Update from bch

So we received an update from BOSTON today. They have diagnosed Addyson with Intractable constipation and Prolonged IAS relaxation . Intractable constipation is a motility disorder of the colon. So HOPKINS was right, when her surgeon said I think Addyson is battling more than just idopathic constipation. He said there is something going on regarding motility. BOSTON confirmed this!!!!
Intractable constipation is a major colon motility disorder. This prolonged constipation does not resolve with dietary changes or other simple therapeutic measures. Intractable constipation may be caused by several factors:

  • Abnormal colon contractions
  • Anal sphincter spasm leading to a functional obstruction
  • Dysfunctional innervation of colonic, anal sphincter, or pelvic floor muscles. These abnormalities can lead to an uncoordination among the colon, anal sphincter, and pelvic floor.

Intractable constipation motility conditions include:

  • Abnormal colon contractions — chaotic and non-propulsive colon contractions do not allow for natural movement of materials through the colon.
  • Dysfunctional colonic nerves or muscles — absence of colonic contractions due to altered neuromuscular function delays colonic transit or slow movement of materials through the colon and leads to severe constipation. Some patients with this dysfunction also complain of incomplete bowel movements.
  • Anal sphincter functional obstructions — partial or complete failure to relax the sphincter blocks bowel content movement through the anus.
  • Pelvic floor dyssynergia (anismus) — failure of pelvic floor muscles to have coordinated relaxation or contraction preventing normal stool elimination..

Diagnostic Testing- Diagnostic motility testing for colon motility disorders allows physicians to visualize colonic transit and muscle condition.

  • Colonic transit studies (You do this test before the cecostomy) — Colon transit time is measured by following the movement of ingested markers with a series of x-rays. The patient swallows 24 radio-opaque markers. The markers are followed through x-rays until all the markers are eliminated or for five days. This technique allows for identification of slow or normal transit constipation, determination of site of slow transit, and follow-up of the patient’s response to treatment.
  • Colon motility (THIS IS THE ONE WE JUST HAD DONE IN BOSTON) Using a manometry pressure tube, the colon muscle strength and responsiveness to stimulation are measured.

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