Slow Transit Constipation

By Dr. Julia Lizy, MBBS (KEMU)
Slow Transit Constipation

Slow transient constipation, formerly called neuronal intestinal dysplasia, refers to the slow passage of stool through colon. This may lead to chronic constipation.

Slow Transit Constipation

Symptoms

• Infrequent bowel movements
  
  
• Uncontrolled soiling of clothing
  
  
• Abdominal pain
  
  
• Bloating
  
  
• Constipation
  
  
• Nausea
  
  
• Lack of appetite
  
  
• Lack of an urgency to have a bowel movement

Causes of Slow Transient Constipation (STC)

1. There occurs a functional disability of nerves supplying intestinal muscles causing sluggish movement of the colon. It effects the peristaltic wave-like movements of intestines which are responsible for moving stool through the bowel.
   
   
2. There is an abnormality of the neurotransmitters.
   
   
3. There is reduced cholinergic response while adrenergic response is enhanced. This also leads to slow emptying of the colon.
   
   
4. A dyssynergy of recto sigmoid colonic activities resulting in a sluggish colon and constipation.
   
   
5. There is a reduction in rectal pressure to trigger the defecation reflex. This renders the feces small and hard due to their extended stay in the colon.
   
   
6. Gut motility can also be affected by some extrinsic factors such as a change in diet, stress, a lack of exercise, and normal routine interrupted by extended time traveling.
   
   

In short, all of the above mechanisms lead to the following:

• Colonic motor activity impaired
  
  
• Sluggish passage of stool through the colon
  
  
• Peristaltic waves are significantly reduced and less frequent
  
  
• The slow emptying of the contents of the colon
  
  
• A lack of an urge to defecate
  
  

Diagnosis of slow transient constipation

Investigation for slow transient constipation includes an initial diagnosis of chronic constipation.

Tests include a simple abdominal X-ray or an X-ray with a barium enema. Defecating proctography is also done sometimes to exclude many obstructive causes.

The specific investigation for slow transient constipation includes a colonic nuclear transient study in which tests are done after a person swallows a radioactive material.

Full thickness laparoscopic biopsy is also an investigation of choice.

Treatment of Slow Transient Constipation

Slow transient constipation is a chronic condition which currently has no cure.

But a number of treatment options are available to enhance the quality of life.

The following strategies help to treat slow transient constipation:

Life style modifications

A change in the type of foods one eats and an increase in fluid intake is needed to help soften and make stool larger.

This is needed to help induce the rectal pressure required to initiate defecation.

Exercising each day is also necessary to aid the treatment of slow transient constipation.

Use of a magnesium supplement

A magnesium supplement may be taken daily to help reduce slow transit constipation symptoms.

Magnesium is an osmotic laxative that draws water into the colon. The additional water makes stool moist, soft and slippery for easier passage.

Because it is a mineral supplement that is not habit forming and can be taken daily, it may help to provide long-term relief of constipation.

Biofeedback

Here is a risk free method to aid in the treatment of slow transient constipation.

Up to 60% of patients using biofeedback see some improvement. For most people with slow transit constipation, there exists an inability to coordinate between abdominal and pelvic floor muscles.

This leads to a difficulty in the evacuation of stools. Biofeedback therapy helps with the following:

• Coordination between abdominal and pelvic floor muscles
  
  
• Correcting a person’s position during the evacuation of stools
  
  
• Maintaining a stool diary, which can promote regularity
  
  

Pharmacological Treatment

Laxatives are used for the treatment of slow transient constipation.

Treatment is based on an escalating dose of laxatives. The most commonly used laxatives for slow transient constipation are stimulant laxatives like include senna and bisacodyl.

They stimulate peristaltic contractions which lead to a decrease in transient time and an emptying of stool. These drugs also cause less water to be absorbed by the colon, thus maintaining a softer stool.

Besides stimulant laxatives, an osmotic laxative such as lactulose or polyethylene glycol can also be used. This class of laxatives adsorb and retain water, speeding up the passage of stool through the colon.

Chloride channel activators

Lubiprostone produces softer and more frequent bowel movements by  promoting secretion through chloride channels in the bowel, thus making it easier for stool to pass through the bowel.

Sometimes plain enemas are used to flush feces of rectum.

Interferential Electric Stimulation Therapy

This provides low frequency electrical stimulation of nerves without any painful or unpleasant side effects.

This results in muscular stimulation and the increase in gut motility, increasing the evacuation of stool.

Surgical Treatment

Surgical intervention is the last resort to treat slow transient constipation.

It is preferred in patients with well documented chronic constipation who are resistant to medical treatment. Before resorting to surgery, any functional outlet obstruction must be ruled out.

The surgical procedure that is performed for slow transient constipation is abdominal colectomy and anastomosis of the small intestine to the rectum.

It can be done using either open or laparoscopic approaches. The operation increases the frequency of bowel movements, helping the patient to experience more normal bowel movements.

A recent approach is to put in place a continent conduit from the sigmoid colon that provides access for colonic irrigation.

Conclusion:

Constipation includes symptoms of slow, impaired and painful defecation.

It is necessary to evaluate the exact cause and to treat it accordingly. In the case of resistance to initial treatment, it is then necessary to undergo specialized evaluation to determine the cause, such as slow transient constipation.

Although there is no cure for slow transit constipation, lifestyle modification, biofeedback exercises and the moderate use of laxatives can help to reduce its symptoms.

(Return from Slow Transit Constipation to What is Constipation)