What is constipation?
Most healthy people have 1-2 bowel movements a day or 1-2 bowel movements a day, and the stools are mostly formed or soft, while a few healthy people have up to 3 bowel movements a day or 1 bowel movement a day, and the stools are semi-formed or hard and salami-like. Constipation is a symptom of a variety of diseases, manifested as: too little stool, too hard, too difficult to pass, or combined with some specific symptoms, the Rome III criteria developed in 2006 is currently the latest, most comprehensive and systematic scientific classics of functional gastrointestinal disease, in which the diagnosis of chronic constipation criteria are as follows: in the past 12 months, continuous or cumulative for at least 12 weeks and Having 2 or more of the following symptoms.
□ excessive straining in at least one of the four bowel movements
□ at least one of the four bowel movements feels like it is not emptying properly
□ at least one of the four stools is hard or pellet-like
□ anorectal obstruction or blockage in at least one of the four bowel movements
At least one of the four bowel movements requires manual assistance
□ Less than 3 bowel movements per week, with daily bowel movements of less than 35 grams
No loose stools and does not meet the diagnostic criteria for irritable bowel syndrome (IBS)
What are the causes of constipation?
Normal defecation requires that the intestinal contents pass through the segments at normal speed, reach the rectum in time, and stimulate the recto-anus to cause the defecation reflex, and that the pelvic floor muscles coordinate their activities during defecation to complete defecation. Failure of any of the above links may cause constipation.
Chronic constipation has functional and organic causes. Functional constipation has unclear etiology, while organic etiology can be caused by gastrointestinal diseases, systemic diseases involving the digestive tract such as diabetes, scleroderma, neurological diseases, etc. Many drugs can also cause constipation, as follows.
1: organic lesions of the intestinal canal such as tumors, inflammation or other causes of intestinal lumen narrowing or obstruction.
2: rectal and anal lesions: endorectal prolapse, hemorrhoid disease, anterior rectal bulge, puborectal hypertrophy, puborectal separation, pelvic floor disease, etc.
3: endocrine or metabolic diseases: e.g. diabetic enteropathy, hypothyroidism, parathyroid disease, etc.
4: neurological disorders: such as central brain disorders, stroke, multiple sclerosis, spinal cord injury, and peripheral neuropathy.
5: smooth muscle or neuronal lesions of the intestinal canal.
6: colonic neuromuscular lesions: pseudo-intestinal obstruction, congenital megacolon, megarectum, etc.
7: psychiatric and psychological disorders.
8: pharmacological factors: aluminum antacids, iron, opioids, antidepressants, anti-Parkinson’s disease drugs, calcium channel antagonists, diuretics, and antihistamines.
What are the classifications of constipation?
There are many different ways to classify constipation, including acute constipation and chronic constipation according to the duration or mode of onset of the disease; organic constipation and functional constipation according to the cause; colon constipation and rectal constipation according to the site of stool accumulation; and slow-transit constipation, outlet obstruction constipation, and mixed constipation according to the type of intestinal dynamics abnormality, which is also the most common typing method in academia today. This is the most common typing method.
How is constipation treated?
The treatment of constipation should be comprehensive, with the aim of relieving symptoms and restoring regular bowel habits. The following treatment principles are mostly followed: (1) individualized treatment; (2) early treatment; (3) comprehensive treatment and avoiding laxative abuse.
(i): General treatment: Diet.
Eat more coarse fiber foods: For movable patients, such as white-collar workers, the recommended fiber supplement is 10g/d, but the exact effective dose varies from person to person. Fresh vegetables, fruits, beans, coarse grains, potatoes, meat to beef, especially red beef contains more muscle fiber, laxative effect food such as bananas, milk, honey, sesame, walnuts
Drink more water (1500-2000ml / d), drink warm water in the morning on an empty stomach, or light salt water, or honey water 1 cup, can promote intestinal peristalsis, laxative bowel movements
Drink less alcohol, strong tea, coffee
Eat less spicy and stimulating food
Exercise.
Should emphasize walking, walking leg lifting action directly or indirectly affect the ability of the pelvic pubic symphysis muscle and anal sphincter, can walk or jog 10-30 min a day, very effective in preventing constipation.
Recovery of normal defecation.
Normal defecation behavior refers to good defecation habits. Most patients with constipation have changes in defecation habits, so it is important to restore normal defecation behavior. 0.5 or 1 h after meals to go to the toilet, when the gastrocolonic reflex is most active, as a signal of conditioned reflex, training defecation, so as to establish good defecation habits and regularity.
(ii) Drug treatment.
1.Laxative drugs.
Laxatives are divided into: volumetric laxatives, osmotic laxatives, stimulant laxatives, lubricating laxatives, and intestinal motility drugs according to different mechanisms of action, but all of the above mechanisms of laxatives have certain side effects.
2.Micro-ecological preparations
Micro-ecological agents are increasingly used in the prevention and treatment of many clinical diseases. Especially for intestinal diseases such as acute and chronic enteritis, diarrhea and constipation, these preparations help to relieve the symptoms of chronic constipation, such as Bifidobacterium, Bifidobacterium gold, lactobacillus tablets, etc.
(C) detoxification hydrotherapy for constipation
Hydrotherapy is a treatment and health care method that controls certain pressure and temperature through instruments, injects filtered and disinfected warm water into the intestine, cleanses the whole intestine in segments, and helps patients remove toxins and fecal residues from the colon through massage by enterotherapists, acting on the whole colon and achieving complete colon cleansing.
(D) Psychotherapy of constipation
For constipation caused by anxiety, depression, the application of psychological counseling, psychotherapy and psychotropic drug treatment has a better effect. And moderate and severe constipation patients often have anxiety and even depression and other psychological factors or disorders, should be cognitive therapy, so that patients eliminate tension
(E) biofeedback treatment of constipation
Biofeedback therapy is an emerging bio-behavioral therapy, it is through electronic engineering technology, some can not or not easily perceived by the human body physiological and pathological activities, into sound, images and other information can be or easily perceived, the use of biofeedback mechanism, so that patients according to their own physiological activities observed information to adjust physiological activities, in order to achieve the the purpose of treating diseases. Generally speaking, biofeedback therapy is satisfactory for outlet obstructive constipation, especially for pelvic floor coordinated movement disorder constipation. Currently, the literature reports that biofeedback therapy is mainly used for pelvic floor muscle dysfunctional constipation and fecal incontinence, but it can also be used to treat other types of constipation, but it is not good for slow transmission constipation.
(F) Chinese medicine and acupuncture and massage treatment
The effect of treatment of constipation through dialectical treatment and acupuncture and massage in Chinese medicine is sure.
(vii) Surgical treatment of constipation
If after strict non-surgical treatment still has little effect, and various special examinations show that there is a clear pathological anatomy and conclusive functional abnormalities, surgical treatment can be considered. Indications for surgical intervention include secondary megacolon, partial colonic redundancy, colonic weakness, severe anterior rectal distention, endorectal stenosis, rectal mucosal prolapse, etc.
In conclusion, the current research on the diagnosis and treatment of constipation is progressing rapidly, and the main line of treatment is strictly in accordance with the process of functional constipation diagnosis and treatment, which aims to identify the cause and the presence of alarm symptoms, and then to treat them accordingly. Regarding the above treatments, the first consideration should be the general treatment and medication, following the principle of reasonable selection of drugs with reliable therapeutic effect, small side effects and high safety, while biofeedback therapy is theoretically effective for patients with outlet obstruction and worth trying.