for timely intervention and prevention of complications such as bowel obstruction or perforation.

Symptom	Description	Frequency/Severity	Source(s)
Abdominal Pain	Colicky, cramping, or persistent pain	Common, can be severe with obstruction	1, 2, 3, 6
Bowel Changes	Constipation, diarrhea, or alternating patterns	Frequent, sometimes abrupt in onset	1, 2, 5
Obstruction	Partial or complete blockage of stool passage	Acute, may require emergency care	2, 3, 6
Rectal Bleeding	Blood in stool or per rectum	Occasional, especially with inflammation	2, 5

Table 1: Key Symptoms

Abdominal Pain and Discomfort

Colonic strictures often present with abdominal pain, which may range from mild cramping to severe, colicky discomfort. This pain can be intermittent or persistent, sometimes escalating with the progression of the narrowing. In some cases, the onset is sudden and severe, particularly if the stricture leads to acute obstruction 2 3.

Altered Bowel Habits

Changes in bowel movements are a hallmark of colon stricture. Patients may experience constipation due to the physical narrowing, or, in some cases, diarrhea if inflammation or partial blockage causes increased motility. Alternating patterns of constipation and diarrhea can also occur, creating diagnostic confusion with other bowel diseases 1 2 5.

Signs of Obstruction

A significant narrowing can cause partial or complete intestinal blockage, known as bowel obstruction. This is a medical emergency that may present with severe pain, abdominal distention, vomiting, and the inability to pass gas or stool. Obstruction is more frequent with longer or more severe strictures 2 3 6.

Rectal Bleeding

Though less common, rectal bleeding can occur, particularly if the stricture is associated with mucosal ulceration or inflammatory processes. This may manifest as visible blood in the stool or as occult blood loss, sometimes leading to anemia 1 2 5.

Types of Colon Stricture

Understanding the types of colon stricture is essential for accurate diagnosis and effective treatment planning. Strictures may be classified based on their underlying cause, location, appearance, and clinical behavior.

Type	Features/Location	Associated Conditions	Source(s)
Benign	Smooth, non-cancerous, localized	Inflammation, NSAID use, infection	1, 2, 3, 5, 6, 8, 9
Malignant	Irregular, often with tissue invasion	Colon cancer	10
Inflammatory	Associated with chronic bowel disease	Crohn’s, ulcerative colitis, TB	2, 11
Post-surgical	At anastomosis sites after bowel surgery	Resection, stapling	8, 9, 10
Infectious	Due to pathogens (e.g., Entamoeba, CMV)	Amoebiasis, cytomegalovirus	4, 5, 6

Table 2: Types of Colon Stricture

Benign vs. Malignant Strictures

• Benign strictures are the most common type aside from malignancy, characterized by smooth, localized narrowing without evidence of cancer. They often result from chronic inflammation, medication effects, or infection 1 2 3 5 6 8 9.
• Malignant strictures are caused by tumors invading the colon, resulting in irregular, often progressive narrowing. These require prompt oncologic assessment 10.

Inflammatory Strictures

Chronic inflammatory conditions, notably Crohn’s disease, ulcerative colitis, and, less commonly, tuberculosis, can result in stricture formation. These are typically associated with a longer history of bowel symptoms and may recur after surgical resection 2 11.

Post-surgical Strictures

Strictures can develop at sites of previous surgery, especially after bowel resections with anastomosis (surgical joining of the bowel ends). Advances in surgical techniques have reduced the incidence, but when they occur, they tend to be short, localized, and amenable to endoscopic treatment 8 9 10.

Infectious Strictures

Certain infections can cause colonic strictures, either through direct tissue injury or secondary inflammation. Notable pathogens include:

• Entamoeba histolytica (causing amebiasis and ameboma) 5 6
• Cytomegalovirus (rare, but significant in immunocompromised or neonatal patients) 4

Causes of Colon Stricture

Colon strictures can arise from a range of etiologies, some more common than others. Identifying the cause is vital for targeting therapy and preventing recurrence.

Cause	Mechanism/Pathology	Population/Risk Factors	Source(s)
Chronic Inflammation	Fibrosis from chronic colitis/Crohn’s	IBD patients	2, 11
NSAID Use	Mucosal injury, ulceration, fibrosis	Chronic NSAID users	1, 3
Infection	Tissue damage, granulation, fibrosis	Immunocompromised, travelers	5, 6, 4
Post-surgical Changes	Ischemia or scarring at anastomosis	Post-resection patients	8, 9, 10
Malignancy	Tumor growth causing narrowing	Older adults	10
Unknown/Idiopathic	No clear cause found	Elderly women (rare cases)	2

Table 3: Causes of Colon Stricture

Chronic Inflammation

Long-term inflammation from inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, is a leading cause of benign colonic stricture. Chronic injury to the bowel wall leads to fibrosis and narrowing. These strictures often recur and can be challenging to manage 2 11.

Drug-induced Strictures

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a well-recognized but underappreciated cause. Chronic use of certain NSAIDs, notably sustained-release formulations, can induce mucosal ulceration and subsequent stricture formation, often in the proximal colon 1 3.

Infectious Etiologies

Infections such as amebiasis (Entamoeba histolytica) and cytomegalovirus (CMV) can produce localized or diffuse strictures:

• Ameboma is a mass-forming variant of amebiasis that mimics malignancy and can cause significant narrowing, particularly in immunocompromised patients 5 6.
• CMV colitis can cause stricture formation, especially in neonates or immunosuppressed individuals, and may present as bowel obstruction 4.

Surgery and Ischemia

Strictures may develop at the site of previous surgical intervention (anastomosis) due to scarring or local ischemia. These are most common after resections for cancer or diverticular disease 8 9 10.

Malignancy

Colonic tumors can encircle and constrict the bowel, resulting in a malignant stricture. These are characterized by progressive symptoms and often require a different therapeutic approach 10.

Idiopathic Cases

Occasionally, benign strictures occur with no identifiable cause. These cases are rare and often present in older women, with a sudden onset of symptoms but good recovery after resection or even conservative management 2.

Treatment of Colon Stricture

Management of colon strictures is highly individualized and depends on the underlying cause, severity, and patient characteristics. Recent advances have expanded the range of less invasive options available for many patients.

Approach	Indication/Use	Outcome/Notes	Source(s)
Endoscopic Dilation	Short, benign, or post-surgical strictures	High success, low complication rates	8, 9, 10
Biodegradable Stents	Refractory or postsurgical strictures	Effective, stent self-absorbs	8
Medical Therapy	Inflammatory/infectious strictures	Steroids, anti-TNF, antibiotics	5, 6, 11
Surgery	Failed endoscopic/medical therapy, malignancy	Resection with anastomosis	2, 6, 8, 9
Conservative (Observation)	Mild, non-progressive strictures	Sometimes resolves without intervention	2, 5

Table 4: Treatment Options

Endoscopic Treatments

Endoscopic dilation using balloons or bougies is the mainstay for many benign or post-surgical strictures. These techniques are safe, effective, and repeatable, making them the preferred initial approach for most patients who are suitable candidates 8 9 10.

• Balloon dilation is generally more effective than bougie dilation and can be performed with minimal risk of perforation.
• Endoscopic electrocautery or laser may be used for malignant strictures or when standard dilation fails 10.

Biodegradable Stents

For strictures that are refractory to dilation or recur after initial treatment, biodegradable stents offer an innovative, minimally invasive solution. These stents expand to relieve narrowing and degrade naturally over time, eliminating the need for removal. However, repeated procedures may sometimes be necessary 8.

Medical Therapy

• Inflammatory strictures (e.g., Crohn’s disease) benefit from anti-inflammatory drugs, including corticosteroids and, in select cases, anti-TNF biologics. Early use of these agents improves long-term outcomes and may reduce the need for surgery 11.
• Infectious strictures are managed by targeting the underlying organism. For instance, metronidazole is highly effective in amebiasis, often resolving the stricture without surgery 5 6.

Surgery

Surgical intervention is reserved for situations where less invasive methods fail, when malignancy is suspected or confirmed, or in cases of acute obstruction or perforation. Surgery typically involves resection of the affected segment and re-establishment of bowel continuity (anastomosis) 2 6 8 9.

Conservative Management

Some strictures, particularly those of uncertain cause or mild severity, may resolve with supportive care and close monitoring. Conservative management may be appropriate in select cases, with follow-up imaging to assess for resolution 2 5.

Conclusion

Colon stricture is a complex condition with diverse causes, presentations, and management strategies. Early recognition and tailored treatment can prevent serious complications and improve quality of life.

Key points covered:

• Colon strictures present with a spectrum of symptoms, most notably abdominal pain, bowel habit changes, obstruction, and occasionally rectal bleeding.
• Types of strictures include benign, malignant, inflammatory, post-surgical, and infectious, each with distinct features and implications.
• Common causes range from chronic inflammation and medication effects to infection, prior surgery, malignancy, and unexplained (idiopathic) factors.
• Treatment options are varied and include endoscopic dilation, biodegradable stents, medical therapy (anti-inflammatories/antibiotics), surgery, and, occasionally, conservative observation—each chosen according to the underlying cause and patient needs.
• Recent advances in endoscopic and biologic therapies have improved outcomes, especially for inflammatory and post-surgical strictures.

By understanding the spectrum of colon strictures, clinicians and patients can work together to select the most effective and least invasive therapies, leading to better outcomes and improved digestive health.