From the Research
Melanosis coli is a benign condition that typically resolves on its own after discontinuing the use of anthranoid laxatives, and no specific treatment is required. The condition is characterized by dark pigmentation of the colon lining, usually caused by long-term use of anthranoid laxatives such as senna or cascara 1. If you're experiencing melanosis coli, I recommend gradually stopping the anthranoid laxatives and switching to alternative bowel management strategies, including:
- Increased dietary fiber (25-30g daily)
- Adequate hydration (at least 8 glasses of water daily)
- Regular physical activity
- Possibly osmotic laxatives like polyethylene glycol if needed
- Stool softeners such as docusate sodium may also help during the transition 2. The dark pigmentation occurs because anthranoid compounds damage colonic epithelial cells, which are then engulfed by macrophages that accumulate in the lamina propria, giving the characteristic brown-black appearance during colonoscopy 3. While some studies suggest a possible association between melanosis coli and an increased risk of colon cancer 4, 5, the most recent and highest quality study found that melanosis coli is not associated with increased diagnosis of colorectal cancer, but rather with enhanced polyp detection likely due to a chromo-endoscopy-like effect 2. Therefore, addressing the underlying constipation through lifestyle modifications is important for long-term bowel health, and regular colonoscopies should be performed to monitor for any potential complications.