Constipation Treatment

When to visit a doctor for constipation?

Typically, constipation hinders normal bowel movements, and its symptoms include irregular bowel habits, frequent use of laxatives, strained defecation, or incomplete defecation.

About 80 percent of people suffer from constipation at some time during their lives, however people tend to ignore this nagging problem But if it 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. 

Most people in India suffer from constipation, although most Indians tend to ignore this nagging problem. The problem can get really severe if left untreated for a long time. Serious causes of constipation like cancer should be ruled out. It can be treated by Diet, life style modifications and bio feedback. For ODS surgery may be beneficial.

Constipation is treated by lifestyle modifications and treatment of the cause of the constipations but surgical resection of redundant colon and rarely Colectomy (surgical removal of the colon) may be advised for severe symptoms caused by colonic inertia. However, the benefits of this surgery must be weighed against possible complications.

A condition known as Obstructed defecation syndrome or ODS is a chronic defecation disorder that affects thousands of Indians, especially the women. In case of women in India, this defecation disorder is attributable to the general weakness in the pelvic support structures. In case of ODS, usually the lining of the rectum juts out during bowel movements, which severely obstructs the passing of stool. According to the latest medical research, about 45 percent of individuals suffering from ODS have reported having the condition for at least five years if not more.

The latest surgical solution for constipation (ODS): STARR

As many previous attempts to correct defecation disorders through surgery proved unsuccessful, surgeons had few options for rectifying troublesome bowel symptoms. With the emergence of the Stapled Transanal Rectal Resection (STARR) procedure, now the surgeons can easily remove the structural deformities causing ODS through minimally invasive methods.

The introduction of the STARR procedure for correcting defecation disorders In India in 2008 has proved successful. This less-invasive surgical procedure treats ODS to correct all symptoms of chronic constipation and obstructive defecation. 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. In this link, you can read how Neoalta treats ODS patients.

The STARR procedure for rectifying constipation

Patients undergoing the STARR procedure receive antibiotics before surgery and either spinal or general anesthesia. Then, a round-shaped anal dilator is inserted into the anus and secured with sutures. Afterwards, two surgical staplers are inserted into the anus to remove the excess tissue in the rectum area. This procedure can significantly improve the anatomical defects in human bodies that result in ODS. As this procedure is conducted through the anus, it does not require any incision and generally leaves no visible scars.

Patients undergoing STARR procedure typically

• remain in the hospital for only one to three days
• do not have any visible scars
• experience minimal post-operative pain
• need little recovery time, and resume normal activities in a week or two
• experience significant improvements in defecation after undergoing the procedure

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.

Dr Nitish Jhawar is Director of one stop colorectal clinic at Fortis Hiranandani Hospital Vashi & Neoalta Specialty Clinic Vashi, Navi Mumbai. He is fellow association of colorectal surgeon of India FACRSI and fellow Colorectal Surgery US and offers constipation surgery at Navi Mumbai India.

What causes constipation?

• Anatomic causes
• Cancer
• Stricture
• Functional causes
• Irritable bowel syndrome
• Slow transit constipation
• Pelvic outlet dysfunction
• Medical causes
• Medication
• Disorders of nervous system
• Parkinson’s disease
• Stroke
• Spinal cord injuries
• Disorders of endocrine system
• Thyroid disease

What factors contribute to constipation?

• changes in habits or lifestyle, such as travel, pregnancy, and old age
• abuse of laxatives
• inadequate fiber and fluid intake
• sedentary lifestyle
• environmental changes
• repeatedly ignoring the urge to have a bowel movement

How to diagnose the cause of constipation?

Serious causes of constipation should be ruled out, like cancer (especially if patient is older than 50 years).

• A through history of medical conditions.
• Digital examination of the anorectal area.
• Barium enema given into the rectum. An x-ray of the abdomen can show strictures, obstructions, and other problems.
  Colonoscopy
• Colonoscopy allows the physician to view the entire length of the large intestine, and help identify abnormal growths, inflamed tissue, ulcers, and bleeding.
• Sigmoidoscopy
  A sigmoidoscopy allows the physician to view a portion of the large intestine.
• After excluding any mechanical cause of obstruction if functional constipation is diagnosed, further investigation can be carried like “marker studies,” in which the patient swallows a capsule containing markers that show up on ¬x-rays taken repeatedly over several days, (may ¬provide clues to disorders in muscle function within the intestine-slow-transit colon – ‘sleepy’ colon or pelvic floor dysfunction).

In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be nonspecific. 

How is constipation treated?

• Diet modifications, diet with 20 to 35 grams of fiber daily helps in the formation of soft, bulky stool. Foods such as beans, whole grains, bran cereals, fresh fruits and vegetables are high fiber diet. Limiting foods such as ice cream, cheeses, meats, and processed foods can also be helpful.
• Lifestyle changes, increased water intake, regular exercise, and designating a specific time each day to have a bowel movement may be helpful to some patients.
• Laxatives
• Eliminating or changing medication
• Biofeedback, to treat chronic constipation caused by anorectal dysfunction. This treatment retrains the muscles that control release of bowel movements.
• In rare circumstances surgical procedures may be necessary to treat constipation.

What can be complications of constipation?

Constipation can cause hemorrhoids by straining to have a bowel movement, or anal fissures when hard stool stretches the sphincter muscle.

Straining may cause rectal prolapse, where a small amount of intestinal lining pushes out from the anal opening.

Fecal impaction can occur in children and older adults. The hard stool packs the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool.

Obstructed Defecation Syndrome (ODS)

Normal urges to defecate but an impaired ability to expel the faecal bolus

Symptoms:

• Repeated unsuccessful attempts at defecation
• Straining
• Rectal bleeding
• Evacuation by finger
• Perineal and lower abdominal pain

Other screening tests i.e. barium enema, and CT colography (virtual colonoscopy) may not be as effective and reliable as FOBT or colonosc