Other treatments for constipation

BiofeedbackMost of the muscles of the pelvis surrounding the anus and rectum areunder some degree of voluntary control. Thus, biofeedback training can teachpatients with pelvic floor dysfunction how to make their muscles work more normallyand improve their ability to defecate. During ano-rectal biofeedback training,a pressure-sensing catheter is placed through the anus and into therectum. Each time a patient contracts the muscles, the muscles generate a pressure thatis sensed by the catheter and recorded on a screen. By watching the pressures onthe screen and attempting to modify them, patients learn how to relax andcontract the muscles more normally.ExercisePeople who lead sedentary lives are more frequently constipatedthan people who are active. Nevertheless, limited studies of exercise on bowelhabit have shown that exercise has minimal or no effect on the frequency ofbowel movements. Thus, exercise can be recommended for its many other healthbenefits, but not for its effect on constipation.SurgeryFor individuals with problematic constipation that is due to diseases of the colon or laxative abuse, surgery is the ultimate treatment.During surgery, most of the colon, except for the rectum (or therectum and part of the sigmoid colon), is removed. The cut end of the smallintestine is attached to the remaining rectum or sigmoid colon. In patients with colonicinertia, surgery is reserved for those who do not respond to allother therapies. If the surgery is to be done, there must be nodisease of the small intestinal muscles. Normal small intestinal muscles are evidenced by normalmotility studies of the small intestine itself.Electrical pacingElectrical pacing is still in its experimental phases. Electrical pacing may be done using electrodes implanted into the muscular wall of the colon. The electrodes exit the colon and are attached to an electrical stimulator. Alternatively, stimulation of the sacral skin can be used to stimulate nerves going to the colon. These techniques are promising, but much more work lies ahead before their role in treating constipation, if any, has been defined.