A. What does constipation mean
First of all, let’s talk about what constipation means.
Normally, people generally think that it is normal to have a bowel movement once a day. If the interval between bowel movements exceeds one day, it is considered constipation. Is this also true from the point of view of our doctors?
From a doctor’s professional point of view, the constipation we usually refer to is chronic functional constipation. Constipation is a functional disorder of the intestinal tract that is characterized by persistent difficulty in defecation, reduced frequency of bowel movements or a feeling of incomplete defecation. The definition of constipation includes.
(1) straining to defecate, dry and hard stools, having the urge to defecate but not being able to, reduced frequency of defecation or incomplete defecation.
(2) defecation less than 3 times per week, defecation volume less than 35 g/d, or defecation straining time greater than 25% of the defecation time.
To diagnose constipation must be
1. have symptomatic episodes in the last 3 months of the 6 months prior to coming to the clinic. Two or more of the following symptoms should be included.
(1) At least 25% of bowel movements with straining.
(2) At least 25% of the bowel movements are hard fecal masses.
(3) Incomplete evacuation in at least 25% of the bowel movements.
(4) anorectal obstruction in at least 25% of the bowel movements
(5) at least 25% of the bowel movements need manual assistance; (such as finger defecation, support the pelvic floor); (6) less than 3 bowel movements per week.
2.Soft stools without laxatives are rare.
3, does not meet the diagnostic criteria of irritable bowel syndrome (IBS).
Chronic constipation includes.
1, functional constipation (slow transmission type constipation)
Low colonic motility, prolonged colonic transit time (10.2%)
2.Functional defecation disorder
Uncoordinated contraction of pelvic floor muscles during defecation, insufficient relaxation of anal sphincter or insufficient propulsion during defecation (50.8%)
3.Mixed type (Mix)
Both of the above conditions exist (39.0%)
4.Constipated irritable bowel syndrome (IBS-C)
II. Causes of constipation
The main known causes of constipation include the following.
Inadequate intake of fiber, lack of water, sedentary and environmental changes, etc., may be aggravated by travel, pregnancy, or mental stress. Other causes, such as prolonged forced bowel movements and abuse of diet pills or laxatives, are also important causes of constipation.
Chronic constipation may also be secondary to organic diseases, such as colorectal tumors or strictures; systemic diseases including cremasteric injury, diabetes, scleroderma, hypothyroidism, multiple scleroderma, post-stroke or Parkinson’s disease, etc.
Third, how to prevent and treat constipation
Firstly, the goals of treating constipation are
1.To relieve symptoms
2, restore normal intestinal dynamics and defecation physiological function
The principles of treating constipation.
1, individualized overall treatment
2.Good spiritual and psychological state
3.Rational diet structure
4.Establishment of correct bowel habits
5, to have a clear cause of the etiology of treatment
6, long-term application of laxatives should be avoided in the treatment of laxative abuse
7.Surgery should be strictly controlled for the indications
When is it necessary to go to the hospital for treatment?
Change in bowel habits such as increase or decrease in the number of bowel movements, decrease in the volume of bowel movements, or increase in the degree of difficulty in defecation, etc., and these symptoms persist for more than 3 weeks, it is time to consult a doctor.
The preventive treatment measures for constipation are mainly the following.
1, diet and lifestyle adjustment: most patients with mild constipation can improve their bowel movements through dietary adjustment, regular life, regular eating and regular bowel movements; moderate exercise and strengthening physical fitness.
(1) Reasonable diet
Increase the intake of dietary fiber and water
Foods with high content of non-water-soluble dietary fiber such as unmilled cereals, sweet potatoes and beans, whole grain flour of barley and wheat, brown rice or corn flakes, oatmeal and other foods containing many cereal germ or wheat bran can provide more dietary fiber
Vegetables and fruits are rich in dietary fiber
Seaweeds such as wakame or lamb’s quarters contain a large amount of dietary fiber called alginic acid, which is different from the dietary fiber of cereals and vegetables.
Nuts, such as sesame, walnuts, almonds and peanuts, also contain a large amount of dietary fiber
Increase water intake.
The recommendation is to drink 6-8 cups (about 1500-2000 ml) of a liquid diet, including water, juices and various soups, daily.
WHO’s recommendation is a diet of three low and one high: low salt, low sugar, low fat and high dietary fiber.
(2) Regular life
Eat and defecate regularly every day and go to the toilet as soon as you feel the urge to do so.
(3) Increase exercise to promote bowel movement.
Such as doing gymnastics during leisure time at work; doing full-body exercise once or twice a week; taking frequent baths and massaging the lower abdomen in the bathtub, especially the left lower abdomen, the stimulation generated helps to cause bowel movement, etc.
2.Medication.
Volume type light laxative (bulking agent): Oxytetracycline, febipran
Osmotic laxatives: lactulose, polyethylene glycol, magnesium sulfate
Stimulant laxatives: phenolphthalein, anthraquinones, castor oil
Enterokinetic agents: tegaserod
3.Training defecation.
For children with chronic constipation and constipation patients with reduced rectal sensory function can be helped by saline enemas at regular intervals to help emptying, improve the texture of stool and rebuild regular bowel movements. Doctors will guide specific training methods according to each person’s sensory function measurement index.
4.Acupuncture treatment.
Through overall adjustment, from the central nervous system, sympathetic parasympathetic nervous system and intestinal nervous system three levels, to promote intestinal peristalsis, stimulate their own regulatory mechanisms, enhance physical fitness and improve symptoms.
5.Pelvic floor biofeedback.
A probe is placed into the rectum, and a specific training program under the guidance of a therapist helps to feel the coordinated movement and fine sensation of the pelvic floor muscles during correct defecation, which is the preferred method of treatment for patients with pelvic floor muscle movement incoordination and pelvic floor laxity syndrome, safe and painless.
When do I need to choose surgical treatment?
Most patients with functional chronic constipation can achieve better results with a combination of non-surgical methods. In some cases, when standard non-surgical treatment is not effective, the need for surgery can be determined only after a comprehensive assessment by the physician based on the results of fecal imaging, barium enema, colon transport test and other tests, combined with non-surgical treatment. To sum up, chronic constipation is a common and frequent disease. As long as we do regular life, reasonable diet, active treatment, reasonable exercise and other conditioning, we can effectively prevent and control.