Constipation


Introduction

Constipation is a disorder of bowel habits that can appear as a lower frequency of bowel movements, straining, long time for defecation, hard or dry stools, incomplete evacuation and feeling of anal plug with the need of handling or fingering to help pass the stool.

The main causes can be: slow transit of the faecal bolus in its way along the colon, anatomical alteration that causes stool obstruction or dysfunction of the anorectal neuro-muscular mechanisms that regulate the defecation process.


Treatment

The treatment varies depending on the cause: dietary modifications and laxatives are useful in case of slow transit constipation, while sphincter and pelvic floor rehabilitation is indicated for neuro-muscular-based anorectal dysfunction in the absence of anatomical alteration.

Sacral root stimulation is a new treatment that can improve the constipation that does not respond to rehabilitation treatment, and has no surgical correction. It consists of an outpatient surgical procedure by which a pulse generator (a small pacemaker) is implanted in the buttock. It stimulates the nerves of the sacral plexus and the final tract of the intestine and can correct the motility disorder of the colon and rectum.

Surgery is indicated depending on the cause of difficulty or inability to defecate: 1) In case of constipation due to severe slow transit, also called "colonic inertia", 2) When the problem is secondary to an anatomical alteration that obstructs stool, as occurs when there is a dolichocolon (very long colon), sigmoidocele or enterocele (pressure bowel on the rectum), rectocele (hernia of the front wall of the rectum), internal rectal prolapse or rectal invagination (the upper part of the rectum is inserted into the lower part) or external rectal prolapse (the rectum comes out through the anus).

In cases of severe colonic inertia, a complete or partial resection of the colon is indicated, depending on the degree of affectation, the entire colon or only a part of it; the proximal part of the intestine (ileum or colon) will be joined to the rectum without needing a stoma (bag).

If the cause is obstructive, a specific surgery will be performed to solve the pathology.

A correct diagnostic study will make possible the approach to the problem without delay, so as to treat it in an appropriate way by saving the patient from years of unnecessary suffering, many expenses on medicines and an impaired quality of life. What most patients do not know is that there are many possible causes and pathologies that have as a common symptom, the difficulty to have the usual bowel movements, in terms of frequency, strain or consistency. Therefore, not all the situations are solved in the same way and the treatments range from a simple dietary measure to a complex surgery.



Benefits

Patients suffering from this frequent health problem are physically and emotionally affected; they are irritable, worried, depressed and have a negative impact on their working and social activities. Both medical or surgical treatment will bring an important change in the ability to evacuate, the patient will feel "normal" again, will regain the emotional stability and will notice a significant improvement in all aspects of his/her quality of life.



Expert opinion

Dr. Domenico Fraccalvieri
Dr.  Domenico Fraccalvieri

All patients unable to perform bowel movements normally, report having constipation and the use of laxatives, natural or medicinal, sometimes effective and often ineffective. When laxatives are not successful and their use become an abuse, it is important to request the evaluation of a coloproctologist with experience in functional digestive pathologies.


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