The term constipation may have a different meaning from person to person. The frequency of a bowel movement varies considerably among people, ranging from 1-3 times/day to once in 3 days. Therefore, it is difficult to have a precise definition for constipation that would stand true for all. Thus, constipation is generally described as having fewer than three bowel movements a week. It also means passing stools very infrequently, passing hard stools, or having any kind of difficulty in evacuating the bowel. Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Typically lasting for more than several weeks, chronicconstipation can cause significant pain and discomfort and affect one’s quality of life.

Causes of Constipation

Constipation basically occurs when the waste matter moves very slowly through the large intestines, causing it to become hard and dry.

Some of the common causes of constipation include:

  • A diet that is poor in fiber (fruits, vegetables, cereals)
  • A change in your routine or lifestyle, such as a change in your eating habits
  • Ignoring the urge to pass stool (common in children)
  • Not drinking enough fluids
  • As a side effect of certain medications ex. Iron supplements, anti-depressants
  • Sedentary lifestyle, lack of exercise
  • Pregnancy – The female hormone Progesterone causes the muscles of the intestines to relax, making the peristaltic movements sluggish.
  • Obesity
  • Inflammatory Bowel Syndrome (IBS)
  • Constipation is one of the symptoms of dysbacteriosis — a condition where the normal, intestinal flora is dead and missing
  • Hormonal problems like Hypothyroidism

Lastly, constipation may be functional, caused by Obstructed Defecation Syndrome (ODS), a relatively common cause that can now be diagnosed with newer tests like MRI Defecography (MRD).

Other more serious conditions that may cause constipation include:

  • Bowel cancer
  • Crohn’s disease
  • Spinal cord injuries/diseases

Symptoms of Chronic Constipation

  • Less than three bowel movements per week
  • Straining more than 25% of the time
  • Hard and lumpy stools more than 25% of the time
  • Feeling of incomplete evacuation more than 25% of the time
  • Stomach ache and cramps
  • Feeling of bloating
  • Feeling of fullness with loss of desire to eat, nausea
  • Extremely foul smelling feces and flatulence
  • Needing help to empty your rectum, such as using your hands to press on your abdomen or using a finger to remove stool from your rectum

Transient episodes of constipation are fairly common and should not be a reason to worry. However, its best to take an expert opinion when symptoms last for more than 3 weeks.

Kindly note that if you have worsening nausea and repeated vomiting or if abdominal pain becomes severe and constant,you should seek immediate help.

Also, if constipation is associated with a change in stool size - narrow like a pencil or ribbon, change in frequency, or if any blood is seen from the rectum, consult a doctor immediately.

Diagnosis of Chronic Constipation

Although diagnosis of constipation is pretty straightforward, investigations may be required to evaluate the underlying cause in case of chronic cases. Thus, after a detailed history of your bowel habits and general health and lifestyle, your doctor may consider getting one or few of the following tests done:

  • Rectal examination or Proctoscopy – This may be done either with a lubricated gloved finger or using an instrument called Proctoscope.
  • Colonoscopy - This test is frequently performed to investigate the lower part of the bowel. During the test a long flexible tube with a light and camera at the end is passed through the anus. It allows the doctor to directly visualize the insides of your bowel on a screen.
  • Anal Manometry – In this test a small device is inserted into your rectum and attached to a machine that measures pressure readings, as you squeeze, relax and push your rectum muscles. This gives an idea of how well the muscles and nerves in and around your rectum are working.
  • MRI Defecography - Magnetic resonance imaging (MRI) defecography is a non-invasive test that uses magnetic resonance imaging to obtain images at various stages of defecation to evaluate how well the pelvic muscles are working and provide insight into rectal function. It is used to help determine the cause of fecal incontinence, constipation, and other conditions such as pelvic organ prolapse that may interfere with a person’s ability to pass stool.
  • Blood tests – Thyroid function tests, Serum B12, Serum D3, Serum Calcium
  • Food intolerance test

Complications of chronic constipation

Transient episodes of constipation do not cause any serious complications. However, chronic constipation may lead to certain sequelae:

  • Haemorrhoids– Long term straining causes the veins of the pelvic floor to swell, lose elasticity and become tortuous. These Haemorrhoids aka piles typically cause bleeding during defecation.
  • Fissure-in-ano/Anal fissure – Hardened stools may cause tiny tears in the delicate skin around the anus which makes passing stools extremely painful, and further aggravates constipation.
  • Rectal prolapse - Straining to have a bowel movement over a long period of time, can cause a small amount of the rectum to stretch and protrude from the anus.
  • Fecal impaction - Chronic constipation may cause an accumulation of hardened stool that gets stuck in the intestines, particularly in the elderly. If severe and prolonged, fecal impaction can lead to colonic perforation.
  • Chronic constipation sufferers also are at risk of developing a sigmoid volvulus, or 'twist' of the colon
  • Constipation affects one’s quality of life, causes stress, and diminishes overall sense of well-being. These things tend to self-perpetuate, and profoundly affect the cardiovascular, endocrine, and immune systems.

Obstructed Defecation Syndrome (ODS) is an inability to smoothly evacuate stools out of the rectum.This means that there is no malfunction in the digestive process and stools are formed normally. But the problem lies at the last stage i.e. excretion of the stools. It is believed that ODS is a result of an anatomical abnormality of the pelvic organs. An improper functioning of the muscles involved in defecation process is another cause. ODS accounts for almost 30-50% cases of Chronic Constipation.It is usually found in women due to nerve damage as a result of childbearing.

The most common symptom of a person suffering from ODS is incomplete evacuation. They typically complain of a feeling that something is left behind in the rectum after passing stools. Other symptoms include:

  1. Passing hard fragmented/lumpy stools
  2. Straining during defecation
  3. Feeling of heaviness
  4. Need for manual maneuvers to assist evacuation
  5. Laxative abuse

The diagnosis is confirmed with MRI Defecography


MCDPA

With a tagline – ‘SAY NO TO SURGERY’- MCDPA is the idea of Dr Ashwin Porwal, who has dealt with thousands of patients of piles and chronic constipation. He noticed that a lot of these patients do not need to go under the knife. What is needed in these cases is a conservative approach along with lifestyle modifications. With these observations he formulated a treatment technique he labelled MCDPA (Medicines-Constac-Diet-Physiotherapy-Ayurveda). It is a pioneering amalgamation of modern science, age-old Ayurveda and Pelvic Floor Physiotherapy, which ensures a multipronged attack on the disease, effectively increasing possibilities of a satisfactory cure. Emphasis on approved scientific treatments and all round care of the patient is the basis of MCDPA.

A QUICK GLIMPSE OF MCDPA

M-Medicines: Probiotics are micro-organisms (bacteria and yeast) that our beneficial to the health of the gut. It has been found that a decrease in the count of these healthy gut bacteria may be a cause of constipation and hence, a short course of probiotic supplement may be given

C-Constac: Ayurvedic medicines can be wisely used to treat conditions like constipation, sans the side effects that Allopathic medicines often have. Extensive research from ourteam comprising of Ayurvedic doctors enabled us to formulate purely herbal products, Constac and Constac Plus. They are given under the guidance of doctors and are extremely safe.

D-Diet: A diet rich in fiber aids in formation of stools and is the backbone of any constipation treatment. Our nutritionists will guide you in formulating a diet that suits your lifestyle and culture.

P-Pelvic Floor Physiotherapy: This is aimed at strengthening the muscles of the pelvic region as they play an important role in evacuation of stools. Many a time, especially in females, the weakened pelvic floor muscles are the major cause of the constipation. The exercises are taught by a Physiotherapist.

A-Ayurvedic therapy:This includes Basti which is an Ayurvedic oil enema therapy. It is one of the components of the highly revered Panchakarma therapy of Ayurveda. It helps in relaxing the rectal muscles and anal sphincter.

BIOFEEDBACK

Biofeedback is basically done to regain control over the rectal muscles. As discussed earlier, in chronic constipation, especially in Obstructed Defecation Syndrome, impaired rectal muscle function is an important causative factor leading to difficulty in expulsion of stools. In this non-invasive treatment, a probe is inserted into the rectum and the muscle activity is monitored on a computer screen. A physiotherapist will then guide you and train you to improve your defecation effort.

STARR SURGERY

In cases of Obstructed Defecation Syndrome or when Chronic Constipation has led to rectal prolapse, surgical intervention in the form of STARR Surgery may become necessary. The aim of the surgery is to remove the part of the obstructed/prolapsed rectum and replace it with a healthy portion of the remaining rectum.In STARR surgery, done under general anaesthesia, two circular staplers are used to produce a circumferential trans-anal full thickness resection of the lower rectum. The combination of the two stapled resections eliminates the structural abnormalities associated with ODS.

STARR (Stapled Trans Anal Rectal Resection) Surgery was invented by world-renowned colorectal surgeon, Dr Antonio Longo. Dr Porwal was fortunate to get an opportunity to learn the technique from Dr Longo himself, and currently, Dr Porwal performs the maximum number of STARR surgeries per month in India. He was the first to perform it in Maharashtra, and with efforts to spread awareness, he has managed to cure hundreds of patients of Chronic Constipation, some having suffered from it for decades.

ADVANTAGES OF STARR SURGERY

  • It is a procedure that is performed through the anus, requires no external incisions and leaves no visible scars.
  • The recovery time is short and patient can join office work by 5th day.

STARR is a surgical procedure that is performed through the anus, requires no external incisions and leaves no visible scars. Using a surgical stapler, the procedure removes excess tissue in the rectum and reduces the deformities that can cause ODS. Patients undergoing STARR are typically hospitalized for one to three days and have minimal recovery time after leaving the hospital.Is STARR Effective?

Yes. In a recent clinical study, chronic constipation symptoms significantly improved in most patients undergoing the STARR procedure. Overall patient satisfaction with the STARR procedure was high, with 90 percent of patients rating the results as either good or excellent.

Constipation is one of those topics few people like to discuss. But if you suffer from constipation you know it can be painful and frustrating and interferes greatly with your daily life. Almost everyone suffers from constipation at some time. Studies show that up to 16 percent of women in the India meet symptom criteria for chronic constipation. Moreover, people tend to suffer with the condition for a long time. Research shows up to 45 percent of individuals with constipation report having the condition for five years or more. Now there is a good reason to talk about chronic constipation. There is a surgical alternative that may be able to help women who have been unable to find solutions in the past for a type of chronic constipation called Obstructed Defecation Syndrome (ODS). Before you can understand whether you may have ODS, you need to understand more about chronic constipation. Constipation clinic now at chinchwad, Chakan and Opening Soon at Navi Mumbai...