1.General treatment
Patients with constipation need to adopt 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. Emphasis should be placed on lifestyle treatment, strengthening patient education, adopting reasonable dietary habits, such as increasing dietary fiber content, increasing water intake to enhance stimulation of the colon, and developing good defecation habits, such as morning defecation, timely defecation when there is an urge to defecate, avoiding straining to defecate, and at the same time, activities should be increased. During treatment, attention should be paid to the removal of excessive fecal accumulation in the distal rectum; active adjustment of the mind is needed, which is extremely important to obtain effective treatment.
2.Drug treatment
(1) Volumetric laxatives mainly include soluble fiber (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 is easy to discharge, easy to use, such as cork, 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 constipation patients with poor efficacy of volumetric light laxatives.
(5) Stimulant laxatives include anthraquinone-containing botanical laxatives (rhubarb, Frangipani, senna, aloe), 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 colonization, causing atrophy of smooth muscle and damage to the inter-intestinal muscular plexus, but aggravate constipation, reversible after discontinuation of the drug.
(6) prokinetic agents Mosapride, Itopride has a pro-gastrointestinal dynamics, Proscapride can selectively act on the colon, can be selected according to the situation.
3.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.
4.Biofeedback therapy
It can be used for constipation patients with recto-anal and pelvic floor muscle dysfunction, and its long-term efficacy is better. Biofeedback therapy can train patients to relax the pelvic floor muscles during defecation, so that the abdominal muscles and pelvic floor muscle groups can coordinate their activities 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.
5.Cognitive therapy
Patients with severe constipation often have anxiety or even depression and other psychological factors or disorders, and should be given cognitive therapy to eliminate the patient’s tension, and if necessary, give antidepressant and anti-anxiety treatment, and ask psychologists to assist in the diagnosis and treatment.
6.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, case selection must be careful. Among the large group of constipation, those who really need surgical treatment are still in the minority.
Constipation prevention
1. Avoid eating too little or too fine food, lack of residues, and reduced stimulation of colonic motility.
2, to avoid disturbance of defecation habits: due to mental factors, changes in lifestyle patterns, long trips over fatigue and other failure to defecate in a timely manner 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 250 ml 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 toward 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.