FAQs

1) What is constipation?

In general, a condition is regarded as constipation when a person encounters fewer than three bowel movements per week But it has different meanings to different individuals. Patients may use the term to indicate the lack of an urge to defecate, Most commonly, it refers to a decreased frequency of bowel movements, decrease in the volume or weight of stool, the need to strain to pass stool, a sense of incomplete evacuation, difficulty in passing hard scybalous stools, or the need for enemas, suppositories or laxatives in order to maintain regularity For most people, it is normal for bowel movements to occur from three times a day to three times a week. Constipation is a very personal experience of the bowel not doing its job properly. For this reason, changes from your ‘normal’ habit can be the best way to tell whether or not you are constipated.

2) What is a normal consistency for a bowel movement?

Bowel movements should be soft and formed. They should pass easily like toothpaste flowing out of a tube.

3)What causes constipation?

After food is digested in the stomach and the nutrients absorbed in the intestines, the remains pass down the colon, where they are transformed into feces. If they remain in the colon too long, they can dry out and harden, resulting in hard stools that are difficult to pass. This can be caused by:
• Irregular eating habits, or eating very small portions
• Insufficient exercise a sedentary lifestyle
• Dehydration or insufficient intake of liquids
• Lack of fibre-rich foods
• Stress
• Not visiting the toilet when the urge arises when you put off going to the toilet your body will react in the same way – a build up of stools in your colon, which can harden and become difficult to pass. Suppressing the urge may also affect the nerve signaling between your digestive system and your brain causing further problems.
Constipation may be aggravated by travel, pregnancy or change in diet. More serious causes of constipation include growths or areas of narrowing in the colon, so it is wise to seek the advice of a anorectal surgeon when constipation persists.

4) Can medication cause constipation?

Yes, many medications, including pain killers, antidepressants, tranquilizers, and other psychiatric medications, blood pressure medication, diuretics, iron supplements, calcium supplements, and ¬aluminum containing antacids can slow the movement of the colon and worsen constipation.

5) When should I see a doctor about constipation?

If you suffer from constipation for a prolonged period of time, if there is blood in your stools, or if you also experience sudden weight loss or severe stomach pain you should consultthe surgeon & get certain test done.

6) How is constipation treated?

If you suffer from constipation on a regular basis, here is a useful list of guidelines you can follow:
• Drink 1 to 1.5 litres of liquid daily – water, juice, etc. The colon draws water from stool, the longer stool sits in the colon, the harder the stool becomes Plenty of decaffeinated fluid (if you are not on fluid restrictions) also helps to keep bowel movements soft.
• Eat plenty of fibre - like bran, shredded wheat, whole grain breads and certain fruits and vegetables .t. The recommended amount is between 25-35 grams of fiber a day. Fibre binds fluid and bulks up your stools, making them easier to transport through the intestines.
• Eat less red meat and processed food. Limit foods that have little or no fiber such as ice cream, cheese, meat, snacks like chips and pizza, and processed foods such as instant mashed potatoes or already-prepared frozen dinners.
•Be active – go for a walk, swim, jog, bike ride or something similar, every day A 20- to 30-minute walk every day may help.
• Practice good toilet habits – go at the same time every day and take your time
• Don't ignore the urge to have a bowel movement
Laxatives are medicines that will make you pass a stool laxatives, enemas or suppositories should be used only when recommended and monitored by your colon and rectal surgeon

7) What self help things can I do if I suffer from constipation?

Bowels like a routine, so eating the same amounts around the same time of day helps to regulate the bowels. ,If you go to toilet about the same time each day your digestive system will get used to it. Bowels also like regular exercise to keep them moving. Exercise helps the muscles in your intestines contract efficiently, which improves the flow of stools through your system. Body position can help you to move your bowels. While sitting on the toilet, placing your feet on a small step stool can position the rectum at an angle which makes it easier to pass stool

PELVIC FLOOR DYSFUCTION

1) What is pelvic floor dysfunction?

For most people, having a bowel movement is a seemingly automatic function. For some individuals, the process of evacuating stool may be difficult. Symptoms of pelvic floor dysfunction include constipation and the sensation of incomplete emptying of the rectum when having a bowel movement. Incomplete emptying may result in the individual feeling the need to attempt a bowel movement several times within a short period of time. Residual stool left in the rectum may slowly seep out of the rectum leading to reports of bowel incontinence.

2) How is pelvic floor dysfunction diagnosed?

The diagnosis of pelvic floor disorder starts with a careful history regarding an individual’s symptoms, medical problems and a history of physical or emotional trauma that may be contributing to their problem. Next the physician examines the patient to identify any physical abnormality. A defecating proctogram is a study commonly used to demonstrate the functional problem in a person with pelvic floor dysfunction. During this study, the patient is given an enema of a thick liquid that can be detected with x-ray. A special x-ray video records the movement of the pelvic floor muscles and the rectum while the individual attempts to empty the liquid from the rectum. Normally the pelvic floor relaxes allowing the rectum to straighten and the liquid to pass out of the rectum. This study will demonstrate if the pelvic floor muscles are not relaxing appropriately and preventing passage of the liquid.

3)How is pelvic floor dysfunction diagnosed?

The defecating proctogram is also useful to show if the rectum is folding in on itself (rectal prolapse). Many women have outpouching of the rectum known as a rectocele. Usually a rectocele does not affect the passage of stool. In some instances, however, stool may become trapped in a rectocele causing symptoms of incomplete evacuation. The defecating proctogram helps to identify if liquid is getting trapped in a rectocele when the individual is trying to empty the rectum. Wrong habbit and inadequate training during childhood can be curse in future

4)How is pelvic floor dysfunction treated?

Pelvic floor dysfunction due to non-relaxation of the pelvic floor muscles may be treated with specialized physical therapy known as biofeedback. With biofeedback, a therapist helps to improve a person’s rectal sensation and pelvic floor muscle coordination. There are various effective techniques used in biofeedback. Some therapists train patients by teaching them to expel a small balloon placed in the rectum. Another technique uses a small probe placed in the rectum or vagina or electrodes placed on the surface of the skin around the opening to the rectum (anus) and on the abdominal wall. These instruments detect when a muscle is contracting or relaxing and provide visual feedback of the Pelvic floor dysfunction due to non-relaxation of the pelvic floor muscles may be treated with specialized physical therapy known as biofeedback. With biofeedback, a therapist helps to improve a person’s rectal sensation and pelvic floor muscle coordination. There are various effective techniques used in biofeedback. Some therapists train patients by teaching them to expel a small balloon placed in the rectum. Another technique uses a small probe placed in the rectum or vagina or electrodes placed on the surface of the skin around the opening to the rectum (anus) and on the abdominal wall. These instruments detect when a muscle is contracting or relaxing and provide visual feedback of the muscle action. This visual feedback helps the individual to understand the muscle movement and aids in improving muscle coordination. Approximately 75% of individuals with pelvic floor dysfunction experience significant improvement with biofeedback. Abnormalities identified with a defecating proctogram such as rectal prolapse and rectocele may be treated with a surgical procedure.

RECTOCELE

1) What is a rectocele?

A rectocele is a bulge of the front wall of the rectum into the vagina. The rectal wall may become thinned and weak, and it may balloon out into the vagina when you push down to have a bowel movement.

2) What can cause a rectocele?

Birth trauma such as multiple, difficult or prolonged deliveries, the use of forceps or other assisted methods of delivery, perineal tears, or an episiotomy into the rectum or anal sphincter muscles. In addition, a history of constipation and straining with bowel movements, or hysterectomy may contribute to the development of a rectocele

3)What are the symptoms of a rectocele?

Many women have rectocele but only a small percentage of women have symptoms related to the rectocele. Symptoms may be primarily vaginal or rectal. Vaginal symptoms include vaginal bulging, the sensation of a mass in the vagina, pain with intercourse or even something hanging out of the vagina that may become irritated

4)How is a rectocele diagnosed?

An x-ray study called a defecagram. This study shows how large the rectocele is and if it empties with evacuation.

5)What treatment is available for a rectocele?

Rectoceles that are not causing symptoms do not need to be treated. In general, you should avoid constipation by eating a high fiber diet and drinking plenty of fluids.

6) Medical treatment

A bowel management program is the best first step. This includes a diet high in fiber and 6 to 8 glasses of fluids each day. Fiber acts like a sponge Avoid prolonged straining.

7) Surgical treatment

If symptoms persist even with medical therapy, then surgical repair may be indicated.

STARR

STARR is novel technique which involves a double stapling technique using two 33 mm circular staplers to carry out a full thickness resection of the lower rectum with simultaneous anastomosis to restore bowel continuity.It is done in Obstructed Defaection syndrome. (ODS)

What is ODS?

ODS- Obstructed Defecation syndrome is defined as an acquired behavioral disorder characterized by excessive straining at stools with unsatisfactory evacuation in the absence of local, systemic or metabolic disorder associated with failure of relaxation of sphincters and pelvic floor muscles. It is characterized by a spectrum of symptoms including difficult evacuation, excessive straining during defecation, sensation of incomplete evacuation, prolonged time to defecate, anal pain, bleeding, and the use of digital maneuvers to aid defecation. It is commoner in multiparous women. Associated anatomical conditions include rectal mucosal prolapse/rectal intussusceptions, rectocoele. urogenital prolapse, enterocoele