What is constipation?

Constipation is a condition in which the patient experiences difficulty in emptying the bowels, usually due to hardened faeces.

What leads to constipation?

A few lifestyle reasons like,

• 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. Structural or functional abnormalities may lead to constipation. Certain medications may also lead to constipation.

Types of constipation & their treatments

3 broad categories for constipation, defining the causes are:

1. Normal transit constipation,
2. Slow transit constipation, and
3. Pelvic floor dysfunction.

The treatment for constipation largely depends on the above categories.

While a 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 Botox injection is used to alleviate non-relaxation or paradoxical contraction of involved muscles.

The surgical options available for different types of constipation:

Although surgical options for outlet obstruction constipation are limited. A complete preoperative evaluation and careful selection is required for optimal rectocele repair. The probability of a patient to require a colon resection is very few, colon resection involves surgical removal of the colon connected to the small intestine and to the remaining rectum. This can be performed either using a standard open surgery or a laparoscopic surgical procedure, the latter is recommended. Colon resection reliably increases the frequency of bowel movements and patients’ satisfaction ranges from 39-100%.

Another surgery option is, Antegrade Continent Enema (ACE), this procedure involves the creation of a small opening in the appendix, upper colon or small intestine. This stoma is 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. This is a minimally invasive procedure and involves no cuts, scars, incision or any kind of wounds. The patients are free to take discharge in less than four days and the recovery is very quick. During this surgery, two surgical staplers are used to remove the excess tissue from the rectum through the anus.

Clinical studies report significant results. 90% of the patients are successfully treated through this procedure.

Results:

Abdominal colectomy does not promise to solve the issue of constipation, despite the remarkable results. The bowel movements are unpredictable and the patients might also have persisting constipation or even develop diarrhoea. Faecal incontinence can also be experienced with the patients who are not able to control liquid stools in the rectum, post-surgery. In such cases, preoperative examination plays a crucial role. It is to be noted carefully that the surgery is irreversible and a functional failure could also lead to a permanent ileostomy.

Colectomy for constipation is associated with a relatively high incidence of intestinal blockage, either from adhesions or due to poor motility in the remaining small intestine.

Conclusion:

Practice a healthy diet, take good care of you digestive system and consult your doctor within time rather than to suffer from complex issues. Including Fibre and lot of liquids and juices in your diet is a great idea to prevent such occurrences with constipation