Megacolon: New Treatments for Chronic Constipation - Gastroenterology and Hepatology

Megacolon

Hello Doctor, I have suffered from constipation since childhood.
It is common for me to go several days without a bowel movement, but my diet has always been quite normal and I do not have any food aversions.
However, as I have aged, my constipation has become increasingly severe.
I have tried many laxatives without success, and even the bowel prep medication before surgery was ineffective.
In an emergency, a nurse was willing to assist me with a water therapy treatment temporarily.
Later, when I sought medical help, the doctor performed an imaging study of my intestines and discovered that my intestines are particularly long.
Due to the limited space in my abdomen, they are compressed and twisted at awkward angles.
The doctor told me that this issue might not be manageable, which left me feeling very hopeless, so I did not seek further assistance for several years.
Recently, I have been feeling that my life is nearing its end due to my constipation issues.
I experience abdominal pain from bowel obstruction, frequent nausea, and yet I still feel hungry.
Is there truly no hope for me? Considering that it has been several years since my diagnosis of megacolon, are there any new treatment options available with current medical advancements? I would greatly appreciate your insights on this matter.
Thank you very much.

Youyou, 40~49 year old female. Ask Date: 2024/03/15

Dr. Lin Minghui reply Gastroenterology and Hepatology

Since your issue has been present since childhood, it may have worsened with age due to decreased gastrointestinal motility and smooth muscle function.
Pelvic muscle coordination can also affect bowel movements.
Stress, anxiety, and depression can impact the nerves that facilitate bowel movements, potentially leading to more severe constipation.

To manage this, it is important to maintain good lifestyle habits, such as increasing fiber intake, supplementing with probiotics, staying hydrated, and engaging in regular exercise (including aerobic activities, stretching, and pelvic floor exercises).

I recommend consulting a gastroenterologist or a colorectal specialist at a medical center to explore updated treatment options and undergo relevant examinations to assess your current health status.

Wishing you good health!

Reply Date: 2024/03/15

More Info

Understanding megacolon and chronic constipation can be quite complex, especially when traditional treatments have failed. Megacolon, or an abnormally enlarged colon, can lead to severe constipation and other gastrointestinal issues. It is important to recognize that this condition can be caused by various factors, including congenital abnormalities, nerve damage, or prolonged constipation.
In your case, it seems that the length of your colon and its abnormal positioning are contributing to your chronic constipation. This can lead to a situation where stool becomes impacted, causing pain, discomfort, and other symptoms such as nausea. It’s understandable to feel despair when faced with such a challenging condition, especially when previous treatments have not provided relief.

Current Treatments for Megacolon and Chronic Constipation
1. Dietary Changes: Increasing fiber intake is often the first recommendation for managing constipation. Foods rich in fiber, such as fruits, vegetables, whole grains, and legumes, can help promote regular bowel movements. Additionally, staying well-hydrated is crucial.

2. Medications: There are various medications available for treating chronic constipation. These include:
- Laxatives: Over-the-counter options like polyethylene glycol (MiraLAX) or magnesium-based laxatives can help soften stool and promote bowel movements.

- Stool Softeners: Docusate sodium can help make bowel movements easier.

- Prescription Medications: If over-the-counter options fail, doctors may prescribe medications like lubiprostone (Amitiza) or linaclotide (Linzess), which are specifically designed to treat chronic constipation.

3. Biofeedback Therapy: This is a newer approach that can help patients with pelvic floor dysfunction, which may be contributing to constipation. It involves working with a therapist to learn how to relax and coordinate the muscles used in bowel movements.

4. Enemas and Manual Disimpaction: In cases of severe constipation, enemas may be used to help clear the bowel. Manual disimpaction, performed by a healthcare professional, may also be necessary.

5. Surgery: If conservative treatments fail and the megacolon is significantly impacting your quality of life, surgical options may be considered. Procedures can range from removing a portion of the colon to more complex surgeries that address the underlying anatomical issues.
6. Newer Therapies: Research is ongoing into new treatments for chronic constipation and megacolon. For instance, neuromodulation techniques, which involve stimulating the nerves that control bowel function, are being explored as potential treatments.

Seeking Help
Given your history and the severity of your symptoms, it is crucial to consult with a gastroenterologist who specializes in motility disorders. They can provide a comprehensive evaluation and discuss the most appropriate treatment options for your specific situation. It’s also important to communicate openly about your symptoms, including any changes in your condition, as this can help guide treatment decisions.

Conclusion
While it may feel like there is no hope, advancements in medical treatments and a better understanding of gastrointestinal disorders mean that there are options available. It’s essential to seek professional help and explore all possible avenues for treatment. Remember, you are not alone in this, and there are healthcare professionals who can assist you in managing your condition effectively.

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