Proper understanding of constipation
Constipation is mainly defined as a decrease in the frequency of bowel movements, dry and hard stools and/or difficulty in passing stools. Decreased frequency of bowel movements refers to less than 3 bowel movements per week. Difficulty in defecation includes straining to defecate, difficulty in passing stool, feeling of incomplete defecation, time consuming defecation and needing manual assistance to defecate. Chronic constipation is called chronic constipation when the disease lasts for more than 6 months. Zhang Ruixing, Department of Gastroenterology, Fourth Hospital of Hebei Medical University
The prevalence of chronic constipation is on the rise because of the change in diet structure, accelerated pace of life and psychosocial factors. The prevalence of chronic constipation among adults in China is 4%-6%, which increases with age, and the prevalence of chronic constipation among people over 60 years old can be as high as 22%. Women are more prone to the disease than women. The prevalence of chronic constipation is higher in rural than in urban areas. Thin, low education, living in densely populated areas are more likely to have constipation. Low-fiber foods and reduced fluid intake can increase the likelihood of chronic constipation, and laxative abuse can aggravate constipation.
Constipation is closely related to anorectal diseases (e.g., hemorrhoids, anal fissures, and rectal prolapse). Chronic constipation may play an important role in the development of diseases such as colorectal cancer, hepatic encephalopathy, breast disease, and Alzheimer’s disease. In diseases such as acute myocardial infarction and cerebrovascular accidents, excessive forceful defecation can even lead to death.
Chronic constipation can be caused by a variety of diseases, including functional and organic diseases, and many drugs can also cause constipation. Most of them are functional diseases, including functional constipation, functional bowel disorders and constipated irritable bowel syndrome.
Diagnosis of chronic constipation.
Based mainly on symptoms, patients with chronic constipation also often present with reduced or lack of bowel movement, wanting to defecate but not being able to (emptying), time-consuming defecation, low daily defecation volume, and may be accompanied by abdominal pain, bloating, anorectal pain, and other discomforts.
In patients with constipated irritable bowel syndrome, abdominal pain and abdominal discomfort often improve after defecation.
Physical examination includes general examination, abdominal examination and anorectal examination. In patients with anorectal pain, the puborectal muscle should also be examined for tenderness to distinguish between anal raphe syndrome and nonspecific functional anorectal pain. Fecal routine and occult blood test should be performed as routine examination and regular follow-up for patients with chronic constipation.
Differential diagnosis: In patients with recent constipation, constipation or changes in concomitant symptoms, especially those aged >40 years with alarming signs (blood in stool, positive fecal occult blood test, anemia, wasting, significant abdominal pain, abdominal mass, history of colorectal polyps and family history of colorectal tumors), necessary laboratory, imaging and colonoscopic examinations should be performed.
The examination methods include: 1. colonic transmission test: 2. manometry: 3. balloon forcing out test: 4. fecal imaging, etc. Psychological status needs to be checked if necessary.
Treatment
The goal is to relieve symptoms and restore normal bowel dynamics and physiological functions of defecation. The principle is individualized and comprehensive treatment, including recommending a reasonable dietary structure, establishing correct defecation habits, and adjusting the patient’s mental and psychological status; treating the etiology of the disease if there is a clear cause; avoiding laxative abuse if long-term laxative maintenance treatment is needed. Surgical procedures should be strictly controlled for indications.
Lifestyle adjustment: reasonable diet, drinking more water, exercise and establishing good bowel habits are the basic treatment measures for chronic constipation. It is recommended to consume 25-35 grams of dietary fiber and at least 1.5-2.0 liters of water daily; moderate exercise: it is more beneficial to elderly patients who are bedridden and have little exercise; establish good defecation habits: colon activity is most active in the morning when waking up and after meals, so it is recommended that patients try to defecate in the morning or within 2 hours after meals.
Avoid long-term use of stimulant laxatives. Stimulant laxatives act on the enteric nervous system to enhance bowel motility and stimulate intestinal secretion, including fruit conductors, anthraquinones, and castor oil. Long-term use of stimulant laxatives may lead to irreversible intestinal nerve damage, and long-term use of anthraquinone laxatives may cause colonic melanosis, but the relationship between the latter and tumors is controversial. Short-term, intermittent use of stimulant laxatives is recommended.
Enemas and suppositories are administered intra-anally to lubricate and stimulate the intestinal wall, softening the stool and making it easy to pass.
Probiotics can improve the symptoms of chronic constipation. Chinese medicine (including proprietary Chinese preparations and tonics) can effectively relieve the symptoms of chronic constipation; massage and massage can promote gastrointestinal motility and help improve the symptoms of constipation.
Patients with chronic constipation who really need surgical treatment are still in the minority. When the patient’s symptoms seriously affect work and life, and after a period of strict non-surgical treatment is ineffective, surgical treatment can be considered, but must master the indications for surgery.
1, the elderly: lack of exercise, due to chronic diseases taking a variety of drugs is an important cause of constipation in the elderly, should try to stop using drugs that cause constipation, pay attention to change the lifestyle. For those with fecal impaction, the first step should be to remove the embedded feces. Laxatives can be preferred to volumetric laxatives and osmotic laxatives, for patients with severe constipation, can also be short-term moderate application of stimulant laxatives.
2, pregnant women: increase dietary fiber, drink more water and appropriate exercise is the main treatment measures for these patients, volumetric laxatives, lactulose, polyethylene glycol safety is good, can be used. Anthraquinone-based laxatives and castor oil should be avoided.
3.Children: Basic treatment includes family education, reasonable diet and bowel habit training, and for those with fecal impaction, enemas with open cork or warm sodium chloride solution can be used. Volumetric laxatives, lactulose, polyethylene glycol are effective and well tolerated.
4, diabetic patients: is a common digestive tract symptoms, control of blood glucose may be beneficial, can try to use volumetric laxatives, osmotic laxatives and stimulant laxatives.