Etiology and pathogenesis of constipation

  Chinese medicine believes that constipation is a clinical manifestation of human yin and yang qi, blood, fluids, visceral functions, diet and mood disorders, and the invasion of the six prostitutes, and its etiology can be summarized as follows: real constipation, heat accumulation in the gastrointestinal system, or heat accumulation in the large intestine, or over-eating spicy and thick flavors, resulting in heat accumulation in the gastrointestinal system, depletion of fluids, dry feces, and difficulty in expulsion. Difficulty in excretion.  Qi stagnation Liver depression and Qi stagnation or Qi stagnation, resulting in Qi stagnation in the internal organs, abnormal flow and descent, and internal stagnation of dregs.  Yin and cold stagnation Eating cold food, or external cold, or taking cold drugs, damage the intestines and stomach, resulting in abnormal conduction, resulting in irregular bowel movements.  Deficiency and constipation Qi deficiency, Yang failure, hunger and satiety disorders, fatigue and internal injury, and physical weakness can lead to weak conduction of the large intestine, or weakness of the stool.  Yin deficiency, blood deficiency, blood deficiency, or blood loss and sweating, or excessive consumption of dry and pungent products, and prolonged consumption of laxatives, etc., resulting in the large intestine does not glory, the intestines do not moisten, resulting in constipation.  According to modern medicine, the causes of constipation are: too little fiber, insufficient water, low activity, endocrine and metabolic diseases, mental factors and mental diseases, and the constipating effect of some drugs, etc. In 2008, the Guide to the Diagnosis and Treatment of Constipation concluded that normal defecation requires gastrointestinal contents containing a certain amount of dietary fiber to pass through all segments of the digestive tract at a normal speed and reach the rectoanal canal in time to induce defecation. Reflexes. During defecation, the pelvic floor muscles coordinate their activities to complete defecation. Any one of the above obstacles can cause constipation. Mental or psychological disorders are also a cause of constipation, even intractable constipation, and often coexist clinically with organic lesions and functional disorders of the colorectal and pelvic floor. Currently, constipation is classified as slow-transmission constipation, outlet obstruction constipation, and mixed constipation.  Slow-transmission constipation is most commonly seen in patients who have been taking stimulant laxatives for a long time, are bedridden for a long time, or have psychological abnormalities, and is mainly characterized by a decrease in the number of bowel movements. Colonic transmission test is one of the most commonly used tests to determine colonic transmission dysfunction according to the distribution of markers in the colon within a certain period of time, as well as to observe the shape, location and extent of the colon with transmission dysfunction, and generally the diagnosis can be confirmed if the above tests are abnormal twice. In recent years, with the development of neurogastrointestinal dynamics, several studies at home and abroad have concluded that slow-transmission constipation is closely related to excitatory neurotransmitter defects in the intermuscular plexus of the intestine and alterations in Cajal interstitial cells.  The exit-obstruction type of constipation is more common and is essentially an abnormality of the pelvic floor structure, resulting in impaired fecal expulsion with a variety of clinical manifestations. Rectal palpation reveals fecal retention in the rectum and paradoxical sphincter contraction. The diagnosis is often confirmed by a fecal imaging. In recent years, the application of dynamic magnetic resonance imaging of the pelvic floor can accurately evaluate pelvic organ prolapse and pelvic floor morphology. By observing the morphological changes of pelvic floor muscles and adjacent structures, a more complete picture of pelvic floor anatomy can be shown, and a complete and systematic evaluation of anorectal and pelvic floor diseases can be made.  The constipation type of irritable bowel syndrome is a category of constipation related to abdominal pain or bloating, which may have characteristics of each of the above types.