Chronic Constipation
There are some conditions that you may be unsure about (or uncomfortable) discussing with your doctor. For example, if you are finding it hard on a regular basis to have three complete bowel movements a week, with prolonged straining, you may be suffering from chronic constipation. Many people, especially women who have given birth, have structural defects in their rectum that result in what is called Obstructive Defecation Syndrome or ODS.

How is ODS Diagnosed?
Proper diagnosis is the key to successful treatment of defecation disorders, such as ODS. Diagnosis can be complex and requires evaluations by your primary care physician, gastroenterologist, and colorectal surgeon to be sure the actual cause – or causes – of the disorder is identified. In addition to a physical exam, some of the diagnostic tests that may be performed are:

• Colonoscopy — allows a doctor to look at the interior lining of the large intestine (rectum and colon) through a thin, flexible viewing instrument called a colonoscope. The test looks for abnormalities, including narrowing or obstructions and inflammatory diseases such as Crohn’s disease and ulcerative colitis.
• Colonic marker studies — the patient swallows small radiopaque, or markers, which can be seen on x-ray films. During a period of seven days, the patient is x-rayed to track the progress of the markers and see how quickly they are moving through the digestive tract.
• Electromyography (EMG) — tests for weakness in the pelvic floor muscles and the muscles surrounding the anus to determine how well they are working.
• Anorectal manometry — tests how well the muscles surrounding the anus are working.
• Dynamic defecography — during this test, the patient sits on a special toilet and strains while being viewed under x-ray. Images are taken while a paste mixture passes through the bowel. This allows your doctor to assess bowel function.

Treating Obstructed Defecation Syndrome (ODS)
Most people with ODS can treat it with routine use of laxatives or enemas. This requires multiple trips to the bathroom and perhaps other measures to physically help pass the stool for relief. But for some, surgery may be the only way to correct the defects that are causing the constipation.

Options for Surgery
If your doctor recommends surgery, it’s important to know that there’s a minimally invasive procedure that can correct ODS without external incisions, and leaves no visible scars.

This procedure is called Stapled Transanal Rectal Resection (STARR) removes the excess tissue in the rectum, reducing the anatomical defects that can cause ODS. This minimally invasive procedure means for most patients a quick procedure and a short recovery time.⁶

In a study of 90 patients undergoing the STARR procedure, patients were hospitalized one to three days, experienced minimal postoperative pain after the procedure, and resumed employment or normal activity in 6-15 days. In this study, most ODS patients experienced a significant improvement in their ODS symptoms following STARR.⁶

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Talking to your Doctor about Chronic Constipation
It’s important for you to learn as much about chronic constipation and treatment options as possible, and your doctor is your best resource. These questions can help you start the conversation:

• What is constipation?
• How do I know if I am constipated?
• Why is constipation an important topic?
• How is chronic constipation treated?
• If diet and exercise do not relieve chronic constipation, what is the next step?
• What are the symptoms of ODS?
• How is ODS diagnosed?
• Is ODS treatable?
• Is surgery a treatment option for me?

 

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