What is constipation?
Constipation has different meanings for different patients. International scholars have explored and developed the Rome III diagnostic criteria for functional constipation based on the results of evidence-based medical research, which are now widely used in clinical practice. Its diagnostic criteria are.
(1) Symptoms must include 2 or more of the following:
(1) Symptoms must include two or more of the following: (1) At least 25% of bowel movements are labored;
(2) At least 25% of the bowel movements must be dry bulbous stools or hard stools;
③ At least 25% of the bowel movements are incomplete;
④ At least 25% of the bowel movements had a feeling of anorectal obstruction or blockage;
⑤ At least 25% of the bowel movements required manual assistance (e.g., finger-assisted defecation, pelvic floor support);
⑥ Frequency of defecation. 3 times/week.
(2) Rarely have loose stools when not using laxatives.
(3) There is insufficient evidence to diagnose irritable bowel syndrome (IBS).
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.
Causes of constipation
There are many causes of constipation, the main ones being low fiber and water intake, reduced activity level and environmental changes. Constipation can also be exacerbated by factors such as travel, pregnancy, and dietary changes. In addition, some people also suffer from constipation due to frequent holding back of stool. It is important to note that constipation is also one of the clinical manifestations of serious diseases such as colorectal tumors. Therefore, if you have been experiencing constipation-related symptoms for a period of time, please consult a specialist promptly. In addition, spinal cord injury can also cause constipation. Constipation is often associated with diabetes, scleroderma, thyroid disease, multiple sclerosis, Parkinson’s disease and other diseases.
Can medications cause constipation?
Some medications can cause constipation, including painkillers, sedatives, psychotropic drugs such as antidepressants, blood pressure medications, diuretics, iron and calcium supplements, and aluminum-containing antacids can slow the movement of the colon and worsen constipation.
When do I need to see a doctor?
Any persistent change in bowel habits, change in stool frequency or change in stool characteristics requires prompt professional examination and evaluation. When constipation persists for more than three weeks, you should consult your doctor.
How to find the cause of constipation?
There are many causes of constipation and it is extremely important to identify the cause of constipation so that the treatment of constipation can be more targeted. Of course, the most important part of constipation screening is to exclude serious diseases such as colorectal tumors. In clinical practice, constipation-related examinations are mainly the following.
1, rectal finger examination
Rectal finger examination is one of the important tests for initial screening of constipation. Rectal finger examination helps to understand whether the patient has rectal tumor, inflammation, prolapse, stricture, fecal mass, hemorrhoids, anal fissure, anal sphincter spasm or relaxation, and determine whether there is exit obstructive constipation.
2.Barium X-ray examination
It mainly includes barium enema and whole digestive tract transmission test.
Barium enema is a method of carefully observing the lesions of the digestive tract through the digestive tract after inflation and photography after injection of barium that can be visualized under X-ray from the anus. To clarify the nature, location and extent of organic lesions of the colon, barium enema is appropriate. High-quality gas-barium double contrast imaging can detect even tiny cancerous lesions as small as 0.5 cm in diameter.
The whole gastrointestinal transmission test can be used to understand the time of barium passage through the gastrointestinal tract and the functional status of the small intestine and colon. Under normal condition, barium can reach the splenic flexure of the colon within 12 to 18 hours, and all of it should be expelled from the colon within 24 to 72 hours, and emptying is often delayed in case of constipation.
3.Colonoscopy
Colonoscopy can directly observe the situation inside the intestines of patients, such as whether the mucosa is congested and edematous, and whether there are ulcers or polyps in the intestines. It is necessary to do this examination when patients with constipation have abdominal pain, blood in stool, thin stool shape or also have weight loss. The biggest advantage of this test is that pathological biopsy and some basic treatment can be done.
4.Fecal imaging
Defecography is to instill barium into the rectum simulating feces, and dynamically observe the functional changes of the anus and rectum during the process of barium discharge (simulated defecation) under the radiation. The purpose of fecal imaging is to diagnose pelvic floor spasm, endorectal prolapse, prolapse of the rectum, intestinal hernia, redundant sigmoid colon and perineal descent.
5.Anal rectal manometry
Anorectal manometry involves placing a special manometric device inside the anus to detect the pressure in the rectum and anal canal to find out whether the muscles and organs related to defecation are functioning properly and whether the different organs are working in harmony with each other. At the same time, this test can also understand whether the function of some neural reflexes related to defecation is normal, such as the recto-anal inhibition reflex, which is the gold standard for checking whether there is congenital megacolon.
6.Anal electromyography
Anal electromyography is the application of electrophysiological techniques to detect the function of some muscles related to defecation in the pelvis, including the puborectalis muscle and external sphincter muscle. Anal electromyography is to place electrodes on the patient’s body to detect the electrophysiological activity of the muscles related to defecation, somewhat similar to our usual ECG, which is painless and can easily help us find the cause of constipation.
7.Balloon expulsion test
This is a simple and practical screening method for defecation function. The specific method is to insert a catheter with a balloon at the top into the rectal jug abdomen through the anus, and then fill the balloon with different volumes of warm water or gas and ask the patient to expel it. Patients with constipation can only expel larger balloons because of the reduced sensory sensitivity of the rectum, especially in the case of outlet obstruction constipation, and the patient’s rectum will only become irritated when the balloon is filled to more than 200 ml and the balloon is expelled from the body. This method is mainly used to evaluate the patient’s bowel power and rectal sensitivity.
Treatment of constipation
Most patients with constipation can improve their symptoms by increasing their intake of high-fiber foods (such as bran, cracked wheat, whole-grain bread, and certain fruits and vegetables) and by increasing their water intake. Lifestyle changes can also help in the treatment of constipation. In addition to relieving constipation symptoms, fiber supplements such as bran can help lower cholesterol levels, which in turn reduces the risk of colon polyps and cancer, and helps prevent hemorrhoids. Fiber supplements may take several weeks or possibly even months to be fully effective. If using other types of laxatives, enemas or suppositories it is recommended that a specialist be consulted.
Instructing patients to have regular bowel movements and thus develop good bowel habits is also an effective treatment. In some cases, biofeedback can help patients with exit obstruction constipation. If conservative treatment does not work, surgery is the main way to resolve constipation. However, you will need to discuss this with your specialist to determine the best treatment. The main surgical options available for the treatment of persistent constipation are anastomotic transanal partial rectal resection (STARR) and laparoscopic total colectomy.