Constipation is defined as a decrease in the frequency of bowel movements, a decrease in the volume of stool, dry stool, and straining to pass stool. The duration of chronic constipation is at least 6 months. With the change of diet structure and the influence of psychological and social factors, the prevalence of chronic constipation in China is gradually increasing, which seriously affects people’s quality of life.
Diagnosis
1, diagnosis: the diagnosis of functional constipation can be based on the Rome III criteria.
(1) must include 2 or more of the following.
(1) at least 25% of the bowel movements feel laborious.
(2) At least 25% of the bowel movements are dry bulbous stools or hard stools.
(3) At least 25% of the bowel movements are incomplete.
(4) At least 25% of the bowel movements have a feeling of anorectal obstruction or blockage.
(5) At least 25% of the bowel movements require manual assistance (e.g., finger-assisted bowel movements, pelvic floor support).
(6) The number of bowel movements is <3 times/week.
(2) Rarely have loose stools in the absence of laxatives.
(3) There is insufficient evidence to diagnose IBS.
(4) Symptoms have been present for at least 6 months prior to diagnosis, and the symptoms in the last 3 months meet the above diagnostic criteria.
2.Typing: Functional constipation is divided into 3 types according to the characteristics of the intestinal dynamics and anorectal function changes that cause constipation.
(1) slow transmission type constipation (STC): low colonic power, prolonged colonic transmission time caused.
(2) Outlet-obstructed constipation (OOC): manifested as straining to defecate, requiring manual assistance to defecate, and feeling of incomplete defecation.
(3) Mixed constipation (MIX): with the characteristics of STC and OOC.
3.Severity judgment: according to the severity of constipation and related symptoms and its impact on life is divided into.
(1) Mild: refers to the symptoms are mild, does not affect life, through the overall adjustment or a short period of medication can be.
(2) Moderate: between mild and severe.
(3) Severe: the symptoms are heavy and persistent, seriously affecting work and life, requiring medication and cannot be stopped or medication is ineffective.
Treatment】
1, general treatment: help patients fully understand the factors that lead to constipation, and relieve patients of the psychological burden of excessive tension about defecation. It is recommended to increase the amount of water and physical activity, and instruct patients to develop good bowel habits.
2, dietary fiber and dietary fiber preparations: constipated people need more fiber to maintain the volume of stool and intestinal transmission function. Dietary fiber preparations can be supplemented, such as wheat bran, methyl cellulose, etc. It should be noted that large doses of dietary fiber preparations can lead to abdominal distension, suspected intestinal obstruction is prohibited.
The above two points are most important. Because any drug, although effective, with the prolongation of taking the drug, will produce resistance. For example, today take a piece of medicine is effective, perhaps six months later, need to eat 3 tablets to be effective.
3, laxatives: the choice of laxatives should consider the efficacy, safety, drug dependence and price to effectiveness ratio. Avoid long-term use of irritating laxatives. For fecal impaction, use clean enema or liquid paraffin and other rectal administration to soften the feces. For constipation combined with hemorrhoids, compounded keratanic acid ester preparations are available.
(1) volumetric light laxative (bulking agent): by increasing the water content and solids in the stool to play a laxative effect, such as oxytetracycline.
(2) Osmotic laxatives: including non-absorbed sugars, salt laxatives and polyethylene glycols. Non-absorbed sugars (such as lactulose) can be used for the treatment of mild and moderate constipation. Salt preparations (e.g. magnesium sulfate) can allow water to penetrate into the intestinal lumen, but it should be noted that excessive application can cause electrolyte disorders and should be used with caution in the elderly and those with reduced renal function. Polyethylene glycol can effectively treat constipation, and less adverse reactions.
(3) Stimulant laxatives: including phenolphthalein, anthraquinones, castor oil, etc.. Such laxatives are prone to drug dependence, electrolyte disorders and other adverse reactions, long-term application can cause colon melanosis and increase the risk of colorectal cancer.
4.Promotional agents: Mosapride can increase the intestinal power, and thus has a better effect on STC.
5.Chinese medicine: certain Chinese medicines (including Chinese patent preparations and tonics) can effectively relieve the symptoms of chronic constipation.
6.Biofeedback therapy: It is applicable to functional defecation disorder, thus establishing correct defecation behavior.
7.Surgical treatment: Patients with chronic constipation who really need surgical treatment are still a minority. When the patient’s symptoms seriously affect work and life, and after a period of strict non-surgical treatment is ineffective, surgery can be considered. It is important to master the indications for surgery. Surgical treatment has a certain recurrence rate. Necessary medication should be given after surgery.