‘15% of piles, fistula patients suffer obstructed defecation’

Until a week ago, 46-year-old housewife Trupti Chawla (name changed) had been living on a diet of two measly chapattis per meal for the past six years. When the mother of two began experiencing difficulty in passing stools and had to visit the public toilet in her chawl at least eight times a day amid raised eyebrows, her appetite for food vanished.

She says, “I would turn down invitations to weddings or trips out of town. I always feared that wherever I went, I wouldn’t find a toilet.” 

A form of chronic constipation that cuts across classes, people afflicted with obstructed defecation (OD) in India must not only bear with the social stigma attached to the condition but also the ignorance regarding it in the medical community.

OD is a term used to refer to the abnormal functioning of the muscles involved in defecation, leading to a feeling of obstruction in the rectum.

Observed more often in women who’ve had multiple child births, OD is impossible to diagnose in a traditional endoscopy and as a result, many OD sufferers are made to believe their condition is a psychological one.

But according to gastrointestinal and laparoscopic surgeon Dr Roy Patankar of Joy Hospital, about 15% of patients of piles, fissure and fistula have OD. Sufferers often have to resort to inserting a finger into the rectum or vagina to express their stools.

Patankar adds, “Another habit observed among those in the upper classes is the use of the water jet to extract the stool that’s stuck in the rectum.” Such practices lead to infections and further complications.

Currently, Joy Hospital in Chembur and Jaslok Hospital offer an MRI defecography which helps doctors closely examine the patient in a fully reclined position.

However, to ensure proper examination and diagnosis, Patankar and radiologist Ritesh Kamath have set up the first conventional x-ray defecography in the city.

Through this, a patient can sit on or squat over a radioluscent plastic commode so that doctors can get a precise look at the position of the rectum and muscle strain during the act of defecation.

Those diagnosed with OD qualify for the Stapled Transanal Rectal Resection (STARR) procedure, a 30-minute trans-anal surgery to straighten and shorten the rectum, giving instant relief to OD patients. 

The procedure avoids the need for surgery via abdomen and significantly reduces post-operative pain.