Colonic Inertia
What is colonic inertia?
Colonic inertia is a defecation disorder occurs due to abnormality in the neuromuscular control of GI tract. In colonic inertia gastric motility is hampered due to malfunctioning of muscles and nerves present in the GI tract. The waste materials do not pass smoothly within the colon which delays the empting of faeces from the GI tract. Patient complains for severe constipation.
Chronic colonic interia also affects gastric emptying as it causes pseudo-obstruction is upper GI tract which delays the passage of food materials in stomach and small intestines. For 7- 10 days the passage of stool is ceased in case of chronic colonic inertia.
It is found that in colonic interia, nerves and muscles present in colon gets affected which causes hindrance in movement of waste materials within the colon and for that reason the delay in the defecation process and constipation occurs.
Symptoms of Colonic Inertia
The prime symptom of colonic inertia is severe constipation. In such cases, individual do not pass stool for several days and he/she takes much time in washroom and has to give much more strain to rectal emptying. Some may feel incomplete defecation due to partial rectal emptying. Strain in the colonic and pelvic muscles and incomplete rectal emptying also results in the following symptoms:
- Hard stool
- Irregular (less than 3 times a week) stool pass
- Bloody stool
- Blood discharged during defecation
- Painful defecation
- Abdominal spasm
- Flatulence
- Nausea
- Vomiting
- Anorexia
- Weight loss
- Anaemia
Causes of Colonic inertia
Constipation is a very common symptom for many of the ailments which include diabetes and hypothyroidism. Other than this, inadequate balanced diet which has insufficient dietary fibres also causes constipation. Water and fluid insufficiency also causes hard stool and constipation. Some medicines also affect neuromuscular activity in colon and lessen intestinal fluid. The medications which cause constipation are antacids (except magnesium containing antacids), antihypertensive drugs, anticholinergic, antipsychotic, anti-epileptic opiates, iron supplements and calcium supplements. It is always advisable that before taking any medication whether herbal, OTC or synthetic therapeutic agent better to consult with your general physician to avoid unnecessary complications which also include constipation.
Apart from the above discussed causes, the colon motility disorder is only another reason of delaying rectal emptying. In colonic interia the colon motility disorder can occur due to following reasons:
Abnormal colon contractions
Disordered and negative expulsion force causing colon contractions and restricts the flow of waste materials within the colon.
Dysfunctional colonic nerves or muscles
Delay in passage of waste materials is due to malfunctioning of neuromuscular structure of colon and causes colonic construction. Outcome of this dysfunction is severe constipation or incomplete rectal empting.
Anal sphincter functional obstructions
The anal sphincter present at the junction between colon and anus is obstructed and cause partial or complete blockage of entrance of the sphincter causing obstruction of faecal transit through the anus.
Pelvic floor dyssynergia (anismus)
Malfunction of pelvic musculature causes imbalance between contraction and relaxation of pelvic floor muscle and prevent regular stool removal.
Treatment of Colonic Inertia
To understand the actual reason, doctors conduct different diagnostic examinations which include:
- Blood test (to evaluate the associated diseases)
- Colonoscopy (analysis of inherent malfunctions of the colon)
- Defecography (a radiographic assessment to determine structural defects during defecation) and or
- Electromyogram (estimation of muscular activity)
For treating the acute constipation of colonic interia, dietary measures and regular exercise can help to control the symptoms by softening the stool, strengthening the internal system and improving activity of abdominal muscles. Dietary measures include:
- Adequate fluid intake
- Intake of 10-12 glasses of water
- Consumption of Dietary fibres
- Avoidance of fatty food
Chronic colonic interia cannot be only controlled by dietary measures or using laxatives. Some innovative medical guidance may improve the conditions like:
- Appropriate exercises technique,
- Biofeedback* fortify muscles,
- Balancing the coordination between colonic muscle contraction and relaxation, and
- Instructing patients to evade damage which is generated due to strain in the muscles of lower gut wall and anus.
- Medicines
Bowel Training
Few simple bowel training provided can be provided to the patient to control the colon by improving strength of the muscles and guidance how to practicing habit for regular elimination of stool at a specific time.
Biofeedback
It is a computerised technology which gives the feedback about strength of pelvic floor muscle and improvement in constricting the anal sphincter by performing exact exercise accurately.
Medicines
When usual laxatives do not function then some newer medicines may help to give symptomatic relief. The available medications are Lubiprostone (Amitiza) and Tegaserod (Zelnorm). All these medication including laxatives are having habit forming properties, so better to take doctor’s advice.
Surgery of Colonic Inertia
Surgical process involves complete removal of the colon and reconnects the small intestine to the rectum. This intervention is rare as there are debates and controversies about the benefit from this surgery. This surgical process is not useful if the patient has upper GI tract obstruction, so careful diagnosis is very important to get the optimum result.
References
- http://www.iffgd.org/library/download/159
- http://www.cpmc.org/
- http://www.ddc.musc.edu/
- http://www.aboutconstipation.org/