Shandong Medical Association, director of the branch of the anorectal disease, Ding Ke told reporters: in fact, constipation is a folk saying, it is not very different from constipation. Most people think constipation can be improved by simply strengthening exercise and increasing the intake of fiber and water. But if it does not work, or is chronic constipation, you must do anal and rectal examination and abdominal X-ray to exclude organic disease. Long-term use of laxatives is not a desirable method, because the abuse of laxatives can easily trigger intestinal dilatation and impair intestinal function. Some businesses advertise that people should take long-term bowel cleansing products to keep the intestinal tract clean is not scientific, to correctly understand the constipation, constipation, first of all, we must understand its definition and classification. The so-called constipation, does not mean dry stool, but the state of the bowel movement is not smooth or defecation accompanied by special symptoms. It is a functional disease characterized by dry stool, low stool volume, less than 3 bowel movements per week, and difficulty in defecation, which can be accompanied by a feeling of falling and rectal distension. There are two types of constipation: organic constipation and functional constipation. Organic constipation is constipation that occurs when there is an organic lesion in the abdominal cavity, large intestine, or anus that obstructs or affects the normal passage and discharge of stool. Such as benign and malignant tumors of the large intestine and anus, chronic inflammation caused by the narrowing of the intestinal cavity to become small, giant colon disease caused by rectal spasm narrowing, post-surgical complications of intestinal adhesions, partial intestinal obstruction, etc.; or huge tumors in the abdominal cavity, such as ovarian cysts, uterine fibroids, as well as pregnancy, ascites and other compression of the large intestine, so that the passage of feces is difficult, can appear constipation. This type of constipation is caused by organic lesions, so the cause needs to be removed through surgery, etc., in order to cure constipation. Functional constipation, also known as habitual constipation, refers to primary persistent constipation, which is clinically considered as a separate disease. In recent years, many data show that the definition of so-called functional constipation is not accurate, such as constipated patients often have degeneration of the colonic wall muscle fibers and intermuscular plexus, exit obstruction type constipation more rectal mucosal prolapse, perineal descent syndrome, rectal protrusion, pelvic floor relaxation syndrome or pelvic floor spasm syndrome and other organic lesions. With the conclusion of clinical experience and improvement of examination methods, each of these diseases may become a separate pathology. The occurrence of functional constipation may be related to psychological factors, congenital anomalies, inflammatory stimuli, laxative abuse and long-term conscious inhibition of defecation, or abnormalities in the function of the nerves innervating the internal and external anal sphincters. Its clinical typing, according to the abnormal dynamics can be divided into: slow transmission type: lack of bowel movement or hard feces, delayed passage time of the whole gastrointestinal or colonic or decreased colonic dynamics. Exit obstruction type: incomplete bowel movement, straining to defecate or low bowel movement, often accompanied by anorectal drop sensation. There is often anal sphincter dysfunction and pelvic floor muscle dysfunction. Mixed: slow transmission type and outlet obstruction type are present at the same time. To determine which type of constipation is present, a comprehensive examination should be performed, and the auxiliary examinations required are: routine blood, stool and fecal occult blood tests: routine examinations for patients with constipation, which can provide clues to colorectal and anal organisms’ lesions; rectal finger examination: to determine whether there are lesions such as fecal impaction, anal stenosis, rectal prolapse, rectal masses, and to understand the muscle strength of the anal sphincter; endoscopy Endoscopy: It can observe the condition of colon and rectal mucosa and exclude organic lesions. Some patients can see diffuse dark brown spots in the colonic mucosa, called colonic black change sign, for intestinal mucosal lipofuscin deposits, mostly related to long-term use of laxatives. The accumulation of feces for a long time can cause spasm of the rectal mucosa; imaging: abdominal X-ray can show dilatation of the intestinal cavity, fecal retention and air-fluid planes. Barium meal of the digestive tract can show the movement of barium in the gastrointestinal tract to understand its motor function status. CT or MRI is mainly used for patients with or without intestinal masses or strictures; functional examination: suitable for patients with a preliminary diagnosis of functional constipation by the above tests. Functional tests include: colonic transit time (CTT), which is one of the main methods for the diagnosis of constipation; defecography (BD), which can make a definitive diagnosis of functional and organic lesions in the recto-anal region, especially chronic constipation due to functional outlet obstruction; anorectal manometry [ARM], which measures the function of the internal and external anal sphincter by perfusion or balloon method. It is also used as a monitoring tool for biofeedback therapy; pelvic floor electromyography can show the electrical activity of pelvic floor muscles, which can be used to diagnose pelvic floor muscle dysfunction such as pelvic floor spasm syndrome, and can detect abnormal discharge of puborectal muscles and external sphincter muscles during simulated defecation; balloon force-out test can be performed by placing a balloon in the rectal jug abdomen of the subject, injecting 50m1 of 37 0C warm water, and instructing the subject to take the habitual defecation position and put the balloon into the rectal jug abdomen as soon as possible. The balloon is discharged as soon as possible in the habitual defecation posture, normally within 5 min, which helps to determine whether there are abnormalities in the function of rectum and pelvic floor muscles. The type of constipation is finally determined and the correct treatment method is selected. The principle of treatment should be based on the regulation of diet and bowel habits, supplemented by medication, avoiding the abuse of laxatives and paying attention to the individualization of medication. Adaptation of dietary habits Encourage patients to drink more water, vegetable juice, fruit juice or honey juice in the morning, eat fiber-rich foods such as wheat gum, fruits, vegetables, corn, etc., and increase the activity level appropriately. Fiberform is wheat cellulose, and because the fiber itself is not absorbed, it can make the stool swell and stimulate the colon movement. Adaptation of defecation habits Developing the habit of regular defecation can prevent the accumulation of feces. Encourage patients to defecate after breakfast, and if they still cannot defecate, they can defecate again after dinner, so that they can gradually resume their normal defecation habits. The training of bowel habits can be combined with medication to cleanse the intestines. The purpose of medication is to soften stool, promote intestinal dynamics and stimulate defecation. Clinically, appropriate laxatives can be selected according to the degree, type and nature of constipation, with emphasis on rational and individualized medication, and the selection of drugs should be based on the principle of reducing toxicity, side effects and drug dependence. Volumetric laxatives: wheat bran, konjac can play the role of dietary fiber to increase the intake of liquid. Lubricating laxatives: paraffin oil can soften the stool, taken orally or by enema. However, attention should be paid to aspiration pneumonia, so it should not be taken at bedtime. Because it affects the absorption of fat-soluble vitamins, it is more appropriate to be taken between meals. Hypertonic laxatives: such as PEG and non-absorbable sugar lactulose, polyethylene glycol 4000, sorbitol mixed dielectric solution. Lactulose and sorbitol are degraded by colonic bacteria into low molecular acids, which increase the permeability and acidity of the stool. In order to reduce the rectal irritation and the side effects caused, the dose should be properly adjusted so that it can achieve the purpose of laxative. Salt laxatives: contain non-absorbed cations and anions, due to the role of osmotic pressure, so that the lumen retains enough water, where magnesium ions can stimulate the release of CCK, promote intestinal peristalsis, because some magnesium ions can be absorbed, in patients with renal insufficiency constipation, it is appropriate to take with caution. Stimulating laxatives: such as castor oil, senna, phenolphthalein (fruit guide), rhubarb (rhubarb soda tablets), Bisacodyl (stool stop) stimulate intestinal peristalsis, reduce absorption and promote intestinal dynamics. They have certain side effects and are not suitable for long-term use. Most of these drugs are metabolized in the liver. Long-term use can cause colonic melanosis and counter aggravate constipation. At present, some health products on the market claim to cleanse the intestines, which will quietly put some western medicine, some of them will even do the medicine in the capsule shell in order to avoid detection. Many patients do not know the ingredients and use their products, although the role of laxative, but the consequences are endless, so it is recommended that we do not take such health products for a long time. Once constipation occurs or to seek medical attention in a timely manner, so as not to delay the disease. Cisapride should be used to avoid patients with severe cardiac, renal and respiratory insufficiency, and to avoid combining with drugs that can prolong the QT interval or tricyclic antidepressants, macrolide antibiotics, antifungal drugs, etc. Microecological agents: Patients with constipation often have disorders and overgrowth of intestinal flora, and can apply Rejuveno, Pefikon and other drugs appropriately. Psychotherapy: Patients with constipation are often accompanied by depression and anxiety, which can aggravate constipation and thus need to receive psychotherapy. Although antidepressants have adverse reactions that cause constipation, some people with heavy constipation spend their days worrying about how to defecate, and those with abnormal mental tension can be given a combination of anti-anxiety or antidepressant drugs after treatment is ineffective. Biofeedback therapy: for patients with constipation with rectal sphincter and pelvic floor muscle dysfunction, biofeedback therapy can be used. This method is a kind of training to control the function of the body with intention, including balloon biofeedback method and myoelectric biofeedback method. The trained patients can improve the clinical symptoms of constipation, and also change the abnormal anorectal power parameters. Surgical treatment It is mainly suitable for patients who have failed medical treatment, and various examinations show clear pathological anatomy and conclusive functional abnormal sites, surgical treatment can be considered, such as secondary megacolon, partial colonic redundancy, colonic weakness, anterior rectal distention disease, endorectal overlap, rectal intra-mucosal prolapse, pelvic floor spasm syndrome, etc. The causes of constipation can be summarized as follows: poor dietary habits, making the food contains insufficient mechanical or chemical stimulation (such as fiber in vegetables) or too little intake, especially the lack of food that leaves a lot of residue. Insufficient stimulation of the intestine and weakened reflex peristalsis cause constipation; after the total peristalsis of the colon, the fecal mass enters the rectum, thus causing the defecation reflex. However, the sensitivity of the rectal reflex can be weakened when the intention to defecate is often ignored, when the occasion of defecation and defecation posture are inappropriate, and when strong laxatives or bowel cleansing are often taken. The result is constipation; mental depression or excessive excitement, so that the conditioned reflex is impaired, the higher center to strengthen the parasympathetic inhibition, so that the distribution of the thoracolumbar sympathetic nerve in the intestinal wall to strengthen the role of constipation; bad habits, lack of sleep, continuous high mental tension, etc., can also cause Poor living habits, lack of sleep, continuous high mental stress, etc., can also cause peristaltic malfunction or spastic contraction of the colon, thus causing constipation. Pay attention to dietary regulation, because feces is mainly composed of food digestion, so through dietary regulation to prevent constipation is a simple and easy method. First of all, we should pay attention to the amount of diet, only enough to stimulate intestinal peristalsis, so that the normal passage of feces and excretion of the body. In particular, breakfast should be full. Secondly, we should pay attention to the quality of the diet, the main food should not be too fine, pay attention to eat some coarse grains and grains, because coarse grains, grains after digestion residue, can increase the amount of stimulation of the intestinal tube, conducive to the operation of the stool. Side dishes should pay attention to eat more vegetables containing more fiber, because normal people need 90-100 mg of fiber per kilogram of body weight to maintain normal bowel movements. You can eat more bok choy, leek, celery, tomatoes, etc. Because the fibre is not easily digested and absorbed, the amount of residue can increase the volume in the intestinal canal, improve the pressure in the intestinal canal, increase intestinal peristalsis, which is conducive to defecation. There is also to drink more water, especially heavy laborers, because of sweating, breathing, water consumption, water in the intestinal tube is bound to be absorbed in large quantities, so to prevent dry stool will have to drink more water. A glass of water before breakfast or after waking up has a mild laxative effect. Drink enough water to make the intestine get enough water can facilitate the passage of intestinal contents. In addition, you can intentionally eat more food containing fat, such as walnuts, peanuts, sesame, rapeseed oil, peanut oil, etc., they have a good laxative effect; develop good bowel habits, everyone has a variety of habits, stool is no exception, to a certain time to defecate, if often delayed stool time, destroy the good bowel habits, can make the bowel reflex weakened, causing constipation, so do not artificially control Do not artificially control the sense of defecation. For those who are often prone to constipation, we must pay attention to arranging the bowel movement at a reasonable time, going to the toilet whenever the time comes, to develop a good defecation habit; actively exercise the body, activities, activities, stool since the passage. Walking, running, deep breathing exercises, qigong, taijiquan, turn the waist and lift the legs, participate in cultural and sports activities and physical labor can strengthen the gastrointestinal activities, appetite, diaphragm, abdominal muscles, anal muscles to exercise; improve the power of defecation, prevent constipation. Regular work of the rural elderly rarely constipation, and lazy activities, the city of the elderly constipated more, which explains this reason. In ancient times, the art of channeling was used to prevent constipation. Miscellaneous disease source flow rhinoceros turbid” said “to protect the secret of life said, with the tongue on the palate, guard the hanging congestion, quiet thoughts and liquid from the mouth, once full, red dragon stirring, frequent gargling and swallowing, listen to descend straight down the Dantian, and guard the quiet throat several times, the large intestine from the wet, line after the efficacy.” For the elderly and frail people is really appropriate; timely treatment of relevant diseases, the treatment of relevant diseases to prevent constipation also has a certain role. Such as allergic colitis, colonic diverticulitis, colon tumors, colon stenosis; hypothyroidism, diabetes; uterine fibroids; lead, mercury and other metal poisoning. Shandong Provincial Medical Association, director of the branch of anorectal disease, director Ding also stressed that constipation should be given enough attention, but do not be too nervous, some people are only an occasional constipation, so as long as the diet, exercise to adjust it, do not rush to take drugs. But frequent constipation must go to a regular professional hospital to check, to find out the cause, and to choose the treatment method according to the person and the cause of the disease. This also requires our health care professionals to improve their professionalism and give patients the right treatment. Also, middle-aged people should pay particular attention to the prevention of constipation, there are many elderly patients with severe constipation is not pay attention to the protection of the intestinal tract when they were young, for the occasional constipation did not pay attention to, and the result. Protecting your intestinal tract is not only beneficial to your work and life now, but also for decades to come.