Functional constipation
Constipation often manifests as: less bowel movements and less frequent bowel movements; difficult and laborious bowel movements; poor bowel movements; dry and hard stools and a sense of unclean bowel movements; constipation accompanied by abdominal pain or abdominal discomfort. Some patients are also accompanied by insomnia, irritability, dreaminess, depression, anxiety and other psychiatric disorders. Constipation from the etiology can be divided into two categories: organic and functional. Functional constipation accounts for about 50%. With the change of people’s diet structure and the influence of psychological and social factors, the incidence of constipation has a tendency to increase.
The prevalence of constipation in the population is as high as 27%, but only a small percentage of constipated people will seek medical attention. Constipation can affect people of all ages. It is more common in women than in men, and in older than in younger and older adults. Because of the high prevalence and complex causes of constipation, patients often suffer a lot of distress, and constipation can affect the quality of life when it is severe.
Disease risk
As constipation is a more common symptom, symptoms vary in severity, most people often do not pay special attention to constipation is not a disease, do not need treatment, but in fact, constipation is very harmful.
1, constipation in some diseases such as colon cancer, hepatic encephalopathy, breast disease, the occurrence of premature dementia, there are many research reports.
2, constipation in acute myocardial infarction, cerebrovascular accident patients can lead to life accidents, there are many tragic cases to alert us.
3, some constipation and anorectal diseases, such as hemorrhoids, anal fissures, etc. have a close relationship.
Therefore, early prevention and reasonable treatment of constipation will greatly reduce the serious consequences of constipation, improve the quality of life, and reduce the burden on society and families.
Causes
In Chinese medicine, this disease still belongs to the category of “constipation”, and its causes are mostly due to heat, Qi stagnation, cold condensation and deficiency of Qi, blood and fluid, resulting in abnormal large intestine conduction function.
The cause of functional constipation in Western medicine is still unclear, and its occurrence is related to a variety of factors, including.
(1) low food intake or lack of fiber or water in the food, which reduces the stimulation of colonic motility.
(2) Interference with normal bowel habits due to work stress, fast-paced life, changes in the nature and timing of work, mental factors, etc.
(3) Due to colonic motility disorder, commonly caused by irritable bowel syndrome, caused by spasm of colon and sigmoid colon, with abdominal pain or bloating in addition to constipation, and some patients may show alternating constipation and diarrhea.
(4) Insufficient tone of the abdominal and pelvic muscles, insufficient pushing force for defecation, and difficulty in expelling feces from the body.
(5) Abuse of laxatives, forming drug dependence, resulting in constipation.
(6) Weakness in old age, too little activity, intestinal spasm leading to defecation difficulties, or due to long colon.
Constipation is divided into two main categories according to the pathogenesis: slow transmission type constipation and outlet obstruction type constipation.
Slow-transit constipation is caused by a weakened contractile movement of the intestine, which slows the movement of feces from the cecum to the rectum, or by an uncoordinated movement of the left hemicocele. It is most common in young women and occurs around puberty and is characterized by a decrease in the frequency of bowel movements (less than 1 bowel movement per week), less bowel movements, hard stools, and thus difficulty in defecation; no stools or hard stools are palpated during anorectal examination, while the contraction and forceful defecation of the external anal sphincter function normally;
Prolonged total gastrointestinal or colonic transit time; lack of evidence of outlet obstruction type, such as normal balloon expulsion test and anorectal manometry. Non-surgical treatment methods such as increased dietary fiber intake with osmotic laxatives are ineffective. Constipation in combination with diabetes mellitus, scleroderma, and drug-induced constipation is mostly of the slow-transmission type.
Exit-obstruction constipation is due to muscle incoordination in the abdomen, anorectum, and pelvic floor, resulting in fecal impaction. It is particularly common in elderly patients, many of whom have failed to respond to conventional medical treatment.
The outlet obstruction type may have the following manifestations: straining to defecate, a feeling of incompleteness or falling, low defecation volume, a desire to defecate or lack of desire to defecate; anorectal examination shows a lot of mud-like stool in the rectum, and the external anal sphincter may be paradoxically contracted during forceful defecation; total gastrointestinal or colonic transit time shows normal, and most markers may be retained in the rectum; anorectal manometry shows that the external anal sphincter is paradoxically contracted during forceful defecation. contraction or abnormal sensory threshold of the rectal wall, etc. Many patients with outlet obstruction constipation also have a combination of slow transmission constipation.
Treatment
Dietary modifications.
Increase dietary intake of fiber and water. Solubilizing fiber laxatives such as agar (15-30 ml per session, methylcellulose 1.5-5 g/d, psyllium bark, psyllium powder, and psyllium granules can increase stool volume and water content from a variety of plants, and wheat bran and bran are captured by mucin in the stool, along with adequate amounts of water in the diet. It is worth suggesting that only increasing the intake of fluid in the diet without increasing the intake of fiber is ineffective in correcting constipation, and more interestingly that fiber and a small amount of water combined can treat diarrhea.
Other bulking diarrheal agents use hydrophilic substances such as: polycarbophil and carrageenan (sycamore) gum powder. The main disadvantage of bulking agents: bloating and gas production due to metabolites of cellulose and lignin. High fiber diet: dried plums, raspberries, apples, dates, spinach, white potatoes, corn, cauliflower, radishes, bok choy, lentils, wheat bran, barley, kidney beans, pea faggots, oat rolls, whole wheat bean flour, etc.
Physical therapy: get up early, twist the waist, active abdominal muscles, do deep breathing or qigong, do exercises, practice boxing, walking, jogging, etc. can promote digestion and defecation. Some people believe that getting up with a glass of cool boiled water or intentionally letting the abdomen get cool can stimulate the stomach and colon reflex and promote defecation. We use anal lifting exercise by relaxing the anus when squatting and contracting the anus when standing, 30 times each morning and evening every day.
Psychotherapy.
The purpose is to help patients understand the physiology of defecation, relieve anxiety, change bad living and defecation habits, and squat regularly every morning to cultivate and establish normal defecation habits.
I. Classification and treatment
(A) Qi deficiency and weakness
Symptoms: lack of bowel movement, often 7 or even 10 days without the desire to relieve the stool, and the stool is not necessarily dry, with the toilet defecation weakness, shortness of breath, fatigue, no facial color, light and tender tongue, white moss, weak pulse.
Treatment: Tonifying Qi and moistening the bowels.
Remedy: Astragalus soup with flavor: roasted astragalus 20 g white peony 10 g cinnamon heart 3 g maidong 10 g wu wei zi 5 g licorice 5 g angelica 10 g fore-hu 6 g poria 10 g jujube 4 pieces ginger 3 slices fire marijuana 10 g Chen Pi 6 g.
Addition and reduction: If Qi deficiency is obvious, add 10 grams of Radix Codonopsis, 10 grams of Rhizoma Atractylodis Macrocephalae to replenish the Qi of the lung and spleen; if abdominal distension is uncomfortable, add 6 grams of Mu Xiang and 10 grams of Citrus Aurantium to move Qi and eliminate distension.
(II) Blood deficiency and loss of moistening
Symptoms: dry stools with difficult discharge, pale white face, palpitations, dizziness, pale lips, pale tongue with white fur and thin pulse.
Treatment: Nourishing blood and moistening dryness.
Remedy: Hemp Ren Zhi Spleen Pill Plus: Hemp Ren 10g, Hovenia 10g, White Peony 12g, Angelica 12g, Ripe Rhubarb 10g, Yu Li Ren 8g, Almond 10g, Hou Pu 10g, Guan Yang 10g, Mai Dong 10g.
Addition and subtraction: If the abdominal distension is uncomfortable, add 10 grams of Lycopodium to move Qi and guide stagnation; if the stool is dry and difficult to pass, use Wu Ren Wan to moisten the bowels and open the bowels.
(C) Qi stagnation
Symptoms: stools do not work for several days, dry stools, or not dry but difficult to pass, abdominal distension and stuffiness, after defecation or belching is slow, often take laxatives to help defecation. Thin tongue coating and stringy pulse.
Treatment: Move Qi to induce stagnation.
Remedies: Liu Mo Tang with flavor: 3 grams of incense (later), 10 grams of wood incense, 10 grams of betel nut, 12 grams of ocimum sanctum, 10 grams of heliotrope, 10 grams of rhubarb, 15 grams of coix seed, 10 grams of coke hawthorn.
Addition and reduction: If dry stool is seen, add 10 grams of fire hemp seed and 10 grams of almond to laxative; if dry heat and dry mouth are seen, add 15 grams of raw groundnut, 10 grams of maidenhair and 6 grams of scutellaria to clear heat and generate fluid.
(D) Gastrointestinal dryness and heat
Symptoms: 3 to 4 days or even 7 to 10 days stool once, the feces is dry and difficult to solve, accompanied by short red urine, body heat, dry mouth, thirst for cold, abdominal distension, abdominal pain, red tongue with yellow coating, smooth pulse.
Treatment: Clearing away heat and fire, moistening the bowels and opening the stool.
Remedy: Hemp Ren Pill with flavor: Hemp Ren 10g, White Peony 12g, Citrus aurantium 10g, Raw Rhubarb 6g (later), Hou Pu 6g, Almond 12g, Fried Cassia Seed 10g, Mai Dong 10g, Raw Di Huang 10g.
(E) Yin and fluid deficiency
Symptoms: stool for several days, hard and astringent, accompanied by physical wasting, or see cheek redness, waist and ear tinnitus, red tongue with little coating, thin pulse.
Treatment: Nourishing Yin, moistening the bowels and clearing the stool.
Remedy: Liu Wei Di Huang Wan plus flavor: Shu Di Huang 15 g Cornus 10 g Yam 10 g Mudan Pi 10 g Poria 10 g Ze Di 10 g Zhi Mu 10 g Phellodendron 8 g Tao Ren 10 g Mu Xiang 10 g.
Addition and subtraction: If there is also abdominal distension, dry mouth, yellow coating and other Yin deficiency heat, can be accompanied by raw rhubarb 6 grams (after the next), mannitropin 10 grams (punch), in order to rush down to store Yin; if there is also fatigue, shortness of breath and other Qi deficiency, can add ginseng 10 grams, astragalus 10 grams, to benefit Qi and generate fluid.
(F) Yang deficiency and loss of temperature
Symptoms: Failure to pass stool for several days, effort in relieving, dry or non-dry stool, accompanied by clear and long urine, lack of warmth in the hands and feet, and cold pain in the abdomen. Pale tongue, white fur, sunken and sluggish pulse.
Treatment: Warming Yang and clearing the bowels.
Prescription: Ji Chuan Decoction with flavor: Radix Angelicae Sinensis 10g, Radix Achyranthes Bidentatae 8g, Rhizoma Cistanches 10g, Radix Zeligae 8g, Radix Achyranthes Bidentatae 5g, Citrus Aurantium 8g, Radix Argyi 10g, Atractylodes Macrocephala 15g.
Addition and subtraction: If there are signs of qi deficiency such as fatigue and lack of qi, add 15 grams of Huang Qi; if there is constipation in the elderly, use Half Sulfur Pill to benefit the true yang and relax the large intestine.
Acupuncture therapy
This disease coexists with deficiency and reality, so we should identify the deficiency and reality of cold and heat, and select acupuncture points to treat the evidence. The actual is diarrhea, the deficiency is tonic, the cold is moxibustion.
(A) Body acupuncture
Commonly used acupuncture points: Large Intestine Yu, Qi Hai, Guan Yuan, Cheng Shan, eight s points, etc.
(ii) Ear points Take ear points of the spleen, lung, large intestine, stomach, and lower rectum. Use a detector or match head to detect sensitive points, rub with the hand for 3 to 5 minutes, and then press the Wang Bu Liuxing seeds after obtaining gas, change once every 3 to 5 days, 15 times for a course of treatment.
(C) acupuncture point buried line Take the large intestine Yu, Tianshu, Qihai, kidney Yu and other points, medical sheep intestine line vertically implanted in the above points, every 15 to 30 days repeated buried line once.
Umbilical cord therapy
Take the Chinese medicine formula and pound it, then apply it to the umbilicus.
Biofeedback therapy
It can be used for constipation patients with rectal and pelvic floor muscle dysfunction, and its long-term efficacy is better. Biofeedback therapy is the use of special equipment, the collection of its own physiological activity information to process, amplify, with familiar visual or auditory signal display, so that the cerebral cortex and these organs to establish feedback links, through continuous positive and negative attempts, learn to control physiological activities at will, the deviation from the normal range of physiological activities to correct, so that the patient to achieve the “change self “The purpose of biofeedback therapy is to train the patient to perform a variety of functions in elimination.
Biofeedback therapy can train patients to relax the pelvic floor muscles during defecation, so that the activities of the abdominal muscles and pelvic floor muscle groups are coordinated 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 is no specific specification for the training program, and the training is more intense but safe and effective.
V. Surgical therapy.
For severe intractable constipation, all the above treatments are ineffective. If the constipation is colonic transmission dysfunction type and the condition is severe, surgical treatment can be considered.
Disease prevention
1, avoid eating too little or too fine food, lack of residues, and reduced stimulation of colon movement.
2, to avoid disturbance of defecation habits: due to mental factors, changes in lifestyle, long-distance travel overworked and other failure to timely defecation, easy to 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 250ml 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 sleep and meal, which pushes feces to the distal end of the colon, so morning and after meal 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.