Long-Term Bowel Obstruction: Treatment Options and Costs

Chronic constipation

Dear Dr.
He,
Hello, I am an overseas Chinese resident.
I have a history of bowel obstruction for 23 years, which has transitioned from psychological factors to physiological issues.
The possible conditions I may have include: 1.
Rectal prolapse 2.
Pelvic floor muscle spasm syndrome 3.
Perineal descent syndrome, among others.
All of these are classified as obstructive constipation.
I can only pass about 1/3 to 1/2 of my stool on my own; the remaining soft stool can only be expelled by manually dilating the anus and rectum, and if that fails, I have to dig it out.
I cannot sense whether I have fully evacuated.
I have tried practicing pelvic floor muscle exercises, but the results have been poor.
My quality of life has been severely affected.

In early October of this year, I will return to Taiwan and hope to receive treatment from specialists.
I have a few questions I would like to ask: 1.
I have heard that biofeedback therapy has the best results; what is the typical cost for this treatment? 2.
If I need to undergo STARR or related surgeries, what would the out-of-pocket expenses be? 3.
Given that my visa allows for a 90-day stay, is it possible to complete the treatment within this timeframe?
Thank you for your valuable time.

Best regards,
Jenny Luo

Miss Luo, 30~39 year old female. Ask Date: 2017/02/20

Dr. Ke Fangxu reply Surgery

1.
Biofeedback devices are covered by health insurance, but some hospitals may charge out-of-pocket fees that vary, so please inquire for clarification.

2.
STARR surgery stands for Stapled Transanal Resection of the Rectum, which is typically used to treat rectal prolapse rather than pelvic floor dysfunction.
The cost of the device itself is approximately NT$20,000, but I have not heard of any out-of-pocket pricing for the overall surgery.

3.
If you are to undergo STARR surgery, two weeks should be sufficient.
However, if you are considering biofeedback therapy, a treatment course will require at least several weeks, depending on recovery status and whether additional treatments are necessary.
Personally, I believe the STARR surgery may not yield satisfactory results, so if you hope for a complete return to normalcy, it is difficult to say whether the time will be adequate.

Reply Date: 2017/02/20

More Info

Hello Jenny,
Thank you for reaching out with your concerns regarding long-term bowel obstruction and the associated treatment options. It sounds like you have been dealing with significant challenges related to bowel function for many years, and I commend you for seeking help.

Understanding Your Condition
Based on your description, it appears that you may be experiencing a form of outlet obstruction constipation, which can be caused by various factors, including rectal prolapse, pelvic floor dysfunction, and other related syndromes. These conditions can lead to difficulties in bowel movements, as you've described, where manual assistance is required to facilitate defecation.

Treatment Options
1. Biofeedback Therapy: This is often recommended for patients with pelvic floor dysfunction. Biofeedback can help retrain the muscles involved in bowel movements, potentially improving your ability to defecate without manual assistance. The costs for biofeedback therapy can vary widely depending on the facility and whether it is covered by insurance. In general, you might expect to pay anywhere from $100 to $300 per session, and multiple sessions may be required for optimal results.

2. Surgical Options: If conservative treatments like biofeedback do not yield satisfactory results, surgical options may be considered. The STARR procedure (Stapled Transanal Resection of the Rectum) is one surgical option that can be used to treat rectal prolapse and other related conditions. The cost of STARR surgery can also vary significantly, but it typically ranges from $15,000 to $30,000 in the United States, depending on the facility and whether any complications arise. Since you mentioned that you will be self-paying, it’s crucial to discuss the total estimated costs with the healthcare provider before proceeding.

3. Timeline for Treatment: Given your 90-day visa, it is feasible to complete a treatment plan within this timeframe, especially if you are considering a combination of biofeedback and potential surgical intervention. However, the exact timeline will depend on the specific recommendations from your healthcare provider and how your body responds to initial treatments. If surgery is required, it may take a few weeks for recovery, so planning accordingly is essential.

Additional Considerations
It's important to have a thorough evaluation by a colorectal specialist who can provide a tailored treatment plan based on your specific condition. They may recommend diagnostic tests such as anorectal manometry or imaging studies to better understand the underlying issues contributing to your symptoms.

Additionally, consider discussing the possibility of a multidisciplinary approach, which may include physical therapy focused on pelvic floor rehabilitation, dietary modifications, and possibly medication to manage symptoms.

Conclusion
In summary, you have several options for addressing your long-term bowel obstruction, including biofeedback therapy and surgical interventions like the STARR procedure. Costs can vary widely, so it’s essential to have open discussions with your healthcare providers about your financial situation and treatment goals. Given your upcoming visit to Taiwan, I encourage you to seek out a colorectal specialist who can provide comprehensive care tailored to your needs.

Wishing you the best of luck in your treatment journey, and I hope you find relief and improvement in your quality of life soon.

Best regards.

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