Colonic Volvulus

A long, loose colon with a narrow attachment is more likely to twist. Chronic constipation, a very long sigmoid colon, previous abdominal surgery, and some medicines that slow the bowel can contribute. Often there is no single clear cause.

It is an uncommon cause of bowel obstruction. It is seen mostly in older adults, especially those with long-standing constipation, those living in care homes, and people with neurological or psychiatric conditions. It can occasionally occur in younger people and during pregnancy.

Doctors examine the abdomen and often order an abdominal X-ray, which can show a very dilated loop of bowel. A CT scan is the most reliable test and shows the twist and whether the bowel is damaged. Blood tests check for infection, dehydration and signs of poor blood supply.

Volvulus is an emergency; there is no home treatment for an attack. These points apply to recovery and prevention.

• Do not wait at home hoping it will pass if you have the red-flag symptoms.

• Treat constipation early and keep regular bowel habits.

• Keep active and walk daily as your health allows.

• Carers of older or bed-bound people should monitor bowel movements and report changes.

Nothing should be eaten or drunk during an attack until the doctors decide. Afterwards, diet helps prevent constipation.

• In hospital you may be kept nil by mouth and given fluids through a drip.

• After recovery, increase fibre gradually with vegetables, fruit and whole grains.

• Drink enough fluids through the day unless your doctor has limited them.

Medicines support treatment but do not untwist the bowel.

• In hospital you may receive intravenous fluids, pain relief and antibiotics if there is concern about infection or damaged bowel.

• Ask your doctor to review medicines that slow the bowel, such as some opioid pain relievers and anticholinergics.

• Your doctor may advise a laxative plan after recovery to prevent constipation.

Treatment depends on the site and on whether the bowel is damaged.

• Sigmoid volvulus without damage can often be untwisted with a flexible scope passed through the back passage (endoscopic decompression).

• Emergency surgery is needed if the bowel is damaged, has perforated, or cannot be untwisted by scope.

• After the first episode, planned surgery to remove the affected loop is often recommended to prevent recurrence; your surgeon will explain the options.

• Cecal volvulus usually needs surgery.

Outcome depends mainly on how quickly the problem is treated and whether the bowel is damaged. When treated early, many people do well. Sigmoid volvulus often comes back after the first untwisting, so doctors usually recommend surgery to prevent recurrence in people who are fit enough. Delay in treatment increases the risk of serious complications.

• Which part of my colon twisted, and was the bowel damaged?

• Is surgery recommended to prevent it from happening again?

• What are the risks of surgery for me, and of not having surgery?

• Which of my medicines could slow my bowels?

• What symptoms mean I should come straight back to hospital?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.