Constipation
Chronic difficulty in passing stools or infrequent bowel movements requiring medical evaluation.
Overview
Chronic constipation affects 15-20% of the Indian population. While usually managed conservatively, severe refractory cases (slow-transit constipation or outlet obstruction) may benefit from surgical intervention after thorough evaluation.
Causes
- Low-fiber diet
- Inadequate hydration
- Sedentary lifestyle
- Medications (opioids, anticholinergics)
- Slow-transit constipation (colonic inertia)
- Outlet obstruction (rectocele, intussusception)
- Hypothyroidism, diabetes
Risk Factors
- Female gender
- Age over 60
- Low-fiber diet
- Sedentary lifestyle
- Multiple medications
- Neurological conditions
Symptoms
Diagnosis
- Clinical history (Rome IV criteria)
- Colonic transit study
- Anorectal manometry
- Defecography (MR or fluoroscopic)
- Colonoscopy (to exclude obstruction/cancer)
Treatment Options
Surgical Treatment
Surgery is a last resort for severe slow-transit constipation failing all medical therapy. Subtotal colectomy with ileorectal anastomosis is effective for colonic inertia (80-90% improvement). For outlet obstruction: rectocele repair, STARR procedure. Thorough preoperative evaluation is essential to select appropriate surgical candidates.
Recovery
Subtotal colectomy: 5-7 days hospital stay. Expect 3-5 soft bowel movements daily. Most patients satisfied with outcome. Biofeedback for pelvic floor dysfunction: 6-12 sessions over 3 months.
Prevention
- 30g fiber daily
- 8-10 glasses of water
- Regular exercise (30 min/day)
- Don't ignore urge to defecate
- Limit processed foods
- Review medications with doctor
Frequently Asked Questions
When should I see a surgeon for constipation?
Will I have diarrhea after colon surgery?
Expert Consultation Available
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