What is Slow Transit Constipation?
Discharging wastes from the body is an essential part of the digestive process. The muscles of the large intestine help in carrying the wastes out of the body. The muscles relax and contract in a rhythmic motion and help in pushing the wastes out of the body. This is known as Peristalsis. This movement is controlled by the nerves of the Enteric Nervous System.
Slow Transit Constipation (STC)
is a condition caused when the muscles are wasted and have reduced motility and peristalsis is negatively impacted. It is essentially caused by impaired functioning of the enteric nerves. The transit of wastes through the large intestine is unusually slow. Hence, the name of the condition.
Neurologic, metabolic and endocrine disorders may impair the motility of the muscles of the large intestine causing the condition. Dietary factors like severe calorie restricted diet or side effects of medication can also cause motility disorders in the colonic muscles.
STC can be present at birth
This condition can be detected following birth. Newborns defecate a dark and sticky substance right after birth. This is called meconium. This is actually the protective mucous lining in the bowel of the baby while it was in the womb. If the baby does not pass the meconium within a day of their birth then it could indicate the condition. The symptoms are similar to another congenital condition called Hirschsprung’s Disease. Both STC and Hirschsprung’s disease can coexist together. In the latter, a child may be born without the nerve cells in the large intestine, rectum or both. Peristalsis may not take place making it impossible for the wastes to move out of the body.
What happens in STC?
The nerves of the Enteric Nervous System release chemicals called neurotransmitters. These are chemical messages for the muscle fibres. The receptors in the muscle tissue decode the message. The muscle receptors(nerve cells that receive the message) are actually instructed to cause muscular contractions or peristalsis. In children with STC, the neuroreceptors in the muscles of the large intestine function abnormally. The abnormality is caused by the deficiency of a peptide known as substance P. This peptide is primarily responsible for causing peristalsis.
Symptoms of Slow Transit Constipation
- Infrequent bowel motion
- Abdominal Pain
- Poor appetite
- Uncontrolled defecation or soiling
- Diarrhea and bloody stools are rarely seen
The different methods used for the diagnosis of the condition are as follows:
: Distended abdomen with accumulated feces can be understood from an X-ray.
: An enema containing the radioactive element barium is let into the bowel through the anus and the X-ray is taken to get a better picture.
Nuclear Transit study (NTS)
: A radioactive dose is ingested orally and the passage of the stools through the gastrointestinal tract is tracked.
: Samples of tissue from the muscles in the large intestine and colon are drawn out by making small incisions in the abdomen in at least three spots to look for nerve and receptor cells.
Treatment of Slow Transit Constipation
- Medications to improve motility in the bowel muscles.
- Colon cleansing with water soluble contrast enemas sometimes along with mineral oil under fluoroscopy can be very effective. This could be done at least twice daily. Stimulant laxatives are also another good option.
- Electrical Stimulation therapy could be used on the muscles. They improve the bowel functions reducing the need of drugs and therapies.
- When the patient remains unresponsive to all the above therapies then a surgery needs to be considered. A colostomy can be performed where the bowel opens into a hole made on the abdominal wall. The waste gets collected in a colostomy bag fitted in the abdomen.
- A small hole or stoma may be made on the appendix through a laproscopic or a minimally invasive procedure and enemas are directly given in the appendix. This is an effective method of colon cleansing.
It is important to remember that the said condition can have emotional implications. Soiling can be an embarrassing experience and can have social implications. It is important to be supportive throughout the ordeal to help the patient cope with it.