Colectomy with Ileorectal Anastomosis

Surgical treatment is guided by the results of the specific investigations.3-5 Patients with slow transit constipation, as demonstrated by the failure to eliminate all markers by 7 days during the colonic transit study should be considered for a colectomy and ileorectal anastomosis (IRA). However, this may not be the best option for patients who are unable to evacuate a balloon in the anal physiology laboratory as this may signal rectal dysfunction. Nonetheless, these patients may still be candidates, because the stool produced after this surgery is liquid or very soft and evacuation of soft stool may not be a problem even if rectal dysfunction exists. Instead, if they are unsatisfied and request surgical intervention, an ileostomy is the procedure of choice. A loop ileostomy can usually be done laparo-scopically is reversible. Many individuals experience great relief after an ileostomy in this situation.

Poor anal sphincters with lax sphincter tone may preclude perfuming a colectomy and IRA. The stool frequency after this procedure can be eight or more very soft stools daily. For compromised sphincters, this could lead to anal incontinence. Many patients would understandably avoid an ileostomy and opt for a colectomy and IRA despite the possibility of incontinence. They feel that a subsequent ileostomy is still possible if this fails.

A frequent dilemma is the order in which to manage patients who exhibit slow transit constipation and paradoxical puborectalis contraction. Traditionally, some surgeons thought that the paradox should be managed with biofeedback before the surgical intervention. However, many patients fall into the paradoxical muscle problem because they need to strain and bear down in any attempt to evacuate stool and gain relief. In our experience, until the need to excessively strain is eliminated, biofeedback is not as helpful, therefore, the colectomy should be performed first. If the patient still has difficulty after surgical recovery, they are reassessed with anal physiology. If paradox is found, biofeedback is then recommended.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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