Overview: Slow transit constipation (STC) is the result of a dysfunction of the colon.
Slow transit constipation (STC) is a prolonged defecation cycle and difficulty in defecation due to dysfunction of the large bowel and malfunction of conduction. It is chronic, primary, functional, colonic and slow transit constipation.
Causes
Modern medicine believes that its etiology is not yet fully understood, and may be related to the enteric nervous system and cajal mesenchymal cells, central nervous system and autonomic nervous system regulatory dysfunction, hormone level abnormalities and so on. At present, there is a consensus that long-term bad habits, such as irregular living, too fine a diet, weight loss, dieting and lack of exercise, etc., can make the intestinal tract is not enough stimulation, defecation action is lacking, feces in the intestinal lumen stagnation time is too long and the formation of this disease. In addition, family genetic factors or other types of constipation, due to long-term use of laxative aids, is also the main cause of this disease.
Symptoms
1. Low frequency of bowel movements
Less than 3 times (or 2 times) per week, with prolonged and gradually worsening intervals between natural bowel movements.
2. Dry stools
3. Difficulty in defecation
Difficulty in passing dry and hard stools, and longer time for defecation, usually more than 5 minutes.
4. Accompanying symptoms
Commonly, there are abdominal distension, abdominal pain, bitter mouth, thirst, dizziness, nausea, perineal distension, anal drooping, irritable mood, and skin rash. A few patients are accompanied by neuroticism or anxiety.
Examination
1. Specialized examination
Most of the patients have no special signs, and some of them can palpate the shape of intestinal tube in the left lower abdomen.
2. Auxiliary examination
(1) Colonoscopy or barium enema can exclude organic lesions of the colon.
(2) Colonic transmission test is the preferred examination method for slow transmission constipation. 80% of the markers cannot be transmitted to the rectum or discharged for more than 72 hours, and the markers are diffusely distributed in the whole colon or clustered in the left half of the colon and rectosigmoid region, which can be regarded as the slowing down of colonic transmission.
(3) Defecography and rectoanal manometry can be used to see if there is a combination of outlet obstruction type constipation.
Diagnosis
There are no specific signs in patients with colon slow transmission constipation, and the diagnosis can be clarified by history, symptoms and auxiliary examination.
Differential diagnosis
1. Differentiate from organic lesions of the colon.
Colonoscopy and lower gastrointestinal imaging can be used to exclude colon tumor and congenital megacolon. Bowel obstruction can be excluded by standing X-ray abdominal plain film.
2. Differentiate from secondary constipation caused by common internal diseases.
According to the condition, do the corresponding examination to exclude secondary constipation caused by diabetes mellitus, hypothyroidism, Parkinson’s syndrome, post-stroke sequelae, mental diseases, etc.
3. Differentiate with outlet obstruction constipation
General outlet obstruction constipation is mostly manifested as difficult defecation, some patients do not have dry stool, or the number of bowel movements is also normal, but still have difficulty in defecation or the feeling of incomplete defecation. Sometimes it is manifested as frequent defecation with less amount of stool, and even need to assist defecation by hand, or defecate with corkscrew or enema, or wash the bowels. The diagnosis can be confirmed by transmission function tests and defecography and anal canal manometry.
Treatment
The treatment of this disease is aimed at relieving symptoms and restoring normal intestinal motility and the physiologic function of defecation. Since the causes of this disease are complex, its treatment needs to take individualized comprehensive treatment measures.
1. General therapy
A reasonable diet should be adopted to increase the intake of dietary fiber and water. In addition, it is necessary to maintain a healthy mental state, develop good defecation habits, as well as appropriate and regular exercise.
2. Traditional Chinese Medicine (TCM)
The motherland medicine thinks, the stool discharge difficulty, defecation frequency is reduced, defecation time is prolonged slow transmission of constipation of the central symptomatic features, the disease in the large intestine, although for the viscera disease, but with other organs, qi, blood, fluid relationship is close, so the treatment should be from the regulation of viscera yin and yang to begin with, divided into the deficiency of heat and cold and the treatment of it. Can be divided into real and virtual, clinical treatment. Chinese medicine on the identification and treatment of this disease has more mature experience.
3. Medication
After a high-fiber diet, appropriate exercise, defecation habits have not improved, or persistent constipation, can be considered for drug treatment.
(1) Laxatives Preferred osmotic laxatives, through the stimulation of the intestinal tract, to achieve laxative effect.
(2) Promote power drug Cisapride, selectively promote the release of acetylcholine, thereby accelerating gastrointestinal motility, so that the feces can be easily discharged.
(3) Micro-ecological agents Micro-ecological agents promote intestinal peristalsis through intestinal reproduction and production of large amounts of lactic acid and acetic acid.
4. Traditional Chinese medicine external treatment
Including: acupuncture, massage, Chinese herbal enema, acupoints paste therapy and acupoints embedding therapy.
5. Biofeedback therapy
This therapy stimulates the brain with the help of sound and image feedback to train patients to correctly control the expansion and contraction of the external anal sphincter, thus preventing constipation from occurring.
6.Surgery
If conservative treatment fails, surgery is the last option. Although there are some complications in surgery, it has certain efficacy, and the choice of timing of surgical treatment is still controversial. Commonly used surgical methods include the following:
(1) Total colectomy ileorectal anastomosis Suitable for patients with total colonic dyskinesia.
(2) Subtotal resection of the colon with ascending colorectal anastomosis is suitable for patients without dyskinesia of the right half of the colon.
(3) Segmental resection of the colon Suitable for patients with a segment of the colon that is undynamic.
(4) Colonic pacemaker Pacemakers are now being used to treat slow transmission constipation of the colon, but the efficacy is not yet certain.
Prognosis
At present, there is no uniform diagnosis and treatment standard in China, some patients can be improved by changing their life habits and traditional Chinese medicine, medication, and external treatment of traditional Chinese medicine, etc. Surgery is the treatment of last resort when conservative treatment is ineffective.
Prevention
1. Develop a good habit of regular defecation.
2. Avoid prolonged squatting
3.Healthy diet
Eat more fiber-rich foods, such as fresh fruits and vegetables, coarse grains, etc. every day.
4. Moderate exercise, insist on exercise
Moderate exercise is conducive to promote intestinal peristalsis, thus promoting the discharge of feces.
5. Seek timely medical treatment
The use of medication, whether traditional Chinese medicine or western medicine, should be noted:
(1) Avoid taking single-variety drugs for a long period of time, take drugs intermittently and adjust the types of drugs appropriately according to the physical condition.
(2) Pay attention to caution or avoid prolonged use of anthraquinone stimulating laxatives, such as laxatives containing rhubarb.