Constipation is a symptom that can be produced by many diseases. There is a distinction between organic constipation and functional constipation, and the one to be discussed here is functional constipation without the presence of organic lesions.
Definition of constipation.
Constipation is defined as a decrease in the frequency of bowel movements, less than 2-3 times in a week, or once in 2-3 days, when the stool is small and dry; however, if the stool is once in 2-3 days, if the stool is normal in nature and expelled without effort, it cannot be called constipation; if the stool is not dry but difficult to defecate, and there is a feeling of anal swelling after the stool, it can also be called constipation. It can include the following aspects: 1) less bowel movement and less frequent bowel movements, less than 3 times a week; 2) strenuous bowel movements, highlighted by abnormal difficulty in passing stools; 3) poor bowel movements, frequent anal obstruction, frequent bowel movements, not dry stools, but poor bowel movements, weak effort, always a feeling of anal swelling and unclean bowel movements; 4) constipation accompanied by abdominal pain or abdominal discomfort, and abdominal pain relieved after bowel movements.
Defecation mechanism.
After digestion and absorption of food in the jejunum and ileum, the remaining chyme residue that cannot be reabsorbed is discharged from the small intestine to the colon with intestinal peristalsis, and the colonic mucosa further absorbs water and electrolytes, and feces is generally formed gradually in the transverse colon, and finally transported to the sigmoid colon and rectum. The rectal mucosa is mechanically stimulated by the filling and expansion of feces, which generates sensory impulses, which are transmitted to the cerebral cortex via the pelvic nerve and lumbosacral spinal cord, and then transmitted to the rectum via the efferent nerve, causing the rectal muscle to contract and the anal sphincter to relax, followed by the contraction of the abdominal muscle and diaphragm at the same time, causing the feces to be expelled from the anus. The above is the normal defecation reflex process. If any part of this defecation reflex process is impaired, it can lead to constipation. In summary, there are the following factors.
1, the intake of food or water is too little, so that the amount of celiac residue or feces in the intestine is also small, not enough to stimulate the normal peristaltic movement of the colon.
2.Weak peristalsis of the intestine or reduced muscle tone of the intestine.
3.The presence of stenosis or obstruction in the intestinal cavity obstructs normal intestinal peristalsis, resulting in the inability to pass stool, such as intestinal obstruction or left hemicolectomy.
4.Constipation can occur when there is any obstacle or lesion in the process of defecation reflex, such as weakened sensation of mechanical stimulation of rectal mucosa, pelvic nerve, lumbosacral spinal cord neuropathy, spasm of anal sphincter, weakened contraction of abdominal muscle and diaphragm, etc.
Classification of constipation.
1, acute constipation.
(1) Constipation caused by local lesions of the anorectum, such as anal fissure, swollen and painful hemorrhoids, anal abscess, proctitis, anal papilloma infection, etc. causing painful spasm of the anal sphincter, causing the patient to fear defecation and the disappearance of the defecation reflex leading to constipation.
2) Dysfunctional lesions of the colon, such as colonic torsion and intestinal entrapment.
3) Visceral diseases affect the peristaltic function of the colon, such as appendicitis, cholecystitis, peritonitis, kidney stones, pancreatitis, lumbar muscle strain, etc.
(4) Certain drugs affect, such as aluminum thioglycollate, atropine, bismuth subcarbonate, oxytetracycline and psychotropic drugs can cause intestinal paralysis, resulting in constipation.
(5) living habits, dietary patterns change, defecation patterns are then disrupted, causing constipation.
2, chronic constipation.
(1) chronic deficiency diseases, such as chronic emphysema, chronic cardiac dysfunction, visceral prolapse, long-term malnutrition, multiple pregnancies in women, senior organ failure, colon peristaltic weakness.
(2) contraction weakness after transitional expansion of the rectum, intestinal lumen enlargement, normal amount of stool can not cause defecation stimulation reflex, over time, the formation of stubborn constipation.
(3) The amount of diet is too small or too fine, forming too little fecal residue, which cannot fill the intestinal cavity in the normal defecation cycle and cannot reach the value of stimulating the defecation reflex, so there is no intention to defecate.
(4) Abuse of laxatives, reduced sensitivity of the defecation reflex, weakening or disappearance of the normal defecation reflex, forming a vicious circle.
(5) emotional factors such as stress and anxiety make the plant sympathetic nerve disorder, the peristaltic function of the large intestine is bound to be affected.
The hazards of constipation.
1, causing anorectal disorders. Constipation, defecation difficulties, dry stool, can directly cause or strengthen the anorectal disorders. Such as proctitis, anal fissure, hemorrhoids, etc.
2, gastrointestinal nerve disorders. Constipation, fecal retention, absorption of harmful substances can cause gastrointestinal nerve dysfunction and cause loss of appetite, abdominal distension, belching, mouth bitter, anal exhaust and other performance.
3, the formation of fecal ulcers. Harder fecal lumps compress the intestinal cavity to narrow the intestinal cavity and change the structure around the pelvic cavity, hinder the expansion of the colon, so that the rectum or colon pressure and the formation of fecal ulcers, serious cases can cause intestinal perforation.
4, suffering from colon cancer. It may be due to constipation that the intestinal carcinogens can not be eliminated for a long time. According to data, about 10% of people with severe constipation suffer from colon cancer.
5, induced heart, cerebrovascular disease attacks. Clinically on the constipation and force to increase abdominal pressure, holding the breath to force defecation caused by the heart, cerebrovascular disease attacks have increased year by year trend. Such as the induction of angina pectoris, myocardial infarction attack, cerebral hemorrhage, sudden death from stroke, etc..
6, cause sexual life disorders. This is due to each prolonged forceful defecation, so that rectal fatigue, anal contraction is too tight and spasmodic contraction of the pelvic floor, resulting in non-ejaculation or libido loss, sexual life without orgasm, etc..
7, easy to make women suffer from dysmenorrhea, vaginal cramps, and production of urinary retention, urinary tract infections and other symptoms.
8, affect the brain function. When constipation metabolites long stagnation in the digestive tract, the role of bacteria produce a large number of harmful substances, such as methane, phenol, ammonia, etc., these substances part of the diffusion into the central nervous system, interference with brain function, highlighting the performance of memory loss, distraction, slow thinking, etc.
Treatment of constipation.
Acute constipation: physiological education of defecation, elimination of causes, timely treatment of primary diseases, adjustment of living habits including dietary patterns, work and rest patterns and adjustment of defecation patterns, correction or prevention of patients taking laxatives or enemas frequently.
Chronic constipation: 6 months of recurrent symptoms of difficult defecation and 3 months of aggravation can be diagnosed as chronic constipation.
I. General treatment
(A) life conditioning.
1, should develop good habits, early to bed, early to rise, life has a rhythm, biological clock stability, stool pattern also tends to stabilize.
2, regulate emotions, maintain a good attitude, have patience, confidence, adhere to multiple courses of treatment, systematic treatment.
3, develop the habit of regular bowel movements, soon tolerate stools, need to concentrate when defecating, do not chat on the phone, do not read books and newspapers.
4, strengthen physical exercise, change the static lifestyle, increase outdoor activities, enhance intestinal peristalsis, facilitate defecation
5, physical therapy massage Massage is mainly the abdomen of several points, has the role of promoting intestinal peristalsis. There are also microwave, infrared therapy, divine light acupuncture point irradiation, acupuncture point moxibustion, etc. are helpful in the treatment of constipation.
(B) Diet regulation: 1.
1, first of all, should adjust the diet structure, should eat more coarse grains and fruits and vegetables, avoid frying dry fried stimulating food.
2, oily kernels: such as walnuts, pine nuts, peanuts, sesame seeds and other vegetable oil content is high, can nourish the blood and laxative.
3, supplemental water: adequate amount of water can soften the stool, start drinking water half an hour after the meal is good.
4, regular meals: regular meals can maintain the rhythm of intestinal movement, is to ensure that the prerequisite for timely bowel movements.
5, appropriate tonic: chronic constipation occurs in the elderly, most of them have symptoms of deficiency of qi, blood, yin and yang, so when the appetite is good, you can choose to supplement qi or yin (blood) or yang according to the physical differences. Ginseng, American ginseng, honey, iron-skinned fenugreek, black and white fungus, etc.
(iii) Food therapy.
1.Every day in the morning, drink a glass of honey on an empty stomach and take it with warm boiled water.
2, potato juice: 1 potato, peeled and chopped into a paste, cool boiled water, once a day.
3, honey 250 grams, 250ml fresh lotus root juice, 250 grams of raw groundnut, decoction of raw groundnut with water to concentrate, then add honey, lotus root juice and continue to boil into a paste. Add honey and lotus root juice and continue to boil to make a paste. 3-5 times daily, one tbsp each time.
4. 50g of mulberry seeds, 100g of rice and brown sugar, boil the porridge and take it every morning and evening for postpartum blood deficiency and constipation.
5, peach kernel, cassia seeds, cypress kernel 10 grams each, pounding research fine, water decoction to remove the dregs of juice, add honey with uniform, before going to bed. Can prevent and control hypertension constipation.
6, Danshen Shouwu Hawthorn porridge, Danshen, Shouwu 30 grams each, water decoction to extract the juice, hawthorn to remove the core, with the appropriate amount of rice boil porridge, can be appropriate to add rock sugar consumption, for hyperlipidemia, coronary heart disease constipation.
7, walnut and lily porridge, walnut, lily 30 grams each, 100 grams of rice, boil porridge, morning and evening, can supplement the lungs and kidneys, laxative and laxative, used for constipation in chronic emphysema.
8, sea jelly water chestnut soup, sea jelly 50 grams, 200 grams of water chestnut, washed and shredded soup, add appropriate amount of rock sugar to drink, for the elderly slow branch cough, constipation of lung disease.
II. Beneficial bacteria treatment
Appropriate use of some biological live bacteria preparations, such as accompanying Fikang, whole intestine, Mia, etc., can change the ecological environment of the intestinal tract, and play an auxiliary therapeutic role in constipation.
Third, Chinese medicine evidence-based treatment
For the treatment of chronic constipation, if the formula is based on qi and yin deficiency, the formula will add xuan ginseng, smallpox powder, dendrobium, raw astragalus, etc.; for the type of qi stagnation and blood stasis, it will add incense, sandalwood, Chai Hu, shan leng, curcuma, and reuse peony; for the type of blood deficiency, it will add raw shou wu, rehmannia, cypress seed, etc.; for the type of kidney deficiency, it will add rehmannia, taro meat, locking yang, etc.
Massage: take Shen Que (navel) point as the center, 2 inches from Shen Que point (i.e., the distance of one horizontal palm of one’s own hand), up, down, left and right four points, point pressure massage, each point 5-10 minutes, 3-5 times a day is appropriate; or palm pressure on the abdomen along the above four points in a clockwise direction, can increase intestinal motility.
Five, biofeedback therapy
Biofeedback therapy is a new type of psychological treatment method that uses modern physiological scientific instruments to eliminate pathological processes and restore physical and mental health through the feedback of physiological or pathological information in the human body, so that patients undergo special training to carry out conscious “idea” control and psychological training. In the field of constipation, this therapy is mainly used for functional outlet obstruction type of constipation. It solves the spasm of anal sphincter, corrects the abnormal defecation cooperative action, and establishes normal defecation pattern.
Sixth, enema treatment that is hydrotherapy
Clean enema can only be used for acute constipation with fecal mass obstruction embedded in D. It cannot be used frequently, otherwise it will aggravate constipation; treatment of chronic constipation can be done with Chinese herbal medicine retention enema method, that is, Chinese herbal medicine tonics at a specific temperature and amount of medicine after enema into the rectum and let it be retained for more than 2 hours, which can play a role in softening stool, astringent weak colon and increase intestinal dynamics to promote defecation.
Problems worth noting in the treatment of constipation.
1, the lack of awareness of constipation, constipation is considered a simple symptom, their own random purchase of drugs for treatment.
2, constipation treatment method single, can only alleviate the temporary danger, can not be long-term effect, need a comprehensive treatment.
3, the quick, with a fierce laxative over time to produce drug dependence.
4, the diet does not eat oil and meat, just eat multi-fiber food, but to stimulate the gastrointestinal aggravate constipation.
5, simple constipation do not rush to use laxatives, first adjust the diet and lifestyle habits.
6, chronic constipation patients should not use sedatives, anticholinergics, astringent aluminum-containing preparations, calcium preparations, codeine and other drugs.
7, with cardiac and renal insufficiency, hypertension, intestinal obstruction and intestinal bleeding patients are prohibited stimulant laxatives.
8, persistent constipation: as a worldwide problem, has attracted widespread attention of the medical community at home and abroad, modern research has proved: persistent constipation is not just a symptom, but an independent disease classified as surgery; nor is it functional, but there are obvious organic changes in the colorectal disease of chronic incomplete intestinal obstruction; non-surgical treatment is not effective, drug therapy can not cure a class of diseases. The more common clinical diseases are: colonic tortuous redundancy, rectal mucosal overlap, rectal protrusion, perineal descent, puborectal muscle spasm syndrome, internal dilator muscle loss of chordosis, etc.
9, chronic constipation requires a series of tests to find the cause of the disease. Generally follow the principle from simple to complex, first down and then up, that is, first anal examination, then rectal and then colonic, anal examination: anal visual examination, anal finger examination, anoscopy, which is the simplest and most cost effective and accurate examination, as well as anal rectal manometry, fecal imaging, colonic air-barium imaging, colonic running test, which are more conventional examinations.