Slow‐transit Constipation: Evaluation and Treatment

Abstract

Slow-transit constipation is characterized by delay in transit of stool through the colon, caused by either myopathy or neuropathy. The severity of constipation is highly variable, but may be severe enough to result in complete cessation of spontaneous bowel motions. Diagnostic tests to assess colonic transit include radiopaque marker or radioisotope studies, and intraluminal tests (colonic and small bowel manometry). Most patients with functional constipation respond to laxatives, but a small proportion are resistant to this treatment. In some patients biofeedback is helpful although the mechanism by which this works is still uncertain. Other patients are resistant to all conservative modes of therapy and require surgical intervention. Extensive clinical and physiological preoperative assessment of patients with slow colonic transit is essential before considering surgery, including an assessment of small bowel motility and identification of coexistent obstructed defecation. The psychological state of the patient should always be taken into account. When surgery is indicated, subtotal colectomy and ileorectal anastomosis is the operation of choice. Segmental colonic resection has been reported in a few patients, but methods of identifying the affected segment need to be developed further. Less invasive and reversible surgical options include laparoscopic ileostomy, antegrade colonic enema and sacral nerve stimulation.

Confecção de válvulas biológicas (seromiotomias) para controle de diarréia intratável após colectomia total por inércia colônica

“…Aiming to solve the problem in a more physiological way, seromyotomies have been proposed for the preparation of this patient, following the principles proposed by Lázaro da Silva (1991) in the making of perineal colostomy 15 . This procedure results in slight fibrotic ring without stenosis of the gut lumen, but a braking mechanism that is responsible for the continence 2,5,6,11,14 . The follow-up period of 34 months showed a patient psychologically better, maintaining treatment for alcoholism without relapsing, without diarrhea, evacuating from four to a maximum of six times per day without dermatitis, with improvement of chronic anal fissures, reinserted in the social context and and reaching a lifestyle closer to normal.…”

“…Some authors consider success when there are no more than three bowel movements per day and not less than once every three days 3,14 .…”

Effects of sacral nerve stimulation with acupuncture on gut transit time and c-kit expression in colon of rats with slow transit constipation

“…So far only a few studies have investigated SNS as a treatment of constipation, and early results are encouraging (Kenefick et al, 2002a;Malouf et al, 2002;Holzer et al, 2008;Kamm et al, 2010). Percutaneous tibial nerve stimulation as a new therapeutic option has been reported to increase stool frequency, decrease the use of laxatives, and improve the quality of life in patients with STC (Wong and Lubowski, 2007;Collins et al, 2012). During the past decades, electroacupuncture has been reported to accelerate gastrointestinal motility both in animals and humans (Iwa et al, 2006;Xu et al, 2006;Yin et al, 2010).…”

Cyclooxygenase-Dependent Alterations in Substance P-Mediated Contractility and Tachykinin NK1 Receptor Expression in the Colonic Circular Muscle of Patients with Slow Transit Constipation

“…Sigmoid colon segments were obtained from 27 female patients (median age, 48.5; range, 19 -73 years) undergoing subtotal colectomy with ileorectal anastomosis for STC. These STC patients represented severe cases that were resistant to conventional laxative treatment (Wong and Lubowski, 2007). Control sigmoid colon segments (resected during surgery for carcinoma, taken 10 -15 cm from the tumor) were obtained from 29 female patients (median age, 48; range, 30 -72).…”