I. Overview of constipation
Constipation refers to feces in the intestine for too long, constipation, prolonged defecation cycle, or cycle is not long, but the quality of dry feces, difficult to discharge; or fecal quality is not hard, although there is the intention of the stool, but not smooth evidence of the disease.
Constipation is a common clinical symptom, especially common in the elderly, women and children. In principle, as long as the bowel movement without pain, smooth, can not be called constipation.
Second, the etiology of constipation pathogenesis
Chinese medicine believes that it is mainly due to dietary disorders, emotional and mental disorders, external evil offending the stomach, endowment deficiencies, etc.. Heat knot, Qi stagnation, cold condensation and deficiency of Qi, blood and fluid, resulting in abnormal large intestine conduction function.
Western medicine believes that constipation can occur due to various reasons such as reduced intestinal transport function or obstruction of fecal output channels. Common causes are as follows.
1, dietary factors: due to eating too little, or food is too fine, the lack of food residues, in the large intestine into the quality and volume of feces is not enough to cause peristalsis of the colon, so that the feces in the intestinal tract for too long, excessive absorption of water, the formation of dry fecal mass, resulting in constipation.
2, mental factors: due to busy work, mental tension or unstable life, can not defecate regularly, so that over time the rectal pressure on the stool perception is reduced, the formation of habitual constipation. Long-term stool, or excessive force defecation, can cause damage to the pelvic floor muscles, which in turn causes damage to the pubic nerve, constipation. Mental diseases such as depression, psychosis, anorexia nervosa, etc., can cause constipation.
3, physical factors: physical weakness, such as old age and frailty, bedridden, menstruating women, etc., so that the muscles related to defecation (including the internal and external anal sphincter, anal raphe, intestinal wall smooth muscle, abdominal muscle, diaphragm, etc.) contraction force decreased, unable to defecate, resulting in the occurrence of constipation.
4, intestinal cavity narrowing: intestinal organism lesions, such as colorectal cancer, chronic proliferative intestinal inflammation, intestinal adhesions after surgery, etc., can make the intestinal cavity narrow, fecal passage difficulties, constipation. Rectal and anal canal outlet obstruction such as rectal and anal canal stenosis, anal fissure, hemorrhoids, rectal prolapse, rectal intussusception, rectal protrusion, pelvic floor spasm syndrome, isolated rectal ulcer syndrome, perineal descent syndrome, etc., can cause constipation.
5, central nervous system lesions: such as brain, spinal cord and other nervous system tumors, trauma and other disorders, can lead to the disappearance of bowel movements and constipation symptoms.
6, abnormal colon movement: local neuromuscular lesions of the large intestine, such as irritable bowel syndrome, congenital giant colorectal, intestinal diverticulosis, etc., so that the intestinal movement abnormalities, can cause constipation.
7, endocrine disorders: such as pituitary insufficiency, hypothyroidism, diabetes and other endocrine diseases can be complicated by constipation. Such as women’s pregnancy due to changes in luteinizing hormone, so that the power of the intestinal smooth muscle decline, can also appear constipation.
8, medical factors: constipation caused by more drugs, including, by and large, anesthetics, painkillers, antacids, anticholinergics, anticonvulsants, antidepressants, barium sulfate, bismuth, diuretics, drugs for Parkinson’s disease, ganglion blockers, blood supplements, hypotensive drugs, monoamine oxidase inhibitors, metal poisoning (arsenic, lead, mercury, phosphorus), muscle paralytics, opiates, drugs for the treatment of psychiatric disorders. laxatives after addiction, etc. The common surgeries that cause constipation are lumbosacral spine surgery, abdominal surgery, pelvic surgery, etc.
The causes of constipation are summarized in three categories: intestinal lesions, extra-intestinal lesions and poor living habits.
Third, the clinical manifestations of constipation and diagnosis
(A) the clinical manifestations and signs of constipation
1.Decrease in the number of natural stools.
2.Difficulty in the discharge of stool.
3, constipation accompanied by symptoms.
4, common complications of constipation long-term constipation, excessive absorption of water in the stool, the formation of fecal impaction, fecal calculi. Dry and hard stool mechanical damage to the mucosa of the large intestine to form isolated enteritis. Coarse, dry, hard stool tears the skin of the anal canal, which can lead to anal fissure and its corresponding complications such as external hemorrhoids, anal papillomegaly, anal saphenous fistulitis, and fistulas. Frequent constipation causes degeneration of the supporting tissues of the anal cushion and the formation of hemorrhoids. Long-term continuous use of anthraquinone-based laxatives due to constipation, the development of colonic melanosis, etc.
5.Signs: Observe for anal fissures, fistula openings, hemorrhoid prolapse, etc. Ask the patient to make a defecation movement, with perineal descent, the pelvic floor is seen to protrude significantly downward with the anus as the center; ask to contract the anus, the contraction ability is weakened or disappeared if the pelvic floor nerve is severely damaged.
Rectal palpation is one of the important diagnostic tools for this disease. Finger palpation should not be rough and should fully lubricate the fingers and the patient’s anus.
(B) Other auxiliary examinations
1.Anoscopy.
2.Colonic transmission test.
3.Fecal imaging.
4.Anal pressure measurement.
5.Balloon forcing out test.
6.Pelvic floor electromyography.
In addition, there are such as rectal sensory function and compliance measurement, small intestine transport test, colon transport radiography, sigmoid excitation test, colon electromyography, etc.
Fourth, the classification of constipation
1, slow transmission constipation: refers to the constipation caused by slow passage of intestinal contents due to gastrointestinal transmission dysfunction. Clinical constipation due to colonic transmission dysfunction is common. Mainly including spastic colon, colonic sluggish weakness, sigmoid colon redundancy, congenital megacolon, secondary megacolon, colonic irritable syndrome, etc.
2, export obstructive constipation: refers to constipation caused by abnormal function of the anal canal and rectum. It mainly includes endorectal prolapse, prolapse of rectum, pelvic floor hernia, puborectal muscle syndrome, perineal descent syndrome, isolated rectal ulcer syndrome, internal sphincter spasm syndrome, etc.
3, mixed constipation or both atypical constipation colon slow transmission and exit obstructive constipation.
Constipation is divided into three degrees.
(1) Mild: refers to the symptoms are mild, does not affect life, can improve with general treatment, no medication or a small amount of medication.
(2) Severe: refers to constipation symptoms persist, the patient is in unusual pain, seriously affects life, can not stop medication or treatment is ineffective. The so-called refractory constipation is often severe constipation, which can be seen in outlet obstructive constipation, colonic weakness and severe constipation type irritable bowel syndrome.
(3) moderate: is between the two.
V. Treatment of constipation
(A) general treatment
First of all, the original cause of constipation can be detected, the primary disease should be actively treated. For example, constipation caused by anal fissure, after performing anal dilation or sphincter release, constipation symptoms can disappear; hemorrhoids, anal canal stenosis, etc., can be the corresponding surgical treatment. If the primary disease cannot be detected temporarily or is difficult to control for a while, general treatment should be carried out, including correction of poor dietary habits and defecation habits and development of good living habits.
Dietary regulation is the basic method of treating constipation and should make the daily diet have enough residues to stimulate intestinal motility. Generally normal people need 90-100mg of fiber per kg of body weight to maintain normal defecation, so patients with constipation should appropriately increase fiber intake and eat more fiber-rich foods, such as celery, leeks, spinach, mixed grains, etc.. Should pay attention to breakfast, to promote early morning gastrointestinal motility. There are many foods with stimulating intestinal peristalsis and laxative effect, such as milk, cold boiled water, honey, black sesame, vegetable oil, etc.
Drink a sufficient amount of water to ensure that the intestines are well hydrated to facilitate the passage of intestinal contents. Exercise can increase abdominal muscle tone, increase gastrointestinal peristalsis and improve defecation power deficiency. Therefore, morning walk, jogging, deep breathing or qigong practice, dancing, etc., has a good role in promoting digestion and defecation. If you can adhere to the regular defecation after breakfast, after a period of time, you can develop a good habit of defecation after breakfast.
The causes of constipation, the condition is complex, clinical symptoms, signs and other light and heavy differences. Treatment should be based on the identification of evidence, the combination of overall and local; prevention and treatment.
(II) Internal treatment method
Chinese medicine treatment of constipation is not simply using the attack method, but emphasizes the overall identification. Constipation a certificate, the disease in the large intestine, and the whole body yin and yang qi and blood disorders of the internal organs are closely related, identification should be the first division of yin and yang table cold and heat deficiency, and then combined with the internal organs qi and blood, to determine the different focus, divided into types of evidence, group treatment. Based on clinical experience, the author summarizes that: actual constipation includes heat accumulation in the gastrointestinal tract, qi stagnation, and yin-cold stagnation; deficiency constipation includes qi deficiency, blood deficiency, yin deficiency, and yang deficiency.
Our hospital often uses our own mushroom combination for the treatment of functional constipation, and it is more effective. The first day, each time l0-20ml, 3 times a day, and from the next day, each time 5ml, 2-3 times a day, l0d for a course of treatment.
(C) enema bowel movement
Enema is also one of the effective measures for the treatment of constipation, at the discretion of warm saline, soapy water, liquid paraffin, corkage, intestinal hydrotherapy, large Cheng Qi Tang and other herbal decoction enema. Generally only used in acute constipation and fecal impaction.
(D) laxative drug therapy
Although there are many drugs for the treatment of constipation, but most of the chronic constipation and can not play a fundamental role in the treatment. Commonly used laxatives are broadly divided into two kinds of stimulant laxatives and mechanical laxatives.
1, stimulating laxatives: by stimulating the colonic mucosa, muscular plexus, smooth muscle, increase intestinal peristalsis and mucus secretion and produce the effect of drugs, known as stimulating laxatives, such as rhubarb, senna, phenolphthalein (fruit guide tablets), etc..
Stimulant laxatives can sometimes cause severe colic, and long-term application can lead to water and electrolyte disorders and acid-base balance imbalance, forming a “laxative colon”, should be noted.
2, mechanical laxatives: increase the volume of feces or change the composition of feces to increase the propulsive movement of the colon, known as mechanical laxatives. Mechanical laxatives can be divided into six categories, namely salt laxatives, swelling laxatives, softeners, lubricants, hypertonic laxatives and other laxatives.
(E) Other therapies
1.Suppository
2.Acupuncture therapy
(1) Moxibustion: Choose Zhigou, Tianshu, etc., and match with Yanglingquan, Qihai, and Feosanli, etc.
(2) Acupuncture Acupuncture ZhiGou, FengLong, YangLingQuan, foot SanLi, etc. According to the dialectic evidence, choose the appropriate points, such as heat constipation with large intestine Yu, Tianshu, Nei Ting, etc., using the laxative method; Qi constipation with Qihai, Taichong, Jijiao, etc., using the laxative method of strong stimulation.
(F) the application of biofeedback in the treatment of constipation
Biofeedback therapy is actually the use of sound or visual image feedback stimulation to mobilize the body’s functions, so that patients can control or stop a certain situation. For constipated patients, it is to enable them to correctly control the contraction and diastole of the anal sphincter to achieve normal defecation.
It is mainly used for functional outlet obstruction type of constipation such as pelvic floor spasm syndrome and internal sphincter dystonia. It solves the spasm of anal sphincter, corrects abnormal bowel movement coordination, and establishes normal bowel movement pattern.
Biofeedback therapy emphasizes mobilizing the regulatory function of the patient’s brain and good communication between doctor and patient. It is required to explain to patients in detail the normal anatomy and physiological functions of human colon, rectum, anal canal and pelvic floor muscles, and the normal mechanism of defecation before treatment; also explain the mechanism, purpose and use of the machine of the method, patiently explain to patients the significance of the graphics, and inform where the abnormalities are when resting, holding the breath and forceful defecation, encourage patients to build up confidence and repeat _ training until three consecutive normal defecations.
(vii) Surgical treatment
Sixth, the prevention of constipation and conditioning
Long-term constipation has certain harm to the human body, should be actively prevented, especially functional constipation, the formation of its causes and mental disorders, less food or partial food, lack of fiber or vitamins in food, neglect timely defecation, lazy activity and exercise, long-term laxative defecation and other bad habits. Therefore, constipation is important in the prevention, mainly by self-regulation, according to scientific and hygienic methods to correct bad habits. Specific methods are.
1, to develop a regular defecation habits: colon movement has a certain regularity, in the morning after waking up with the person from lying down to stand up, will occur upright reflex, the colon has a large group peristalsis, pushing feces down into the rectum, causing defecation reflex, so constipation should be intended to go to the toilet in the morning squatting about 5min, after a period of time can establish a normal defecation habits. This can also vary from person to person, to develop a daily defecation, but also at noon or night, which is not a one-size-fits-all;
2, to pay attention to breakfast: after breakfast can cause the stomach a colon reflex, conducive to fecal movement, constipation, such as the importance of breakfast, can take advantage of the situation, early in the morning after breakfast to defecate naturally easier;
3, reasonable arrangement of life and work: to go to bed early and get up early, get up early for a moment, a moment of activity, timely breakfast, can defecate with ease. Get up late, to rush to work, often unable to eat breakfast, relieve stool, disrupting the normal physiology, most likely to cause constipation. For the sedentary less active brain workers, to combine work and rest, appropriate to participate in sports and cultural activities, as the saying goes, “activity, activity, stool from pass”. Running, walking, for deep breathing exercises, turn around to move the waist, etc., can make the gastrointestinal activities to strengthen, appetite, abdominal muscles, diaphragm, thigh muscles to get exercise, so that the bowel movement smooth and fluent;
4, adjust the diet structure: eat more food containing fiber, vitamins. Fine white rice, white flour, refined meat, eggs, canned food, such as fiber and vitamins have been destroyed, looks food senior, tasty to eat, but not necessarily in line with science. Europe and the United States and other countries with a refined diet, the constipation of many people, the incidence of colorectal cancer is also very high. So the more mixed staple foods you eat, the better, fiber is stimulating to the intestinal wall, favorable defecation.
The elderly have bad teeth, you can “swallow the whole” type of vegetables, fruits, coarse has the benefit of coarse, these are not easy to chew the rotten cellulose, is the good medicine for laxative. Milk, cold water can laxative, there are advocates of the morning after waking up a glass of cold water is better than eating laxative, in addition, black sesame, honey, walnuts can also be laxative;
5, do not abuse laxatives: often serve can lead to habitual, dependence and even addiction to laxatives; long serving on the intestinal mucosa stress weakening, resulting in increasing the amount of laxatives; long serving laxatives can cause gastrointestinal dysfunction, but make constipation worse.