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into the lateral intercellular spaces by osmosis via tight junctions and adjacent cells which then in turn moves across the basement membrane and into the capillaries while more sodium ions are pumped again into the intercellular fluid 42 although water travels down an osmotic gradient in each individual step overall water usually travels against the osmotic gradient due to the pumping of sodium ions into the intercellular fluid this allows the large intestine to absorb water despite the blood in capillaries being hypotonic compared to the fluid within the intestinal lumen gut flora edit main article gut microbiota the large intestine houses over 700 species of bacteria that perform a variety of functions as well as fungi protozoa and archaea species diversity varies by geography and diet 43 the microbes in a human distal gut often number in the vicinity of 100 trillion and can weigh around 200 grams 0 44 pounds this mass of mostly symbiotic microbes has recently been called the latest human organ to be discovered or in other words the forgotten organ 44 the large intestine absorbs some of the products formed by the bacteria inhabiting this region undigested polysaccharides fiber are metabolized to short chain fatty acids by bacteria in the large intestine and absorbed by passive diffusion the bicarbonate that the large intestine secretes helps to neutralize the increased acidity resulting from the formation of these fatty acids 45 these bacteria also produce large amounts of vitamins especially vitamin k and biotin a b vitamin for absorption into the blood although this source of vitamins in general provides only a small part of the daily requirement it makes a significant contribution when dietary vitamin intake is low an individual who depends on absorption of vitamins formed by bacteria in the large intestine may become vitamin deficient if treated with antibiotics that inhibit the vitamin producing species of bacteria as well as the intended disease causing bacteria 46 other bacterial products include gas flatus which is a mixture of nitrogen and carbon dioxide with small amounts of the gases hydrogen methane and hydrogen sulfide bacterial fermentation of undigested polysaccharides produces these some of the fecal odor is due to indoles metabolized from the amino acid tryptophan the normal flora is also essential in the development of certain tissues including the cecum and lymphatics citation needed they are also involved in the production of cross reactive antibodies these are antibodies produced by the immune system against the normal flora that are also effective against related pathogens thereby preventing infection or invasion the two most prevalent phyla of the colon are bacillota and bacteroidota the ratio between the two seems to vary widely as reported by the human microbiome project 47 bacteroides are implicated in the initiation of colitis and colon cancer bifidobacteria are also abundant and are often described as friendly bacteria 48 49 a mucus layer protects the large intestine from attacks from colonic commensal bacteria 50 clinical significance edit disease edit main article gastrointestinal disease following are the most common diseases or disorders of the colon angiodysplasia of the colon appendicitis chronic functional abdominal pain colitis colorectal cancer colorectal polyp constipation crohn s disease diarrhea diverticulitis diverticulosis hirschsprung s disease aganglionosis ileus intussusception irritable bowel syndrome pseudomembranous colitis ulcerative colitis and toxic megacolon colonoscopy edit main article colonoscopy colonoscopy image splenic flexure normal mucosa the spleen can be seen through it colonoscopy is the endoscopic examination of the large intestine and the distal part of the small bowel with a ccd camera or a fiber optic camera on a flexible tube passed through the anus it can provide a visual diagnosis e g ulceration polyps and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions colonoscopy can remove polyps as small as one millimetre or less once polyps are removed they can be studied with the aid of a microscope to determine if they are precancerous or not it takes 15 years or fewer for a polyp to turn cancerous colonoscopy is similar to sigmoidoscopy the difference being related to which parts of the colon each can examine a colonoscopy allows an examination of the entire colon 1200 1500 mm in length a sigmoidoscopy allows an examination of the distal portion about 600 mm of the colon which may be sufficient because benefits to cancer survival of colonoscopy have been limited to the detection of lesions in the distal portion of the colon 51 52 53 a sigmoidoscopy is often used as a screening procedure for a full colonoscopy often done in conjunction with a stool based test such as a fecal occult blood test fobt fecal immunochemical test fit or multi target stool dna test cologuard or blood based test sept9 dna methylation test epi procolon 54 about 5 of these screened patients are referred to colonoscopy 55 virtual colonoscopy which uses 2d and 3d imagery reconstructed from computed tomography ct scans or from nuclear magnetic resonance mr scans is also possible as a totally non invasive medical test although it is not standard and still under investigation regarding its diagnostic abilities furthermore virtual colonoscopy does not allow for therapeutic maneuvers such as polyp tumour removal or biopsy nor visualization of lesions smaller than 5 millimeters if a growth or polyp is detected using ct colonography a standard colonoscopy would still need to be performed additionally surgeons have lately been using the term pouchoscopy to refer to a colonoscopy of the ileo anal pouch other animals edit the large intestine is truly distinct only in tetrapods in which it is almost always separated from the small intestine by an ileocecal valve in most vertebrates however it is a relatively short structure running directly to the anus although noticeably wider than the small intestine although the cecum is present in most amniotes only in mammals does the remainder of the large intestine develop into a true colon 56 in some small mammals the colon is straight as it is in other tetrapods but in the majority of mammalian species it is divided into ascending and descending portions a distinct transverse colon is typically present only in primates however the taeniae coli and accompanying haustra are not found in either carnivorans or ruminants the rectum of mammals other than monotremes is derived from the cloaca of other vertebrates and is therefore not truly homologous with the rectum found in these species 56 in some fish there is no true large intestine but simply a short rectum connecting the end of the digestive part of the gut to the cloaca in sharks this includes a rectal gland that secretes salt to help the animal maintain osmotic balance with the seawater the gland somewhat resembles a caecum in structure but is not a homologous structure 56 additional images edit intestines colon deep dissection anterior view see also edit this article uses anatomical terminology colectomy colonic ulcer large intestine chinese medicine references edit this article incorporates text in the public domain from page 1177 of the 20th edition of gray s anatomy 1918 1 2 3 small large intestine seer training training seer cancer gov retrieved 9 april 2025 large intestine retrieved 2016 07 24 cite web cs1 maint deprecated archival service link drake r l vogl w mitchell a w m 2010 gray s anatomy for students philadelphia churchill livingstone kapoor vinay kumar 13 jul 2011 gest thomas r ed large intestine anatomy medscape webmd llc retrieved 2013 08 20 gray henry 1918 gray s anatomy philadelphia lea febiger large intestine mosby s medical dictionary 8th ed elsevier 2009 isbn 9780323052900 intestine concise medical dictionary oxford university press 2010 isbn 9780199557141 large intestine a dictionary of biology oxford university press 2013 isbn 9780199204625 azzouz laura sharma sandeep 2020 physiology large intestine ncbi bookshelf pmid 29939634 david krogh 2010 biology a guide to the natural world benjamin cummings publishing company p 597 isbn 978 0 321 61655 5 1 2 hounnou g destrieux c desmé j bertrand p velut s 2002 anatomical study of the length of the human intestine surg radiol anat 24 5 290 294 doi 10 1007 s00276 002 0057 y pmid 12497219 s2cid 33366428 peritoneum mananatomy com 2013 01 18 archived from the original on 2018 10 08 retrieved 2013 02 07 untitled 1 2 horton k m corl f m fishman e k march 2000 ct evaluation of the colon inflammatory disease radiographics 20 2 399 418 doi 10 1148 radiographics 20 2 g00mc15399 issn 0271 5333 pmid 10715339 rossini francesco paolo 1975 the normal colon in rossini francesco paolo ed atlas of coloscopy springer new york pp 46 55 doi 10 1007 978 1 4615 9650 9_12 isbn 9781461596509 spiral colon medical dictionary spiral colon and caecum archived from the original on 2016 03 04 retrieved 2014 04 02 smithivas t hyams p j rahal j j 1971 12 01 gentamicin and ampicillin in human bile the journal of infectious diseases 124 suppl s106 108 doi 10 1093 infdis 124 supplement_1 s106 issn 0022 1899 pmid 5126238 anatomy of colon and rectum seer training training seer cancer gov retrieved 2021 04 14 anatomy at a glance by omar faiz and david moffat lange johan f komen niels akkerman germaine nout erik horstmanshoff herman schlesinger frans bonjer jaap kleinrensink gerrit jan june 2007 riolan s arch confusing misnomer and obsolete a literature survey of the connection s between the superior and inferior mesenteric arteries am j surg 193 6 742 748 doi 10 1016 j amjsurg 2006 10 022 pmid 17512289 van hoogdalem edward de boer albertus g breimer douwe d july 1991 pharmacokinetics of rectal drug administration part i general considerations and clinical applications of centrally acting drugs clinical pharmacokinetics 21 1 14 doi 10 2165 00003088 199121010 00002 issn 0312 5963 pmid 1717195 the superior rectal vein perfusing the upper part of the rectum drains into the portal vein and subsequently into the liver on the other hand the middle and inferior rectal veins drain the lower part of the rectum and venous blood is returned to the inferior vena cava 1 2 snell richard s 1992 clinical anatomy for medical students 4th ed boston little brown and company pp 53 54 1 2 le tao et al 2014 first aid for the usmle step 1 mcgraw hill education p 196 wilson danielle j bordoni bruno 2022 embryology bowel statpearls treasure island fl statpearls publishing pmid 31424831 retrieved 2022 05 27 mayo clinic staff 2006 10 13 redundant colon a health concern ask a digestive system specialist mayoclinic com archived from the original on 2007 09 29 retrieved 2007 06 11 mayo clinic staff redundant colon a health concern above with active image links riversideonline com archived from the original on 9 november 2013 retrieved 8 november 2013 lichtenstein gary r peter d park william b long gregory g ginsberg michael l kochman 18 august 1998 use of a push enteroscope improves ability to perform total colonoscopy in previously unsuccessful attempts at colonoscopy in adult patients the american journal of gastroenterology 94 1 187 190 doi 10 1111 j 1572 0241 1999 00794 x pmid 9934753 s2cid 24536782 note single use pdf copy provided free by blackwell publishing for purposes of wikipedia content enrichment 1 2 3 4 bernstein c facista a nguyen h zaitlin b hassounah n loustaunau c payne cm banerjee b goldschmid s tsikitis vl krouse r bernstein h 2010 cancer and age related colonic crypt deficiencies in cytochrome c oxidase i world j gastrointest oncol 2 12 429 442 doi 10 4251 wjgo v2 i12 429 pmc 3011097 pmid 21191537 1 2 3 baker am cereser b melton s fletcher ag rodriguez justo m tadrous pj humphries a elia g mcdonald sa wright na simons bd jansen m graham ta 2014 quantification of crypt and stem cell evolution in the normal and neoplastic human colon cell rep 8 4 940 947 doi 10 1016 j celrep 2014 07 019 pmc 4471679 pmid 25127143 nooteboom m johnson r taylor rw wright na lightowlers rn kirkwood tb mathers jc turnbull dm greaves lc 2010 age associated mitochondrial dna mutations lead to small but significant changes in cell proliferation and apoptosis in human colonic crypts aging cell 9 1 96 99 doi 10 1111 j 1474 9726 2009 00531 x pmc 2816353 pmid 19878146 1 2 nguyen h loustaunau c facista a ramsey l hassounah n taylor h krouse r payne cm tsikitis vl goldschmid s banerjee b perini rf bernstein c 2010 deficient pms2 ercc1 ku86 ccoi in field defects during progression to colon cancer j vis exp 41 doi 10 3791 1931 pmc 3149991 pmid 20689513 gremel gabriela wanders alkwin cedernaes jonathan fagerberg linn hallström björn edlund karolina sjöstedt evelina uhlén mathias pontén fredrik 2015 01 01 the human gastrointestinal tract specific transcriptome and proteome as defined by rna 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gastroenterology 56 6 1234 1244 pmid 4886927 terry l miller meyer j wolin 1996 pathways of acetate propionate and butyrate formation by the human fecal microbial flora applied and environmental microbiology 62 5 1589 1592 bibcode 1996apenm 62 1589m doi 10 1128 aem 62 5 1589 1592 1996 pmc 167932 pmid 8633856 mcneil ni 1984 the contribution of the large intestine to energy supplies in man the american journal of clinical nutrition 39 2 338 342 doi 10 1093 ajcn 39 2 338 pmid 6320630 absorption of water and electrolytes archived from the original on 2021 04 14 retrieved 2025 07 31 yatsunenko tanya et al 2012 human gut microbiome viewed across age and geography nature 486 7402 222 227 bibcode 2012natur 486 222y doi 10 1038 nature11053 pmc 3376388 pmid 22699611 o hara ann m shanahan fergus 2006 the gut flora as a forgotten organ embo reports 7 7 688 693 doi 10 1038 sj embor 7400731 pmc 1500832 pmid 16819463 den besten gijs van eunen karen groen albert k venema koen reijngoud dirk jan bakker 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