 Hello and welcome. I'm Khushboo and you're watching Health Mantra. Today here with us we have Dr. Rohan Barbe from Manipal Hospital. Dr. Rohan is a consultant in medical gastroenterology. Doctor, thank you so much for accepting our invitation and taking the time to come here. Yeah, thanks. Let's start off today's show with a very important topic. Something that just goes unnoticed or maybe ignored. Because of course we diagnose ourselves. Maybe I ate something a little less. Maybe I ate something a little more. Maybe I need to eat a banana. Yes, we're talking about digestive disorders. Yes, constipation it is. So let's get to know a little more from Dr. Barbe. Yes, so constipation mainly is defined by two things. One is stool consistency and another is stool frequency. So when the person is passing stools less than three times a week, that is called as constipation. The consistency wise, usually the person by the patient is, they feel that motions are very hard. They need a straining to pass the stools. Sometimes they feel there is a blockage when the stools are coming out. In very extreme cases, they need to put a finger to remove the stools. We call it as a manual evacuation. And the last some patients feel nonspecific symptoms like bloating, excessive flatulence. So these all symptoms come under the constipation. And Dr, is there any particular age group or the kind of people that are affected by this? Yes, so mainly the elderly people are affected by constipation. The one of the reason is as the age grows, the peristalsis that is the movement of food or stool in the intestine becomes slow. That's why it becomes more harder. The stools become more harder and dehydrated and they suffer with constipation. Another is the females, specifically pregnant female and postpartum female. They suffer with constipation. Again the reason being dehydration and some hormonal changes which precipitated these symptoms. Also Dr, are there any specific types, any particular types of constipation? Yes, so constipation there are various reasons. Basically broadly we classify into two groups. One which is called as functional constipation and second under organic diseases. Functional means what? There are no diseases inside. But being as I said the colonic motility is affected by different reasons. That's why patients are suffering with constipation. So almost 80% of the patients are having this functional constipation. While organic there are various reasons. Like there is the disease present in the colon or other metabolic causes because of which they suffer. So in organic we divide into four types. One we call it when the disease is in the colon. Like somebody is having colonic stricture. Stricture means narrowing. In that narrowing case stool cannot come out. Because of this narrowest part the stool gets accumulated above that obstruction. This is called as colonic strictures. The reasons could be Crohn's disease, tuberculosis. This causes this colonic strictures. Second is colonic tumors as we know malignancy. With the malignancy this growth blocks the passage of the stool while they are coming out through the colon. Third the colonic diseases we call when they are affecting the rectum. Rectum is nothing but the last part of our large intestine. So when there is a formation of ulcer we call it as a solitary rectal ulcer syndrome or proctitis. This leads to the constipation. So these are some of the colonic diseases. As I said other causes are like metabolic syndromes as we all know diabetes. So diabetes people suffer with constipation. Basically when diabetes people when their sugars are uncontrolled they affect the nerves. The nerves are connecting brain to our intestines. Because of that again intestinal motility becomes slow. So when it's diabetes second we call it as a thyroid, hypothyroid patients. Those on where thyroid hormone levels are low functional thyroid hormones we call it as a hypothyroidism. Because of this again the colonic motility becomes slow. Third we say hypercalcemia. There are various reasons when the calcium levels in your body increases it can lead to the constipation. The fourth as I said this is the metabolic causes one is colonic diseases. Third is neurological causes. Those patients who are suffering with spinal cord diseases there are various reasons again the colonic motility slows down. Some diseases are called as Parkinsonism which comes with the age and these are the degenerative disorders. In these patients again because of slowing this moment of the peristalsis the stools becomes more dehydrated and hard and they suffer with constipation. So these are various reasons basically in organic causes leading to constipation. As I said functional, functional is which we see more commonly. Out of that functional there are three main types are there. One we call it as a normal transit as I was stressing more on the speed or motility of the large intestine. In normal transit the speed is normal still patients suffer with constipation. These fall more in commonly in a group called as irritable bowel syndrome. So these patients are having predominant constipation as a symptom along with that they have some abdominal pain and bloating and flatulence. Another is slow transit. This is slow transit constipation is seen in which there are some myopathic or neuropathic disorders where there is no organic disease. But still the motility of the colon is slow and third we said difficult disorder. So if you see the constipation one is stool has to travel from the large intestine till the last part. So once the stool is in our last part of our colon we get the urge to pass the stool and then there is a process called as defecation by which the stool comes out of our body. So the defecation process is affected in some people. So the stool travels with normal speed. It reaches the rectum. It gets accumulated. The patient gets the urge but still they are not able to defecate out. In that case the defecation process affected. It is called as defecatory disorders. So there are different causes of constipation. Usually the people see that the constipation is the same thing. But as I told you with so many reasons and so many types the treatment investigation and other all parameters changes. So one should know that there are different types like your constipation and other patients constipation will not be the same. So same treatment will not be applicable to both of you. So first we need to know the exact reason. We need to classify it and then we need to start the treatment in such a way. Doctor are there any investigations available and also how do I know if I need that investigation? Yes. So as I said functional constipation is the most common reason. Not all the patients require the investigations. When the patient comes with the constipation basically chronic constipation which we are talking about. So there are two types one is chronic and acute. Acute constipation is when the patient is suffering with these symptoms for a shorter duration. In that case suppose some patient is having more dehydrated. They had more vomiting. They are not able to drink the proper water. Mainly in summer seasons we see a lot of people are dehydrated. They get constipation. When they correct these factors like hydration, drinking more water, having more fibers this constipation gets corrected. They don't require any evaluation. But those who are suffering with chronic constipation having these symptoms for more than a month and years they should consult the doctor. When these kind of patients come to us not all the patients require investigations or any test. By clinically taking the history we type them in which class their symptoms are or which is the type of constipation and accordingly we suggest. Specifically those who are having alarming symptoms like the patients who are having weight loss. They are passing some blood in the stools. Those who are elderly age more than 45 years. Those who are having altered bowel habits. And those who are requiring manual evacuation definitely these patients require investigations. The investigations are two types. One we usually do called as blood test where we try to see out the metabolic factors as I said. Sugar levels for diabetes. Some kidney patients can have constipation to rule out kidney disorders, thyroid as I mentioned. So these are called as blood test. Another is basically imaging to see there is nothing in the colon which is obstructing the passage of the stool. Okay. So doctor talk you about investigations of thinking what exactly is colonoscopy since it's spoken a lot about especially when it comes to digestive issues. So colonoscopy is the test where the endoscope. Endoscope is nothing but a tube having camera in front. It is passed through the anus and we see whole of the large intestine. With the camera we record whole that process and we take all the images of the colon parts. So in the colon there are different parts. Last part we call it as a cecum. Then there is ascending colon. Then transverse colon. Then descending colon. And then sigmoid and finally rectum. So we see whole of the colon. This process before colonoscopy we give some preparation to the patient by which they pass the stool and their colon gets emptied. Then next day we plan for this procedure. So that if any disease is there inside we can get it done. This is simple OPD based procedure. It takes hardly 15 to 20 minutes. For patients comfort sometimes we do it under anesthesia. So patient will not feel any pain. And same day patient goes after 2 hours back to the home. So it's a very simple procedure and it's very effective. The one important factor about intestinal diseases right from our esophagus that is food pipe till our anus. Whole GI tract is like elastic tube in simple language and it is closed one. It's not open one. So when the food comes it opens by 2 cm and again it closes. This is called as peristalsis. And it is happening right from our food pipe till our anus. So whenever we do any test this food pipe and large intestine are closed. So some diseases can be missed. Because if some diseases are inside the lumen they cannot be seen by the imaging. Imaging I am talking about CT scan or your ultrasound. So when we do the colonoscopy or endoscopy we insert air to distend them properly. So even if any disease in early stage we can detect it. So colonoscopy is more effective than CT scan to detect these colonic diseases. Like efficacy wise if you talk it's more than 95% effective. And if you compare to the imaging like even the CT scan MRI there are hardly 70 to 80% effective. So those who are having alarming symptoms with constipation definitely we suggest them go ahead first in the colonoscopy. That is the first important investigation required in that case. But doctor is there any limitation to this as in terms of age in terms of any other health issues wherein you cannot exactly undergo colonoscopy. No. So colonoscopy can be done right from the infant till the old age group. There is no exact contraindication. Some patients where the colonic stitches are there or where we cannot pass the colonoscope throughout the colon. Because of the disease itself then we cannot screen the rest of the colon. Like some patients have malignancy because of malignancy they get a stricture that is narrowing in the colon. In that part we can see the part of the colonic mucosa till the malignancy. But we can't see beyond that because we can't pass the scope. In that case this area is screened by colonoscopy. We take the biopsies from the malignancy and rest of the part is screened by CT scan or something. So in such a cases only we can't see whole colon. But we can do the colonoscopy in each and every patient. Only thing is there are some indications called as elective like as I said constipation. While emergency indications when person is bleeding through the stools these are emergency. In emergency situation every patient we can take up for colonoscopy. Elective cases we try to avoid in pregnant female mainly in the last trimester or first trimester. So that they should not stimulate the uterine contractions. And some patients where we see the patient is not fit. In that case we try to add elective procedures like elective colonoscopy. But emergency definitely yes we can go ahead with other patients also. One point I want to add in colonoscopy during constipation most common finding which we see is called as colonic polyps. These polyps are nothing but these are growths from the colonic mucosa. So some mucosa becomes hyperactive and it grows more compared to rest of the mucosa. That is detected by colonoscopy. And the most important part is we can remove that colonic polyp during the same procedure. No need of any surgery. So endoscopically we can remove that polyps. And these polyps are nothing but the early stage of colonic cancers. So this is very important point. Okay doctor. And can this condition lead to any other major health issues? Yes. As I said the constipation can be the first symptom of colonic cancer. So this is a major disease. So when somebody is having constipation for more than 6 months with weight loss. Sometimes passing blood in the stool. Sometimes mucous. Definitely they should go ahead with the colonoscopy or required investigations. Because this could be one of the symptoms for colonic cancer. Second thing because of this constipation and constant straining patient develop local complications. Local means at the last part of the rectum and anus. Something called as anal fissure. Everybody might have heard of. Fissure is nothing but there is a wound in the anal canal. It forms because when the heart stool is coming out. It causes friction while coming out of the anal canal. That friction causes wound in the anal canal. This wound is nothing but we call it as anal fissure. That time patient presents to us as having a pain while passing the stool. Sometimes there is a bleeding and this pain is very acute. This is called as fissure. Second complication as we all know is called as piles or hemorrhoids. These are nothing but the blood vessels which lose their tone. Again the reason being the constipation. This constipated patients tries to while evacuating the stool they strain too much. And this repeated straining causes the prolapse of these blood vessels. Out of the anal canal leading to called as piles. And third some patients develop fistula or anal abscess. So when they do this straining there are small small anal glands. These are nothing but the glands in our anal canal. They get blocked because of this constipation and repeated straining. And later on they get infected. After infection they form a tract and the pulse starts coming out near to your anus. It is called as fistula. So this perianal abscess, fistula, fissure, piles. These are nothing but the complications of constipation. And sometimes they are very serious they might require surgical intervention. If not detected in early stage. So doctor what treatment or prevention would you recommend for such patients? So treatment wise there are lot of medicines are available. But first I will tell you the first most important is lifestyle modification. And that one thing comes is a diet. So in diet everybody's diet should contain everyday minimum 25 grams of fiber. These fibers are important because they accumulate more water in your stool. Make it softer and easy for the passage. 25 gram of fiber means if you eat one banana it contains 3.5 gram of fiber. If you eat one bowl of oats it contains 4.5 gram. So 25 gram is easily achievable. So those food containing more fiber should be added in your diet. Like we say green salad, green leafy vegetables, peas, banana, oats. These lot of stuff should be there. Second try to avoid fatty meals. These fatty meals reduces the speed with which the stools are coming out. The stool more they stay in the cologne they get more dehydrated. The speed is more important. This peristalsis is more important. So high fatty meals contains those containing more red meat, more deep fried items, junk foods they should be avoided. They causes more constipation. Third important factor exercise is required. Those who are having sedentary lifestyle they suffer more with the constipation. So everyday we recommend 30 to 45 minutes exercise should be there. It could be walking, jogging or even running. But minimum 30 to 45 days should be there. This again affects your peristalsis. Fourth important factor these are we call it as lifestyle measures. Fourth something called as toileting habit. What we recommend you should go to the toilet early in the morning. Some people have faulty toileting. Like they go 3 times a day or more in the night. They should go early in the morning. Scientifically that time you have maximum urge. And there is a chance you will have complete defecation or complete evacuation of your stools in the morning. So try to see that you are going early in the morning. After brushing your teeth having 2 glass of water you will have maximum urge. Now coming to the medicines. First we always suggest this lifestyle measures to the patient. Even after that if patient are not having improvement we suggest the medicines. There are lot of medicines are available which we call it as laxatives. There are osmotic laxatives, prokinetics. Depends on the type of the constipation we suggest the medicine. And the lastly in some patients where these all things are not effective. They are specifically in a subgroup called as defecatory disorder. Which was trying to tell you during the type of constipation. So these is the subgroup of patients which are they have lot of psychological effect because of constipation. Because none of the medicines work in their case. So they are suffering this constipation for years. And their main symptoms are stools are coming till the rectum. But they are not coming out. So they have constant urge of defecation. But they are not able to evacuate the stools. And none of the medicines work in that case. In these the therapy is called as something called as where they put a screen in front. We call it as a biofeedback therapy. So there is something called as anorectal manometry. So there is one probe which is passed into the anus. And patient has been taught about how the defecatory process happens. And on the screen they are made to coordinate the movement. So when this defecation happens there is something called as rectum should contract. And your anal opening should relax. Then the motions will come out. So this is being taught to defecatory or patients suffering with defecatory disorder. And this is the only treatment available for these kind of patients. This is called as defecatory disorder. So we see lot of patients who get frustrated. None of the medicines are working. Few patients I have seen in my practice. They have attempted suicide because of only constipation. So it goes to that extreme. This patient should get investigated. And if we typify them properly the treatment is available. And they get rid of their symptoms. So the treatment depends on the type of constipation. As I said and most important lifestyle modification. These two factors can cover up the symptoms of the constipation. One more thing doctor. Like you mentioned the blood and stool during constipation. Is it a sign of colon cancer? Yes. The blood in the stool is one of the alarming symptoms. Those patients who are suffering with this constipation for more than 6 months with other alarming symptoms as weight loss. Then they have anorexia. Then they have persistent blood in the stool. These are definitely signs of colon cancer. But one of the misconception is that or people always think once the blood is there in the stool is colon cancer. It's not always. So there are other reasons also. So some patients who are suffering with constipation they develop fissure in anode. Like fissure, the wound in the anal canal. They can also get this blood in the stool. Second those who are suffering with piles. This is again piles comes with constipation. They can also develop blood in the stool. So the presence of blood in your stool doesn't indicate it is a cancer. There are other reasons also. Definitely these patients should consult the doctor and get the proper advice. So when you are suffering from constipation when would you recommend that a patient actually goes in for a colonoscopy or consults a doctor in terms of colon cancer? Yeah, so colon cancer, colonoscopy is the method to detect it in early stage. So it is used as a screening tool. So if you go to the US and UK their national guidelines suggest after the age of 40, whole population of the country undergoes colonoscopy. I am not talking about the patient. I am talking about the whole population. And after that every 10 years. This is not feasible in our country. So in our country, those patients who are having age more than 40 years and those who are having chronic constipation they should undergo colonoscopy at least once. So that if there are early changes of colon cancer we can detect them in early stage and there are a lot of treatments available now which are the curative treatments. So those who with the age more than 40 and with chronic constipation they should undergo colonoscopy. Thank you so much doctor. Thank you for taking all the time out coming here and sharing your knowledge. Thank you. For those of us who still have some queries, some fears we can always consult Dr. Rohan at Manipal hospitals from Monday to Saturday. Let's conclude today's episode with a promise to eat healthy, drink sufficient water, exercise daily and stay healthy. See you again soon with another expert. Until then, stay tuned.