Patients with constipation need to use comprehensive treatment, including general life therapy, medication, biofeedback training and surgery, according to the severity, cause and type of constipation, in order to restore normal defecation physiology.
Those with poor dietary habits or excessive partiality should correct the bad habits and adjust the diet content, increase vegetables and fruits containing more fiber, and appropriately consume coarse and dreary miscellaneous grains such as standard flour, potatoes, corn, barley, etc. Oily foods, cool boiled water and honey all help in the prevention and treatment of constipation, and drink more water. Eat more foods rich in B vitamins and laxatives, such as coarse grains, beans, silver ears, honey, etc. Increase cooking oil appropriately when frying vegetables. Avoid alcohol, strong tea, chili, coffee, etc.
Life treatment.
1. Adjust your lifestyle and develop the habit of regular bowel movements; quit smoking and drinking; avoid abusing drugs. Avoid suppressing bowel movements when you have the urge to defecate. Long-term and repeated inhibition of defecation may lead to higher reflex threshold and disappearance of bowel movement, resulting in constipation.
2. Promote a balanced diet, increase dietary fiber in appropriate amounts, and drink more water.
(1) high fiber diet: dietary fiber itself is not absorbed, can adsorb water in the intestinal cavity to increase stool volume, stimulate the colon and enhance power. Dietary fiber-rich foods include bran or brown rice, vegetables, pectin-rich fruits such as mangoes, bananas, etc. (Note: unripe fruits contain tannic acid, which can aggravate constipation).
(2) Hydration: drink more water, it is recommended that you drink more than 1500ml of water per day to keep the intestines adequately hydrated, which is conducive to fecal discharge.
(3) supply sufficient amount of B vitamins and folic acid: with B vitamin-rich food, can promote the secretion of digestive juices, maintain and promote intestinal peristalsis, conducive to defecation. Such as coarse grains, yeast, beans and their products, etc. In vegetables, spinach, cabbage, which contains a lot of folic acid, has a good laxative effect.
(4) Increase easy gas-producing foods: eat more easy gas-producing foods to promote faster intestinal peristalsis and favorable defecation; such as onions, radishes, garlic, etc.
(5) increase the supply of fat: appropriate to increase the high-fat food, vegetable oil can directly laxative, and decomposition products fatty acids have stimulated intestinal peristalsis.
Seed kernels of dried fruits (such as walnut kernels, pine nuts, various melon seeds, almonds, peach kernels, etc.), which contain a large amount of oil, has the effect of lubricating the intestinal tract and laxative.
3, moderate exercise, mainly medical gymnastics, can be combined with walking, jogging and abdominal self-massage.
(1) medical gymnastics: mainly to enhance the strength of the abdominal muscles and pelvic muscles. Exercise method: standing position can do in situ high leg walk, deep squatting, abdominal back exercise, kicking exercise and turning exercise. Supine position, you can take turns lifting a leg or lifting both legs at the same time, lifting to 40 °, a short pause and then put down. Take turns flexing and extending both legs to imitate the bicycle movement. Raise both legs in a circle from the inside to the outside and sit-ups, etc.
(2) fast walking and jogging: can promote intestinal peristalsis, help lift constipation.
(3) deep and long abdominal breathing: when breathing, the amplitude of diaphragmatic activity increases compared with usual, which can promote gastrointestinal motility.
(4) abdominal self-massage: lie on your back, bend your knees, rub your hands together, put your left hand flat on your belly button, put your right hand on the back of your left hand, take your belly button as the center, and press clockwise. Do it 2 to 3 times a day, 5 to 10 minutes each time.
Drug treatment.
(1) Laxatives
(1) Volumetric laxatives: mainly include soluble cellulose (pectin, plantain, oat bran, etc.) and insoluble fiber (plant fiber, lignin, etc.). Volumetric laxatives have a slow onset of action with few side effects and are safe, so they are more effective for constipation in pregnancy or mild constipation, but are not suitable for rapid laxative treatment of temporary constipation.
② lubricating laxatives can lubricate the intestinal wall, soften the stool, so that the stool can be easily discharged, easy to use, such as corkage, mineral oil or liquid paraffin.
③ salt laxatives such as magnesium sulfate, magnesium milk, these drugs can cause serious adverse reactions, clinical caution should be used.
④ osmotic laxatives Commonly used drugs are lactulose, sorbitol, polyethylene glycol 4000, etc.. Suitable for blocked feces or as a temporary treatment measure for chronic constipation, is a better choice for constipated patients with poor efficacy of volumetric light laxatives.
⑤ Stimulant laxatives: including anthraquinone-containing botanical laxatives (rhubarb, Frangipani, senna, aloe vera), phenolphthalein, castor oil, diethylstilbestrol, etc. Stimulant laxatives should be used only when volumetric laxatives and salt laxatives are ineffective, some of them are stronger and not suitable for long-term use. Long-term application of anthraquinone laxatives can cause colonic black stool disease or laxative colon, causing atrophy of smooth muscle and damage to the inter-intestinal muscular plexus, but aggravate constipation, reversible after discontinuation of the drug.
(2) prokinetic agents: Mosapride, Itopride has a pro-gastrointestinal motility, Pucabri can selectively act on the colon, can be selected according to the situation.
(3) Micro-ecological agents: Clostridium typhimurium enterococci triplex, Pepcid (Streptococcus faecalis, Lactobacillus, Bifidobacterium), whole intestine (Bacillus licheniformis), lactobacillin, etc.
Other treatments.
1.Device aid If the stool is hard and stagnant in the rectum near the anal opening or if the patient is old and frail and has poor defecation power or lack of it, colon hydrotherapy or cleansing enema can be used.
2, biofeedback therapy can be used for rectal anus, pelvic floor muscle dysfunction of constipation patients, its long-term effectiveness. Biofeedback therapy is the use of specialized equipment, the collection of its own physiological activity information to be processed, amplification, with familiar visual or auditory signal display, so that the cerebral cortex and these organs to establish feedback links, through continuous positive and negative attempts to learn to control physiological activities at will, the deviation from the normal range of physiological activities to correct, so that the patient to achieve the “change self “The purpose of biofeedback therapy is to train the patient to perform a variety of functions in elimination. Biofeedback therapy can train patients to relax the pelvic floor muscles during defecation, so that the activities of the abdominal muscles and pelvic floor muscle groups are coordinated during defecation; and for patients with abnormal threshold of bowel movement, emphasis should be placed on the reconstruction of the defecation reflex and the training to adjust the perception of bowel movement. There are no specific norms for the training program, and the training is more intense but safe and effective. For patients with pelvic floor dysfunction, biofeedback therapy should be preferred over surgery.
3, cognitive therapy Patients with severe constipation often have anxiety or even depression and other psychological factors or disorders, should be given cognitive therapy, so that patients eliminate tension, if necessary, anti-depressant, anti-anxiety treatment, and ask psychologists to assist in the diagnosis and treatment.
4, surgical treatment for severe intractable constipation all the above treatments are ineffective, if the colon transmission dysfunction type constipation, serious condition can be considered for surgery, but the long-term effect of surgery is still controversial. In this huge group of constipation, those who really need surgical treatment are still in a very small minority.
Prevention.
1, avoid eating too little or too fine food, lack of residues, and reduced stimulation of colonic motility.
2, avoid disturbance of bowel habits: failure to defecate in a timely manner due to mental factors, changes in lifestyle patterns, and overexertion on long trips can easily cause constipation.
3, avoid the abuse of laxatives: the abuse of laxatives will make the intestinal sensitivity is weakened, the formation of dependence on certain laxatives, resulting in constipation.
4, reasonable arrangement of life and work, to achieve a combination of work and rest. Appropriate physical and cultural activities, especially the exercise of the abdominal muscle is conducive to the improvement of gastrointestinal function, more important for sedentary and less active and highly concentrated brain workers.
5, to develop good bowel habits, regular daily defecation, forming a conditioned reflex, to establish a good bowel pattern. Do not ignore when you have the intention to defecate, defecate in a timely manner. The environment and posture of defecation should be as convenient as possible, so as not to inhibit the desire to defecate and destroy the defecation habit.
6. Patients are advised to drink at least 6 glasses of 250ml of water daily, perform moderate exercise, and develop the habit of regular bowel movements (2 times a day for 15 minutes each time). The action potential activity of the colon is enhanced after waking up and after meals, which pushes the stool to the distal end of the colon, so morning and after meals are the easiest time to defecate.
7, timely treatment of anal fissures, perianal infections, uterine adnexitis and other diseases, laxatives should be applied with caution, do not use strong stimulation methods such as bowel cleansing.