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SPECIAL INVESTIGATIONS FOR CHRONIC CONSTIPATION
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Doctors often hear of this complaint and deal with it by prescribing Dulcolax or any other laxative, to be taken daily. It will be noticed, that these patients remain chronically constipated for years together.
First of all, the doctors should take more interest in the roughage content of the diet and water intake per day.
They must at least examine the perineum and do a rectal examination and proctoscopy. So many patients have chronic anal fissures, huge piles or space occupying lesion in the rectum, which are the cause of chronic constipation.
Always try medical treatment first. Diluted GTN ointment brings about a good healing of anal fissure. Dafflon tablets (Flavinoids) give excellent results in patients having piles. The question arises in patients who are elderly and can afford a few investigations.
A sigmoidoscopy to exclude any malignancy, tuberculous or ischaemic stricture and Ba enema studies to exclude diverticulosis or distal colonic pathology, can be asked for.
The fact is that many patients, where all these investigations, are normal, go on complaining of chronic constipation.
Ideally the following investigations should be done in all such patients:
1. Anorectal manometry studies.
2. Electro-physiological studies equivalent to EMG of the pelvic floor muscles.
3. Defaecating proctography.
In Western countries, there are special centres where all such studies are done. When the motility disorder or any other defects are identified, the proctologist operates, resulting in long term relief from constipation.
After all the above procedures, irritable colon, which is the most common cause, cannot be diagnosed by any test, presently available (manometry not available).
In the rest of India and in Mumbai, at present all the attention is focussed on coronary angiography. Till such time, that we have centres to do studies for motility disorders and rectify them, the problem of constipation will not be solved.
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