New Delhi: There are no words for describing the great relief that one feels after easy passing of the stool. If the same stool gets stuck in your rectum, there are no words to describe your great discomfort either. But there is an effective method for rectum clearing to the great relief of chronic constipation patients. Balloon is the name of the method for stool evacuation.
Constipation is one of the most common and perplexing medical problem affecting people across most age groups and both sexes. It is estimated that up to 20 to 30% of the adult population suffers from troublesome constipation.
Commenting on their experience, Prof. Anil Arora Chairman Institute of Liver Gastroenterology and Pancreatobiliary sciences at Sir Ganga Ram Hospital New Delhi said that recently we analyzed 180 patients coming to our department with chronic constipation (age range 11-86 years, median age 49 years, 80% males). The most common symptom reported by our patients was a feeling of incomplete evacuation (98%) followed by excessive straining at defecation (87%). Interestingly, most of these patients (88%) had already undergone a prior colonoscopy for evaluation of reason for constipation and more than 90% had normal findings on visual inspection of colon alone. After evaluating the cause of constipation, it was seen that Incoordination of anorectal function called dyssynergia was present in 56% of patients and slow transit constipation was present in 15% patients rest of the patients had either normal transit or IBS type of constipation. Whereas the slow and normal transit constipation responds well to high fiber diet with higher fluid intake a special technique called “Biofeedback therapy” is extremely useful especially in patients with constipation who have anorectal dyssynergia.
According to Dr. Srihari, Consultant in Department of Gastroenterology at Sir Ganga Ram Hospital, “In this biofeedback therapy using a balloon patient are educated about the process of stool evacuation by balloon expulsion test with the help of computer assisted software programme in real time in multiple sessions in our GI Motility Lab”. Prof. Arora said that in the last 2 years, seventy-two patients with dyssynergia underwent Biofeedback therapy at their center. Majority of these patients were on 2 or more laxatives and were symptomatic for a median of 3 years (range 1-20 years). A success rate of 70% was seen with biofeedback therapy, with most of the patients were doing well even after discontinuation of all laxatives. Younger patients showed a much better response, with success rates of up to 82%.
A scientific approach towards diagnosis and management of constipation, which has been established at the GI Motility Lab in the Gastroenterology Department at Sir Ganga Ram Hospital. A common mistake in treating constipation according to Prof. Arora is using a “one size fits all approach” by simply prescribing high roughage diet and laxatives to all constipated patients. The legendary Amitabh Bachchan who played protagonist in the movie “Piku” succinctly depicted the harrowing feelings of a chronically constipated retiree and how the world seemed indifferent to his sufferings throughout.
At Ganga Ram Hospital, a detailed evaluation using state of the art tests are performed to identify the exact cause of constipation and patients are offered treatment accordingly.
Using advanced tests like anorectal manometry colonic transit studies and MR defecography, four types of constipation like slow transit constipation, normal transit constipation can be diagnosed, anorectal dyssynergia and irritable bowel syndrome related constipation called IBS-C all of which have different modalities and pharmacotherapy Approaches for appropriate management. Patients with constipation are then offered personalized and directed treatment as per the type of constipation which vastly improves their outcomes and greatly enhances patient satisfaction according to Prof. Arora.
Our study shows that a proper and timely evaluation of type of constipation and the planned appropriate therapy will go in long way in alleviating the cumbersome prolonged misery of many a hapless patient says Prof. Arora.
