organic
1, intestinal stenosis or obstruction caused by organic disease, tumor, inflammation or other reasons.
2, anorectal lesions. Internal rectal prolapse, hemorrhoids, proctoptosis, puborectal muscle hypertrophy, pubic separation, pelvic floor diseases, etc.
3. Endocrine or metabolic diseases. Diabetes, hypothyroidism, parathyroid diseases, etc.
4. Systemic diseases. Scleroderma and lupus erythematosus.
5. Nervous system diseases. Central brain disease, stroke, multiple sclerosis, spinal cord injury and peripheral neuropathy.
6, intestinal smooth muscle or neurogenic lesions.
7, colonic neuromuscular lesions. Pseudointestinal obstruction, Hirschsprung's disease, megarectum, etc.
8. Neuropsychological disorder.
9. Drug factors. Iron agents, opioids, antidepressants, anti-Parkinson drugs, calcium channel antagonists, diuretics and antihistamines.
function
The etiology of functional constipation is unclear, and its occurrence is related to many factors, including:
1, low food intake or lack of cellulose or water in food will reduce the stimulation to colon movement.
2, due to work pressure, fast pace of life, work nature and time changes, mental factors and other factors interfere with normal defecation habits.
3. Colonic dyskinesia is very common in irritable bowel syndrome, which is caused by spasm of colon and sigmoid colon. In addition to constipation, abdominal pain or bloating also occurs, and some patients may show constipation and diarrhea alternately.
4. Insufficient tension of abdominal muscles and pelvic muscles, insufficient driving force of defecation, and difficulty in excreting feces.
5. Abuse of laxatives leads to drug dependence and constipation.
6, the elderly are weak, too little activity, intestinal spasm leads to difficulty in defecation, or because the colon is too long.
Other reasons
1, did not develop the habit of regular defecation, neglected normal defecation, inhibited defecation reflex, and caused constipation for a long time.
2, the diet is too fine and less slag, lacking dietary fiber. Due to the lack of fiber, the volume of feces decreases, the viscosity increases, it moves slowly in the intestine and absorbs too much water, which leads to constipation.
3. Insufficient liquid intake.
4, obesity, inactivity, mainly due to being sick in bed or in a wheelchair, lack of exercise stimulation to promote the movement of feces, eating itself can not make feces move forward, in the case of having to rely on the help of medical staff to cause defecation, such as patients with defecation, can not provide defecation opportunities, the urge to defecate disappears, and it is not easy to defecate.
5, endure inconvenience, often endure inconvenience like this, and eventually lead to constipation. In giving up again and again, the large intestine responds more and more slowly to the defecation signal, and gradually loses the ability to defecate, and even has no desire to defecate seriously.
Symptoms/constipation
1, functional constipation is mainly caused by intestinal dysfunction. People who usually defecate smoothly have temporary constipation. It usually happens to people who don't eat breakfast, eat too little and have a partial eclipse.
2. Acute organic constipation is mainly acute defecation difficulty caused by organic gastrointestinal diseases, which is manifested as intestinal obstruction and volvulus. In addition to the difficulty in defecation, the main symptoms are primary symptoms, often accompanied by severe abdominal distension, abdominal pain, vomiting and other symptoms.
3, intractable constipation is mainly manifested as symptoms of constipation, too little or poor defecation, laborious and difficult, dry stool and small amount. Normal time. 1 ~ 2 times a day or 1 time a day, but the amount and times of feces are often affected by food types and environment.
Examination/constipation
1, pay attention to whether there is any evidence of alarm symptoms and other organic lesions in the whole body.
Patients over 2.50 years old who have a long history of constipation and short-term symptoms are aggravated should undergo colonoscopy to rule out the possibility of colorectal tumors.
3. For those who abuse laxatives for a long time, colonoscopy can determine whether there is laxative colon or/and colon melanosis; Barium enema is helpful for the diagnosis of Hirschsprung's disease.
4. Special examination methods can be selected for intractable constipation, including gastrointestinal passing test (GITT), anorectal manometry (RM), anorectal reflex test, tolerance sensitivity test, balloon ejection test (BET), pelvic floor electromyography, pudendal nerve latency test and anal ultrasound examination; Colonoscopy or barium enema is helpful to determine whether there are organic lesions.
Diagnosis and differentiation/constipation
1, inquire about the patient's diet, living habits and working conditions, past medical history, surgical history, especially the history of hemorrhoids, anal fistula and anal fissure, recent medication history, especially the history of taking laxatives for a long time, and make clear the cause of constipation as much as possible through corresponding examination.
2. For patients over middle age, if the defecation habit changes from one day 1 time or two days 1 time to three days or several days 1 time, we should be alert to the possibility of left colon cancer.
Treatment details/constipation
1, drug therapy
1) volumetric laxative. It mainly includes soluble cellulose (pectin, plantain, oat bran, etc. ) and insoluble fiber (plant fiber, lignin, etc. ). Volumetric laxatives have a good effect on pregnancy constipation or mild constipation because of their slow onset, small side effects and safety, but they are not suitable for the rapid laxative treatment of temporary constipation.
2) Lubricating laxatives can lubricate the intestinal wall, soften the feces, and make the feces easy to discharge and easy to use, such as kaisai dew, mineral oil or liquid paraffin.
3) Salt laxatives. Such as magnesium sulfate, magnesium emulsion, etc., can cause serious adverse reactions and should be used with caution in clinic.
4) Permeable laxatives. Commonly used drugs are beneficial to lactulose, sorbitol and polyethylene glycol 4000. It is suitable for fecal impaction or temporary treatment of chronic constipation, and is a better choice for constipation patients with poor curative effect of volumetric laxatives.
5) Irritating laxatives. Include anthraquinone-containing plant laxatives (rhubarb, rat skin, senna leaf, aloe), phenolphthalein, castor oil, diester, etc. Stimulating laxatives should only be used when volumetric laxatives and salt laxatives are ineffective, and some of them have strong medicinal properties and are not suitable for long-term use. Long-term use of anthraquinone laxatives can cause colon depression or laxative colon, cause smooth muscle atrophy and nerve plexus injury between intestinal muscles, but aggravate constipation, which can be reversed after stopping taking drugs.
6) Accelerator. Mosapride and itopride can promote gastrointestinal peristalsis, and probabilide can selectively act on colon, which can be selected according to the situation.
2. Instrument assistance. If the stool is hard and stays in the rectum near the anus or the patient is old and weak, and the defecation motivation is poor or lacking, colon hydrotherapy or clean enema can be used.
3. Biofeedback therapy. It can be used for constipation patients with anorectal and pelvic floor muscle dysfunction, and has good long-term curative effect. Biofeedback therapy can train patients to relax pelvic floor muscles during defecation and coordinate the activities of abdominal muscles and pelvic floor muscles during defecation. For patients with abnormal defecation threshold, we should pay attention to the reconstruction of defecation reflex and adjust the training of defecation perception. The training plan has no specific norms, and the training intensity is high, but it is safe and effective. For patients with pelvic floor dysfunction, biofeedback therapy should take precedence over surgical treatment.
4. Cognitive therapy. Patients with severe constipation often have psychological factors or obstacles such as anxiety and even depression. Cognitive therapy should be given to help patients eliminate their nervousness, antidepressant and anxiolytic treatment should be given when necessary, and psychologists should be invited to assist in diagnosis and treatment.
5, surgical treatment. The above treatment methods are ineffective for severe intractable constipation. If constipation is colon transmission dysfunction and the condition is serious, surgery can be considered, but the long-term effect of surgery is still controversial, so the case selection must be cautious. In the huge disease group of constipation, very few people really need surgery.
Complications/constipation
1. Long-term constipation will cause carcinogens produced by intestinal bacteria fermentation to stimulate intestinal mucosal epithelial cells, leading to dysplasia and easy to induce cancer. Hard stool blocks the intestinal cavity, narrows the intestinal cavity, oppresses the structures around the pelvic cavity, hinders colon peristalsis, oppresses rectum or colon, and causes blood circulation disorder.
2. Constipation can also induce parenteral complications, such as stroke and life disorder affecting brain function. It also plays an important role in the occurrence of hepatic encephalopathy, breast diseases, Alzheimer's disease and other diseases.
3. Clinically, the onset of cardiovascular diseases caused by constipation tends to increase, such as angina pectoris and myocardial infarction.
Prevention details/constipation
1, avoid eating too little or food too thin, lack of residue, and reduce the stimulation to colon movement.
2. Avoid disturbing defecation habits: due to mental factors, changes in the law of life, and fatigue caused by long-distance travel, constipation is easily caused.
3. Avoid abuse of laxatives: abuse of laxatives will weaken the sensitivity of the intestine, form dependence on some laxatives, and cause constipation.
4, reasonable arrangement of life and work, do a combination of work and rest. Appropriate cultural and sports activities, especially abdominal muscle exercise, are conducive to the improvement of gastrointestinal function, which is more important for sedentary and highly focused mental workers.
5. Develop good defecation habits, defecate regularly every day, form conditioned reflex, and establish good defecation rules. Don't ignore when defecating, defecate in time. The environment and posture of defecation should be as convenient as possible, so as not to inhibit defecation and destroy defecation habits.
6. It is suggested that patients drink at least 6 cups of 250 ml water every day, do moderate-intensity exercise, and develop the habit of defecation regularly (twice a day, each time 15 minutes). After waking up and eating, the action potential activity of the colon is enhanced, pushing the feces to the distal end of the colon, so morning and after eating are the easiest time to defecate.
7, timely treatment of anal fissure, perianal infection, adnexitis and other diseases, laxatives should be used with caution, do not use strong stimulation methods such as intestinal lavage.
Dietary health care/constipation
1. Whole grains and roots are staple foods: brown rice and germ rice can be used instead of white rice for cooking on weekdays, and it is better to add nutritious grains such as oats and coix seed appropriately; When you want bread and noodles, you should choose whole wheat products. In addition, sweet potato, potato and other rhizomes have excellent laxative effect.
2. Replace meat with beans. Using beans and their products (such as tofu) instead of meat can be high in fiber, cholesterol-free and antioxidant. Soybean milk and soybean milk (grinding beans into powder and mixing with milk) are also good laxative drinks.
3, often eat dairy products milk is a natural laxative, you can also eat fermented dairy products such as yogurt, cheese, yogurt to supplement beneficial bacteria and regulate gastrointestinal function.
4. At least five kinds of fruits and vegetables every day. You should eat at least three servings of vegetables and two servings of fruits every day to get enough vitamins, minerals and dietary fiber.
5, avoid fat shortage Many women who love beauty always stay away from fat, but it is indispensable for moisturizing feces and stimulating intestinal peristalsis. If you are worried about harmful cholesterol, you might as well eat a proper amount of plant fat, such as pouring some olive oil on a vegetable salad, which can achieve the dual effects of losing weight and relaxing bowels.
6. Replenish enough water. People who don't like drinking boiled water should not use caffeinated drinks such as coffee, strong tea and cola instead, because they will induce diuresis and inhibit intestinal peristalsis.
7. Regular eating and living In addition to the balanced intake of the above foods, in order to maintain the normal operation of the defecation system, it is necessary to regularly quantify three meals to avoid overeating and not eating midnight snack, so as not to burden the stomach and disrupt the digestive rhythm.