Chronic constipation isn’t a topic that ranks high among the things you share with friends, family or even doctors. And it isn’t something to laugh about if it affects you. Stranger still, most people shrug it off as an inconvenience to be endured or have been told “it’s IBS” or more likely, "eat more fibre”. They live with the miseries of bloating, pain, straining in the bathroom and general ‘unwellness’ for years on end, while rarely seeking professional help.
But there is always a cause and more importantly, usually a solution.
A solution can only be found if the appropriate investigations are undertaken. Causes include motility issues of the intestines, scarring in the abdomen from past surgery, endometriosis and muscular weakness or lack of coordination of muscles in the pelvis. Discovering the cause can be as simple as a physical exam but may need further testing like transit time studies, magnetic resonance (MRI) defecography and ano-rectal manometry.
-A Colonic transit time study uses a swallowed capsule that releases markers visible on X-ray. After a few days after swallowing the special capsule, an X-ray is taken that can show where the hold up in the colon may be.
-MR defecography is a painless procedure where a gel is instilled into the rectum and images obtained as the patient tries to expel the gel. This can provide an extraordinarily detailed picture of what muscles are not acting in a co-ordinated way to allow normal bowel habit
-Ano-rectal manometry employs a thin tube with pressure sensors passed through the anal canal and into the rectum that precisely measures the strength and behavior of the muscles of the anal canal.
By putting together all these results, a clearer picture of what is out-of-sync can be obtained, providing a basis to solving this complex problem.