Defecation is a complex physiological process that involves multiple systems and is influenced by a variety of factors. Constipation is a group of symptoms that can be caused by a variety of diseases, and generally refers to a low frequency of stool, difficulty in passing stool, or both, and is accompanied by abdominal distension, anal pain, and other discomforts. Diseases of the digestive tract itself can cause constipation, and diseases of other systems can also cause constipation by affecting the structure and function of the digestive tract. Difficulty in evacuation can be caused by dry and hard stools that are difficult to evacuate, or by stools that are not dry and hard but also difficult to evacuate. The former is usually secondary to infrequent stools, while the latter is mostly due to obstructive factors at the pelvic floor outlet. The causes hidden behind constipation are very complex and must be carefully diagnosed and should not be underestimated. First, the etiology of constipation is generally believed that because the intestinal contents in the small intestine through time accounts for only a small part of the whole intestinal passage time (about 10%), so the small intestine through time in the pathological process of constipation does not occupy an important position. After the contents of the small intestine reach the colon, it becomes a culture medium for colonic flora, so that the flora proliferate in amounts up to half of the colonic solids and, together with other components, constitute feces, which move slowly toward the distal end at a rate of 5 cm per hour. The structure and function of the colon directly affects colonic motility and is therefore very closely related to constipation. Diseases affecting the smooth muscle structure of the colon can cause constipation, and these diseases often lead to a decrease in the number of smooth muscle cells, which is replaced by fibrosis, resulting in a thinning of the colonic wall and a decrease in motility. There are especially many factors that affect the function of the colon, including the peristaltic pattern of the colon, changes in pressure in the colon, the nervous system, hormones, and regulatory peptides. In addition, the absorptive function of the colonic mucosa and the size of the colonic volume are also closely related to constipation. Absorptive function directly affects the properties of intestinal contents, and the volume of the colonic lumen can also affect the way stool runs. When the contraction of the colon drives stool into the rectum in a certain amount and at a certain speed, it can cause two changes: on the one hand, the stool entering the rectum produces mechanical expansion of the rectum, which raises the internal pressure of the rectum and produces a reflex through the rectal wall; on the other hand, the descending stool presses the pelvic floor, stimulating the defecation receptors distributed in the pelvic floor, and the impulse is transmitted to the cerebral cortex, producing the urge to defecate and causing the smooth muscle of the rectum to The impulse is transmitted to the cerebral cortex, which produces the urge to defecate and causes reflex contraction of rectal smooth muscle. In patients with constipation, lack of bowel movement is one of the most common complaints. Some patients are unable to feel the normal volume of fecal stimulation because of the large rectal jugular volume, while more patients suffer from a gradual decrease in rectal sensory function due to the long-term neglect of the urge to defecate. Also, the dysfunction of the internal sphincter choke and the inability of the transverse pelvic floor muscle and external sphincter to relax during defecation are among the common causes of outlet obstructive constipation. In addition, certain diseases or states that can significantly affect the increase of abdominal pressure can also lead to a decrease in defecation power, and affect normal defecation. In short, there are many causes of constipation, but it is no more than intestinal lesions, extra-intestinal lesions and poor lifestyle habits. Clinical manifestations of constipation Patients with constipation symptoms, their clinical manifestations can be recognized from the following three aspects: 1, the corresponding manifestations of the original cause of constipation: for example, colorectal cancer can have mucus and blood stools, masses; chronic intestinal overlap can have abdominal pain, masses; anal fissure can have painful defecation, fresh blood stools; spinal cord tumors can have neural localization signs, etc. 2, the performance of defecation disorders: (1) natural stool less than three times a week, less stool volume, natural defecation time is prolonged, and can gradually worsen. (2) Difficulty in defecation can be divided into two situations: one is that the stool is dry and hard and difficult to defecate; the other situation is that the stool is not dry and hard and also difficult to defecate. Most of the patients (90%) have normal rectal type bowel movement, and the bowel movement is frequent and the duration of each bowel movement is prolonged, averaging 23 minutes, with the longest being up to two hours. 3. Concomitant symptoms. In addition to the aforementioned characteristic manifestations of the primary disease, for those patients who are not found to have obvious abnormalities after routine examination, common concomitant symptoms include abdominal distension, abdominal pain, thirst, nausea, and perineal distension. Most patients have mood irritability, and some patients also have bitter mouth and headache. A few patients show neuroticism and individual suicidal tendency. Third, the examination and diagnosis of constipation. The examination of constipation includes comprehensive and systematic physical examination and anorectal examination (anal visual examination, rectal finger examination and anoscopy) according to the requirements of diagnostics, and also includes stool examination, blood biochemical examination, barium enema, endoscopy, colon transit function examination, anorectal dynamics examination, pelvic floor electromyography, fecal imaging and histopathological examination and other auxiliary examinations. Diagnosis of constipation: Only natural bowel movements (except laxative bowel movements) less than three times a week, or dry and hard stools, or difficult to pass without dry and hard stools, and accompanied by abdominal distension and anal pain and other discomfort, can be considered constipation. Fourth, the treatment of constipation. Emphasis on treatment for the cause after a clear diagnosis. Treatment without a clear diagnosis is a blind symptomatic treatment, with the risk of missing important lesions, delaying the condition, and even leading to wrong treatment. 1.For the original disease that has been detected, use the corresponding measures for active treatment. 2.For those who have difficulty in detecting the primary disease for a while or have no obvious primary factors detected for the time being, it is beneficial for most patients to develop good living habits (including dietary habits and bowel habits). 3, drug therapy: can be used for constipation treatment of many drugs, but the abuse of laxatives can cause adverse consequences, should be used with caution in clinical practice. 4, enema: the main indications are preoperative intestinal preparation, fecal obstruction, acute constipation. It should be noted that frequent enemas tend to produce dependence. 5, surgical treatment: mainly constipation caused by organic or severe functional lesions of the colon, rectum and anal canal.