Constipation is the most common chronic gastrointestinal symptom, but its health risks are often overlooked. With the improvement of people’s quality of life, as well as the aging of society, the modern pace of life and changes in dietary habits, chronic habitual constipation is receiving more and more attention. According to the survey on the current situation of constipation among the elderly in some areas of Beijing, the incidence of constipation has a tendency to increase significantly with the growth of age.
I. What is constipation
Constipation refers to a decrease in the number of stools and/or dry and difficult to relieve stools, generally no bowel movement for more than two days. It mainly includes: (1) small amount of stool, too hard, too difficult to discharge; (2) defecation difficulties combined with some special symptom groups, such as long-term forceful defecation, a feeling of swelling at the rectum, incomplete defecation or relying on manipulation to help defecate; (3) the number of bowel movements in 7 days is less than 2 to 3 times.
Second, the health hazards of constipation
Constipation is extremely harmful to human health. Long-term constipation can cause loss of appetite, dizziness, headache, fatigue, insomnia, restlessness, left lower abdominal pressure and distension, or even the fear of defecation, mental abnormalities.
Chronic constipation, the incidence of colon and rectal tumors is significantly higher, which is the residue in the intestinal cavity, toxic substances in the waste, so that the intestinal cavity hyperabsorption and hyperstimulation of the intestinal mucosa and muscle layer. Long-term chronic constipation in the elderly can also cause sigmoid torsion, colonic diverticulum, rectal and anal fecal ulcers, proctitis, rectal prolapse, ischemic enteritis, hemorrhoid enlargement and bleeding, anal fissure, urethral obstruction and other disorders.
It is worth to be alert and pay attention to the fact that the elderly can cause sudden changes in cerebral blood flow and coronary blood flow during forceful defecation, which can easily cause syncope, stroke, angina pectoris, arrhythmia, myocardial infarction, rupture of aneurysm or ventricular wall aneurysm, and even sudden death.
Third, why the elderly are prone to constipation
1, physiological factors: the elderly due to the decline in the function of the digestive system, salivary glands, gastrointestinal and pancreatic digestive enzyme secretion is reduced, the abdominal muscles, diaphragm, anal raphe and (or) intestinal wall smooth muscle contraction force is weakened, gastrointestinal peristalsis slowed, coupled with slow response, indifference to stool, is the main reason for constipation.
2, dietary habits: the elderly food intake is too little, too fine, less intake of crude fiber-rich vegetables and fruits, drinking too little water, resulting in the intestinal cavity residue volume reduction, longer stay in the intestine and dry hard knots.
3, conscious control of stool some elderly people suffer from hemorrhoids, anal fissure, in order to avoid pain and bleeding caused by defecation, consciously inhibit stool, over time, the rectum will be less sensitive to the stimulation of stool, coupled with the stool in the intestinal cavity for too long, too much water is absorbed, constipation will also occur.
4, lack of exercise: the usual lack of exercise or old and frail bedridden, so that the original weakened defecation function further decay.
5, psychological factors: lack of sleep, environmental changes, mental depression and other factors, can also make defecation nerve reflex disorder. Some people are overly focused on the stool, that there must be a stool every day, otherwise anxiety, mental overstrain, resulting in intestinal dysfunction.
6, defecation habits: some elderly people do not have the habit of regular defecation, and there are some people who do not concentrate when defecating, such as considering problems, reading the newspaper, etc. (1) When the energy of defecation is distracted will reduce its sensitivity and responsiveness to defecation, over time, constipation will occur; (2) When these habits can not continue due to environmental changes, constipation will also occur. (3) Long-term use of laxatives reduces the sensitivity of the rectum to intestinal contents, which leads to constipation or aggravates the original constipation.
7, the use of certain drugs: some elderly people often suffer from chronic diseases, long-term or often take certain antibiotics, disrupting the balance of the normal intestinal flora; long-term use of colistin, calcium carbonate, aluminum hydroxide, atropine, probenecid, doxorubicin, scopolamine, etc., as well as other anticholinergics, antidepressants, β receptor blockers, etc., will also inhibit intestinal peristalsis, so that feces in the intestinal cavity The retention time in the intestinal cavity is too long and causes constipation.
8, primary diseases: many primary diseases such as proctitis, hemorrhoids, anal fissure, perianal abscess, colon benign and malignant tumors, intestinal obstruction, intestinal wall smooth muscle, anal raphe, chronic emphysema, severe malnutrition, multiple pregnancies, systemic failure, intestinal paralysis, hyperparathyroidism hypothyroidism, diabetes with neuropathy, scleroderma, paraplegia, polyradiculoneuritis, etc.
Fourth, what tests should be performed for constipation consultation
In addition to careful questioning of medical history, symptoms and necessary physical examination, perineal/rectal examination should be performed, in addition to the following tests.
1.Fecal examination: routine examination: fecal routine and occult blood test.
2, blood biochemical examination: mainly for endocrine and metabolic factors that can lead to constipation.
3.Barium enema: It is one of the main methods to diagnose organic lesions of the colon.
4.Endoscopy: the main purpose is to exclude tumor lesions.
5.Colon passage time measurement and anorectal kinetic examination both help to clarify the etiology.
V. Treatment measures
(A) Treatment of primary diseases
For the identified primary disease, after clear diagnosis, use the corresponding measures for active treatment. In order to eliminate the effect of the primary disease on the intestinal function as soon as possible.
(ii) General treatment
In the primary disease is difficult to correct for a while or not detected with obvious primary factors, the following general measures are beneficial to most patients with constipation.
1, correction of poor dietary habits: should strengthen the scientific management of life, eat more food with high crude fiber content, and drink enough water. Fiber intake can be gradually increased, fiber can be added to the diet or use standard fiber supplements. Regular oral administration of small amounts of wheat bran is an effective and inexpensive therapy, but this method is not suitable for those with organic strictures in the intestine. Patients should not expect an immediate effect (as with laxatives), but rather begin a program for several weeks. Start with 2 doses per day, with liquids and/or meals. Get into the habit of drinking plenty of water. Drink up to 3000ml of water per day, and should not drink more tea or coffee-containing beverages to prevent excessive diuresis.
2, correct bad defecation habits: neglecting bowel movements is a common phenomenon among many patients with constipation. Sitting on the commode reading a book and newspaper is another bad defecation habit, which is not conducive to the continuous defecation reflex. For those who are not accustomed to sitting stool, change to squatting defecation can make the rectal angle of the anal canal increase, more conducive to the passage of feces. For those who are used to long-term laxative defecation, should resume normal defecation habits under the guidance of a doctor.
3, to develop good habits: life should be regular, to actively participate in physical activities, to maintain an optimistic mental state, can also help improve the function of the digestive tract.
4. Abdominal breathing exercises or massage can also be performed.
(C) drug treatment
Can be used for constipation treatment of many drugs, but most are not suitable for patients with chronic constipation, not suitable for long-term application. At present, the phenomenon of laxative abuse is more common, the clinical should be carefully selected. Long-term abuse of laxatives should be avoided and lead to laxative enteropathy. Common laxatives are divided into the following categories.
1. Stimulant laxatives: they are used to increase intestinal peristalsis and mucus secretion by stimulating colonic mucosa, intermuscular plexus and smooth muscle, commonly used are rhubarb, senna, phenolphthalein and castor oil. Stimulating laxatives can cause severe colic, long-term use can cause water-electrolyte disorders and acid-base balance imbalance. When used regularly for many years, can cause “ laxative colon ”, because it is difficult to identify, often diagnosed as persistent constipation and administered more laxatives, and even administered other inappropriate treatment.
2, mechanical laxatives: by increasing the volume of feces or changing the composition of feces to increase the colon propulsion movement, and can be divided into the following categories.
(1) salt laxatives: is the most simple and inexpensive salt preparations, such as magnesium sulfate, sodium sulfate. The effect is faster, 0.5 to 3 hours after oral administration, 5 to 15 minutes after rectal administration. Can adjust its dose to achieve soft but not liquid stools.
(2) swelling laxative (intestinal filling agent): this preparation contains cellulose, absorbing water to form a soft gel, so that the stool can be easily excreted, and can stimulate intestinal peristalsis. The effect occurs 1 to several days after taking, no systemic effect, can be used for a long time, especially in low-fiber diet, pregnancy, retreat stimulating laxative is appropriate. Wheat bran, corn bran, konjac starch, agar, methyl cellulose, psyllium preparations, etc. are all in this category. When taking these preparations should be careful to drink more water; those with intestinal strictures should be used with caution because it can lead to intestinal blockage.
(3) Lubricants: such as paraffin oil. In the intestinal tract is not digested and absorbed, can be wrapped around the fecal mass, so that it can be easily excreted; at the same time, it prevents the absorption of water in the colon, and the effect occurs 6 to 8 hours after oral intake. Long-term use may hinder the absorption of fat-soluble vitamins. This product can also leak from the anus and cause itching. Only short-term use, not suitable for chronic constipation.
(4) hypertonic laxatives: because of the role of hypertonicity, increase intestinal lumen pressure, stimulate intestinal peristalsis. Lactulose can increase intestinal peristalsis. But no intestinal irritation, can be used to treat chronic functional constipation.
In general, the treatment of chronic constipation is based on expansive laxatives, and then stimulating laxatives are used only when necessary. Acute constipation can be used in small doses of salt laxatives, stimulant laxatives, lubricants, etc., as appropriate, but do not exceed 1 week; if the constipation cannot be corrected after more than 1 week, the cause should be carefully searched. Anyone who has abused stimulant laxatives for a long time must gradually stop using them and take additional bulking laxatives, while drinking more water to gradually restore regular bowel movements, during this process, a small amount of other laxatives can be added intermittently as appropriate to help smooth transition. It takes 3 to 4 days for the colon to be filled again after the colon is completely emptied with laxatives at one time, therefore, it is not appropriate to use the medicine continuously. Generally, laxatives take 6 to 8 hours to take effect after oral administration, so the more reasonable time to take medication should be before bedtime, so that the next morning after waking up or after breakfast defecation, more in line with the physiology.
(iv) Enema
The main indications are preoperative intestinal preparation, fecal impaction, acute constipation. Warm saline is commonly used, soap and water should be avoided because it is too irritating to the colonic mucosa. In addition, frequent enemas can produce dependence and should be noted.
(E) Traditional Chinese medicine treatment
Chinese medicine on the treatment of constipation has always stressed the need to start from the whole, for the cause, adjust the diet, living, mood, in accordance with the “ preservation of gastric energy, store fluids ” principle, reasonable use of drugs. Oppose the abuse of laxatives, which hurt the gas and consume fluids.
1, regulation of diet and living is the basic treatment of constipation. Chinese medicine attaches great importance to the dietary therapy of constipation, commonly used foods are: black sesame, walnut kernel, hemp kernel, cypress kernel, pine kernel, yu plum kernel, almonds, earth gourd root juice, sunflower seeds, gum, honey, milk, cow pastry, sheep pastry, etc., these foods are smooth and moist, nutritious, especially suitable for elderly patients with constipation.
2, dialectical medicine is the most important feature of Chinese medicine treatment of chronic constipation, opposed to see the simple treatment of constipation and diarrhea. Commonly used treatment are.
(1) increase the water line method: “the medical clan must read” to four things soup plus Cistanches, He Shou Wu, Aconite as the main formula for this method, Yin deficiency plus Chasteberry, lock Yang, asparagus; blood deficiency plus black sesame, mulberry seeds; intestinal dryness and fluid withered plus hemp seeds, cypress seeds, honey; Qi stagnation plus Citrus aurantium, thick park; blood deficiency with heat plus ground bolus, Sophora japonica, Scutellaria baicalensis.
(2) Qi management and opening of constipation method: adapted to Qi stagnation constipation. The main formula is Su Zi Descending Qi Tang (Su Zi, Han Xia, Qian Hu, Hou Pu, Orange Red, Angelica, Licorice, Cinnamon or Shen Xiang), with the addition of Lycopodium, Juniperus, Citrus aurantium and Almond.
(3) Benefit the spleen and tonify the kidneys: Benefit the spleen and tonify the kidneys is a great method to treat stubborn constipation. This formula can treat stubborn constipation, with the following herbs: Cistanches 15g, Huai Niu Knee 10g, Shu Di Huang, Radix Angelicae Sinensis, Atractylodes Macrocephalae 15g each, Weilingxian 10g. This formula is a double tonic for the spleen and kidneys, not dry but not cold, to strengthen the spleen and kidneys in the intestines to promote transportation and defecation. It has a better effect on constipation formed by both the spleen and kidney in the elderly and by taking laxatives for a long time. 10g each of Lycopodium and Houpao can be added for those with deficiency in the spleen and kidney and cold stools in the abdomen. 10g each of leek seed and fenugreek can be added for those with deficiency in the spleen and kidney and cold stools in the abdomen.
(F) biofeedback defecation behavior therapy: biofeedback therapy is a training method to correct uncoordinated defecation behavior, some people report that its efficacy can reach 96%, the method has no drug side effects, low cost, non-invasive and other advantages compared with drug therapy, this therapy has been carried out in China.
(G) surgery: for severe chronic constipation by the above treatment is ineffective, seriously affecting the patient’s quality of life and even nutritional disorders, surgery can be taken.