Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Hello doctor, I am a girl from Hangzhou, 26 years old and unmarried. I have been constipated for 11 years. It seems to be hereditary. My family grandmother, mother, sister-in-law and her children, all are prone to constipation. I have been taking phenolphthalein tablets since 2000 when I didn’t have a bowel movement for a week, and since then I haven’t stopped taking various medications to assist with bowel movements. The amount of medication I take is increasing, and I have to eat every day in order to be able to eat once a day, and as soon as I don’t eat the next day, I am immediately inconvenienced. Now I take 8 or 9 tablets a day to have a normal bowel movement, and sometimes it takes more than a dozen tablets, but still not. In the last month, the flatulence at night affects the sleep, and I can’t sleep for one or two hours. I always feel that my stomach is rumbling, lying which side of the pressure to the gas is uncomfortable, tossing and turning, such a situation if the next day defecation will naturally reduce or disappear, do not defecate the stomach bulging, sometimes shoot up empty straight sound, very uncomfortable. The medicine that I have taken since 2000: phenolphthalein tablets, a year later, 20 or so tablets at a time are ineffective intestinal clearing tea, and then 3 packets at a time, although you can defecate, abdominal pain is serious, depressed mood The last few years to eat Zhentong tablets, now also eat more and more, and I am breakfast and lunch to eat fruit, drink a lot of water, dinner is normal, only then it works. If I eat a little more meat or pasta one day, I will not have a bowel movement. Eleven years to eat the medicine has tens of thousands of dollars, because the amount has increased, more and more become a burden. Never checked the intestines. Worried about early problems. I am going to study abroad in mid-August this year, and such constipation is affecting my life and work. I want to solve it completely through surgery. I have heard that constipation can be treated by subtotal colectomy, so I would like to ask you whether it is possible to operate in my case and whether the success rate of the operation is high. What are the after-effects? What is the approximate size of the scar? (Is it possible to reduce or eliminate the scar afterwards?) How much does the surgery cost? I am from out of town and my parents are far away, how long will I need to stay in the hospital for this surgery and can I take care of myself? If I can do it after the examination, can you help me to arrange the surgery earlier, I will leave the country in mid-August. I really don’t want to take medicine all the time, other people’s so-called conditioning is useless to me, even if eating Chinese medicine to relieve, do not eat there will be so. It is depressing to live in this constant and repeated worry. If I don’t treat it, I will get depression. Please try to help me think of a way to relieve the pain of constipation. Anal surgery: Hello, according to your description, constipation symptoms are really heavy, and conservative treatment is not satisfactory, you can consider surgery. Your situation is actually not uncommon, and there are many young women who suffer from severe constipation and are treated surgically. Subtotal colectomy is effective for most patients with slow-transmission constipation. However, further tests are needed before surgery to clarify the type of constipation and whether this surgical procedure is available. If surgery is performed, we use laparoscopic surgery with a small incision of about 4cm in the abdomen for removing the resected colon after the surgery is completed, located on the pubic bone of the lower abdomen, which is more concealed, and it should be said that the scars are much smaller than traditional open surgery. The cost of surgery is generally about 40-50,000. Recovery after surgery is generally 7-10 days. However, human care is required after surgery. After discharge from the hospital, you still need to recover for a period of time after normal work and study. Your schedule is rather tight. If you are going abroad for a short period of time, you may consider having the surgery after returning to your home country. Patient: Hi, I am going abroad for a long time, at least 3 years, that’s why I want to get my constipation cured this time. I am leaving on the 10th of August, is it very risky to go out like this for a short period of time after surgery? I went to ZMC during the day today, I wanted to do a checkup, but the doctor said it would take a month to get the checkup booked, so I just had a consultation. That doctor also said that it is not uncommon to do this surgery now, but there are risks, so I should go home well to check the relevant sequelae or something, but I asked what specific sequelae, he did not clearly pointed out. So I would like to ask you, does your hospital have a high success rate for this kind of surgery, are there many people of my age, and what are the after-effects? If the surgery is done well, will the recovery be the same as normal with no long term adverse effects, right? I would love to have it done, but it’s hard not to be apprehensive. I’m a girl, and I don’t wear dresses that fit well because I’m easily bloated, because as long as I haven’t had a bowel movement or eaten anything that day, my belly will bulge, and if I breathe in and out, I’ll feel like everything below me is pushing up against my stomach and chest, which is very uncomfortable. Today the doctor prescribed lactulose and polyethylene-whatever medicine, I took two bags of each and drank water for one night, my stomach was so full that I couldn’t hold it up before I had a bowel movement. Although this time it worked, but is this the way to go out for a few years to keep taking the medicine? Even after taking the medication, my stomach keeps bulging like this. I am a fashion design student, and I attach great importance to my appearance, so this really bothers me. I find that before I have a bowel movement, my whole body is so congested and hot that I can’t even sit down without feeling uncomfortable. Tonight I drank a lot of water and finally had a bowel movement, even a little light diarrhea, but my stomach was still bloated. My stomach and bladder are under a great burden for a long time. I can’t imagine myself living like this for years out there. And a $200+ medication won’t last long, so that’s a lot of money over several years. Not to mention that medicine is expensive in the US. I am really overwhelmed and I would still like to go before surgery if you feel it is feasible now. Oh, and one more question, the doctor I saw today said they did an incision at the belly button, 5,6 cm, is it different doctors and different techniques? The kind of incision method you mentioned will see scars after wearing a swimsuit or something? Is it less and less obvious with time? My hometown is in Hebei, I have been in Hangzhou, so I do not know if this surgery is a high-risk surgery? After all, the surgery here in Hangzhou is free of travel, but I’m worried that the qualifications here are not as good as your hospital, so I’d rather go back to Beijing to find your surgery will be a little more solid. My family is also closer to Beijing than Hangzhou. I’m sorry to bother you with so many questions, but I’m anxious to seek medical help, so please bear with me. I’m looking forward to your reply. Anal Surgery: The scope of this surgery is relatively large, so the risks associated with surgery must be considered. If the post-operative recovery is smooth, then a month of recuperation is possible. However, if some postoperative complications occur, the postoperative recovery time cannot be guaranteed. Once this happens, it may affect your expected time abroad, and you need to take it into consideration. If the postoperative recovery is smooth, the main problem after surgery is the increase in the number of bowel movements, which varies from patient to patient, usually 2-5 times, and more up to about 10 times per day, which of course can be gradually regulated by postoperative auxiliary medication, etc. We have some cases where the bowel movements are currently 1-3 times/day, but it takes some time to regulate. In addition, abdominal surgery all have some problems that may occur, such as intestinal obstruction due to intestinal adhesions. The appearance of these conditions can be readily dealt with at home, and whether you have the conditions abroad, these are issues you need to consider as well. The problem of surgical incision, we take into account the aesthetic problems of young women, so we take a small incision in the lower abdomen, swimsuit can cover, not obviously affect the beauty. I wish you a speedy recovery Patient: Thank you for your patient response and for doing such a full and thorough analysis for me. I do need to continue to think through the follow-up possibilities fully, and it would be much safer to get along with the corresponding methods one by one before surgery. I’ll think about it more with my family.