Constipation Cured.Info

In slow transit constipation (STC), there is a failure to move luminal contents through the proximal colon. This may be associated with dietary factors, such as severe caloric deficiency, with medications that alter motility or with certain neurologic,metabolic, and endocrine disorders.Attention to such factors may lead to improvement in colonic transit. Patients with idiopathic STC who fail to respond to conventional laxatives may have abnormalities of the enteric nerves, such as decreased volume of interstitial cells of Cajal and reduction of myenteric neural elements.We usually start with colon cleansing using enemas with or without mineral oil.

If these are unsuccessful, a water-soluble contrast enema (Gastrografin or Hypaque) administered under fluoroscopy may be very effective.After this, the colon may be further evacuated with twice daily high volume enemas or by drinking PEG solution until cleansing is complete.

The patient should then be maintained on a daily osmotic agent with stimulant laxatives every 2 to 3 days if there are no spontaneous bowel movements. Other agents such as misoprostol or tegaserod may be tried if the patient responds suboptimally to osmotic and stimulant laxatives. If a patient with disabling symptoms from STC is unresponsive to medical therapy, surgery may be considered. The most common operation recommended is subtotal colectomy with ileorectal anastomosis for which overall success rates of approximately 90% have been reported.

The following four criteria should be met before surgery is undertaken:

(1) chronic, severe, and disabling symptoms from constipation that are unresponsive to medical therapy,

(2) slow colonic transit of the inertia pattern,

(3) no evidence of intestinal pseudo-obstruction by radiologic and manometric studies, and

(4) normal anorectal function.
Diagnostic studies to rule out pelvic floor dysfunction are critically important, as subtotal colectomy with ileorectal anastomosis is unlikely to help if the latter is not corrected.Another reported surgical approach is antegrade colonic enema, although we use it very infrequently. For patients who have impaired continence mechanisms, an ileostomy is a viable option.We are reluctant to recommend subtotal colectomy in patients when pain is a significant component of their complaint, because it cannot be assumed that it will relieve pain.

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