CHRONIC CONSTIPATION AND PELVIC FLOOR DISORDERS
Constipation is a common disorder affecting quality of life and may be life threatening when caused by certain conditions.It is important that these conditions of mechanical nature are excluded and that medical and medicational causes are adressed.
There are a large group of patients who have no obviously reversible cause.These patients have a functional cause either in the colon itself or the outlet(last part of the digestive tract in the pelvis).
There are generally 2 groups of functionally constipated patients.Those who have very few or no urges to pass stool and those who have the urge but cant evacuate the stool out of the rectum.
The first usually have slow transit of the colon and may respond to standard medication.
There are very few who will in the end require surgical solution to the problem.
The second group fall into the category which we call obstructive defaecation and will require further assessment and another aproach.
SYMPTOMS AND SIGNS
- Inability to empty rectum
- Sensation of incomplete evacuation
- Digitation or perineal support to help evacuate
- Laxative or enema use to pass stool
- Recto/perineal pain or discomfort after stool passage
- Fragmented defaecation(empt - Fragmented defaecation(empty rectum in 2-3 sessions)
INVESTIGATIONS
Clinical examination and endoscopy to exclude any obvious pathology or defects.A specific dynamic xray examination done to examine the whole defaecation process on an xray machine.This is done to determine the function of the rectum in the pelvis during the defaecation process .
TREATMENT
The whole process of defaecation requires a combined effort of all the muscles in the pelvis and anal sphincter.The muscles are very much co ordinated and the shape of the rectum which directs the forces to evacuate the stool.
The shape of the rectum and its dynamics are affected by its attachments and dimensions which are changed by chronic straining and genetics.
In the past we had to do major surgical procedures to alleviate the problem.
We now have the tools and expertise developed by Professor Longo in Vienna to correct most of these problems via the anus.The procedure is called TRANSTARR.(stapled transanal rectal resection)
The procedure takes 30mins and 2 days in hospital. Improvement in stool passage is immediate and it continues to improve for 3 months.Long term results are very good with most patients indicating that they would have the procedure again if the problem recurs.
COMPLICATIONS
- Bleeding uncommon
- Stricture very uncommon
- Rectovaginal fistula very uncommon.
- Infection described but rarely seen.
