Chronic Constipation/ODS

When to visit a doctor for constipation?

If constipation is persistent (more than 3 weeks) or if there are any warning signs (blood in stool, loss of weight or loss of appetite) a person should visit a colorectal specialist.
Serious causes of constipation like cancer should be ruled out.

Most people in India suffer from constipation in one form or another, although it is not commonly talked about. Obstructed defecation syndrome or ODS is a chronic defecation disorder that affects thousands especially the women.

Typically constipation symptoms include irregular bowel habits, frequent use of laxatives, strained defecation, or incomplete defecation.

Constipation is treated by lifestyle modifications and treatment of the cause of the constipations but surgery may be advised for selected cases of constipation or ODS.

What can lead to constipation?

• Avoiding the desire to bowel movement
• Negligible physical activity
• Irregular eating habit
• Health issues like thyroid, colon cancer, stroke, Parkinson’s disease, irritable bowel syndrome and diabetes.
• Certain medications may also lead to constipation.

How to diagnose chronic constipation/ODS?

Checklist of symptoms

• Weekly bowel movements fewer than three
• Strained defecation in at least 25 percent of the instances
• A feeling of incomplete defecation at least 25 percent of the instances
• Hard stools at least 25 percent of the instances.

If a person has experienced two or more of the above conditions for more than three months, it is highly likely that the person is suffering from chronic constipation or ODS, and needs a surgical treatment.

MR Defecography may be advised to study the changes in the rectal and anal canals during bowel movements which are not ordinarily seen in a colonoscopy or sigmoidoscopy.

Anal Manometry is useful.

Types of constipation & Treatments

3 broad types of constipation are:

• Normal transit constipation,
• Slow transit constipation
• Pelvic floor dysfunction

Normal Transit Constipation can be treated with fibre therapy, laxatives, and other drugs recommended by the doctor; Slow Transit Constipation treatment involves, varying medicines and surgical options.

To treat Pelvic Floor Dysfunction (Outlet Obstruction), Biofeedback therapy is the first step for patients. The main goal of the therapy is to break the pattern of inappropriate (paradoxical) sphincter contraction by training patients to relax their pelvic floor muscles.

Often injection is used to alleviate non-relaxation or paradoxical contraction of involved muscles.

The surgery for different types of constipation

Surgeries for outlet obstruction constipation are limited. A complete preoperative evaluation and careful selection is required for optimal rectocele repair.

Very few patients may require a colon resection by open surgery or laparoscopic surgery.

Antegrade Continent Enema (ACE), small opening in the appendix, upper colon or small intestine are created and cleared on a regular basis to empty the large bowel. Mostly children with incontinence or severe constipation undergo this procedure.

Surgery for Obstructive Defecation Syndrome popularly known as STARR: Stapled Transanal Rectal Resection has proved to be successful than any other surgery for constipation.

The latest solution for constipation (ODS): STARR surgery in Mumbai

With the emergence of the Stapled Transanal Rectal Resection (STARR) procedure, now the specialist colorectal surgeons can easily remove the structural deformities causing ODS through minimally invasive methods.
As STARR is conducted through the anus, the procedure involves no cuts, incisions, bleeding wounds, or even scars! The hospitalization is much shorter compared to conventional surgery and the recovery after discharge is also very quick.

Clinical studies show that the STARR surgical procedure significantly rectified chronic constipation symptoms suffered by patients for years. This study also reported that almost 90% of the patients who underwent this procedure rated the procedure and its results as excellent or good.

Side effects of the STARR Procedure

The known side-effects associated with STARR procedure are anal pain, bleeding, urinary retention, fistula formation, pain during intercourse, and accidental bowel leakage.