Constipation is a very common clinical condition and is now not only common in the elderly, but many young people also suffer from the frequent torment of difficult bowel movements. Although constipation itself is not a serious disease, it is a physiological need for human beings to have bowel movements, so the pain it brings to the patient is very great. Some patients have a history of up to ten or twenty years. Long-term constipation can not only induce other serious diseases, but even bring mental torture to patients, and depression can occur in severe cases. Therefore, the prevention and treatment of constipation is particularly important.
Many patients use laxatives for a long time, in the early laxatives are effective, but long-term oral laxatives can cause dependence and thus aggravate constipation, and some cause colonic melanosis.
Effective methods of prevention and control are.
1. Do not ignore the intention to defecate, timely defecation.
2. Defecation should be regular, to develop the habit of regular defecation.
3. Try to avoid sitting and standing for a long time, and participate in physical exercise to strengthen the vitality of the colon and promote intestinal motility.
4. Eat more fiber-rich foods, such as fresh vegetables and whole wheat flour or mixed grains.
5. Drink more water and eat more fruits.
6. Maintain a regular life, adequate sleep and cheerful and optimistic mood is important for the prevention of constipation.
But there are still some serious constipation may need to resort to surgery to cure. This is because such patients either have an excessively long colon or anatomical defects or lesions.
What constitutes severe constipation that requires surgical treatment?
The indications for surgical intervention are
(1) A clear diagnosis with clinical diagnostic criteria that meet the Rome III criteria.
(2) Patients with a clear diagnosis, who require conservative medical treatment for at least 3 months, whose clinical symptoms have worsened year by year due to the ineffectiveness of biofeedback treatment, and who have a strong desire for surgical treatment.
(3) Exclude psychiatric constipation, and routinely perform psychiatric psychological assessment before surgery. For those who have obvious anxiety, depression and other mental abnormalities, psychological treatment should be carried out instead of taking surgical treatment. Only those who meet the above 3 criteria can be considered for surgical treatment.
In general, the causes of severe constipation are complex and are currently two-fold: colonic redundancy and outlet obstruction. Routine preoperative examinations include anorectal examination, routine blood, stool routine and occult blood test, biochemical and metabolic tests, proctoscopy, sigmoidoscopy/colonoscopy, barium enema, etc. Tests for constipation include: colon transfer test, fecal imaging, anorectal manometry, multiple pelvic imaging, balloon force-out test, etc.
Surgical procedures to address the causes of colonic redundancy include
(1) total colectomy and ileorectal anastomosis. Removal of the colon from the end of the ileum to the upper part of the rectum, and ileo-rectal anastomosis.
(2) Subtotal colectomy and anastomosis of the ascending rectum. Subtotal resection of the colon is performed under laparoscopy, and the patient’s postoperative recovery is fast and the surgical scar is small, which is worth promoting.
(3) Colonic open resection. The colon is partially preserved. The surgery is less traumatic and recovery is fast. However, there is a lack of long-term and large number of cases to observe whether the corresponding problems will occur in the open colon.
(4) Partial colectomy. Good results were achieved by removing the suspected diseased bowel according to the colonic transmission test and colonic measurements.
For the etiology of outlet obstruction, surgical procedures are performed as follows.
1.PPH surgery: Because of the limitation of resection depth and length, the recurrence rate is high after surgery.
2.STARR (transanal anastomosis partial rectal resection) surgery: as a new surgical procedure, it provides a minimally invasive surgical method for the treatment of rectal prolapse and endorectal prolapse, which can simultaneously repair endorectal loops and rectal prolapse and restore rectal volume and compliance.
3.Posterior puborectalis excision: it is suitable for puborectalis syndrome (PRS), or local injection of botulinum toxin (BTX) into puborectalis muscle.
With the improvement of living standards, the accelerated pace of work, and the refinement of diet, constipation is occurring more and more. In general, patients with constipation can achieve good results through conservative treatment with the aid of medications, but patients with severe constipation must resort to surgical treatment to completely solve the patient’s pain, while also paying attention to the patient’s psychological counseling, if necessary, the need to relieve the patient’s tension and anxiety through medication.