Evacuation Disorders

Strictures are usually secondary to fibrosis followed by partial dehiscence of the IPAA or ischemia. If severe, the stricture may obstruct the outlet of the pouch and result in evacuation problems, pouch dilatation, and bacterial overgrowth. The anal canal typically narrows by some degree after IPAA. Short strictures at the anastomosis generally respond to careful dilatation. Many strictures are webs and can be either dilated by fingers or dilators. For this reason, either at the initial 6-week postoperative visit or at the time of the ileostomy closure, it has been our practice to perform a routine digital and proc-toscopic assessment and dilatation. We believe that this practice prevents fibrous webs from progressing to subsequent stricture development. Transanal stricture lysis is occasionally necessary for recurrent short strictures. Long strictures (> 1 to 2 cm) require stricture excision and neopouch anal anastomosis either transanally or by abdomino anal approach. Ischemia and sepsis are the two commonest causes.*

Long exit conduit of S or H pouches. These obstructions are managed by intermittent catheter intubation about 4 times a day. If this is deemed disabling by the patient or perforative complication occurs, repeat IPAA or ileostomy is usually needed (Baixauli et al, 2004).

Paradoxical Puborectalis Contraction

This is an infrequent cause of evacuation disorder, often associated with pouchitis. Diagnosis is readily made with electromyelogram or pouchography. Biofeedback is usually successful but requires 4 to 6 sessions (Hull et al, 1995).

*Editor's Note: Regular anal examinations and dilatation, if needed, has been used by some surgeons after mucosal stripping to lessen stricture occurrence (Sitzmann et al, 1999).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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