Many people have constipation, from small children who are just learning to poop on their own, to wonderful young girls, to bedridden elderly people. The causes of constipation vary from age to age, especially between small children and adults, with some adults having constipation carried over from their early childhood. Except for some special causes, which have special treatments, such as colon tumors that require surgery, here we will only discuss functional constipation for which no special cause can be found. The process of functional constipation is mainly the slowing down of colonic transmission and the obstruction of stool elimination. Normal defecation requires a large contraction of the colon to squeeze the stool outward, while the anus relaxes cooperatively to open the door for the stool to pass. Although we have the sensation of exertion when we defecate, we also involuntarily hold our breath and contract our abdominal muscles to exert force, but this exertion normally only plays an auxiliary role, and it is also after the brain receives the signal that the colon has contracted significantly and the door has been opened. Without the internal impetus and the signal that the door is open, we usually do not feel the need to exert ourselves. The peristalsis of the colon is an initiating signal, and exertion makes this signal stronger, and the bowel movement can be completed quickly. This typical positive feedback has great importance. Many animals, including humans, have evolved controlled defecation behavior, unlike some lower animals that defecate as they go. This is because defecation is a process that is vulnerable to attack. Not to mention that I believe many students have the experience of going to the toilet in public restrooms by classmates. This is still a public toilet, if in the field, the road, the square, let alone, was caught in the police station are light, by people online human flesh may be a lifetime ruined. In order to avoid embarrassment, and ancient times were attacked and eaten, we are able to temporarily cut off this positive feedback, cut off the way is very simple, is to tighten the anus when the colon peristalsis. Wave after wave of initiation signals will be temporarily ignored. Although this approach is effective, and I believe that all people have tried it, but if you do this regularly for a long time, the stool accumulates for too long, the water inside is reabsorbed, it becomes dry and hard, the volume shrinks, and the peristalsis of the colon becomes slower and slower, and eventually there is no bowel movement for a week or ten days. Some people may not experience this frequent suppression of bowel movements, but low water intake, lack of fiber content in the diet, low activity, sedentary lifestyle, aging, and taking medications that inhibit bowel movements can also cause the same process. This is basically the typical formation process of slow-transmission constipation. In some cases, there is no slow process of formation like the one described above, but rather it occurs after a sudden major event, and most of these patients develop outlet obstruction type constipation. I once saw a middle-aged male patient with constipation, and an experienced superior professor checked on him, asked him about his situation, and said, “You were either caught having a mistress or having an extramarital affair.” The man looked shocked, but didn’t deny it. What he told me before was that he was a little stressed out recently because he was going through a divorce. We didn’t pursue the details, but the man’s case met many of the typical characteristics of exit-obstruction constipation, as it occurred after a major irritation. The reason, as I mentioned above, is that controlled bowel movements are an evolutionary self-protective behavior, the so-called “tightening of the jugular”. Adults mostly because of overstimulation, children are mostly because of a painful bowel movement. This impression is so strong that they shield themselves from the normal process of defecation, even if they have entered a private, safe and hygienic space, they will not open the door. In both the slow transmission and outlet obstruction types, treatment should begin with dietary and lifestyle adjustments. The first thing you need to do is to make sure you drink water, increase dietary fiber, exercise properly, and develop a regular bowel movement schedule for recuperation. The recommendation of eight glasses of water a day is already a cliché, but it requires deliberate reminders to really do it. Dietary fiber supplementation can be found in nutrition specialty books and websites, but in my experience and that of many physicians, it is not realistic to supplement fiber through diet. Many individual and family dietary habits are difficult to change. For some people who have been eating cafeteria food for a long time, there are not many options either. Using food to supplement dietary fiber is also very calculated in terms of daily intake (most foreign recommendations are around 30 grams per day for adults). Ultimately many people need certain specialized preparations, commonly used such as even psyllium preparations, gorgonian sage seeds, etc. Fiber improves constipation because it is not absorbed by the intestines, thus increasing the volume of stool and stimulating bowel movement, while also retaining water in the stool and softening it like vegetation on a hillside. Since fiber has a water retention effect, it is required to supplement dietary fiber with sufficient water, otherwise it will not improve constipation, but rather aggravate the feeling of bloating. Developing regular bowel habits can be helpful in treating constipation. What are regular bowel habits? It includes two parts: the time of defecation and the posture of defecation. The best time to have a bowel movement is early in the morning and after a meal. As mentioned earlier, defecation mainly relies on the power of colon peristalsis, even if you have Schwarzenegger’s abdominal muscles, have blown through the warm water bag of lung capacity, the colon does not move you are dry eyes, even if the force to the red face and neck, but also do not want to complete a bowel movement. And early in the morning and after meals is the most active time of colon peristalsis, make good use of the strong contraction of the colon peristalsis during this period, we do not even need special force. The posture of defecation, humans have two options: squatting and sitting. Squatting is older than sitting, and for constipation, the older way is more helpful. Even if many people do not have squatting conditions now, they can simulate squatting by putting their feet up so that their knees are above the level of their hips. The reason: In the squatting position, the rectum can become straighter while the abdominal pressure increases, which helps more with bowel movements. Laxatives should be used only after diet and lifestyle modifications have failed, or when temporary relief of symptoms appears to be the goal. Anything that allows easy elimination of stool can be called a laxative. Fiber preparations such as those described above are also laxatives in a sense, but they are not as pleasant as those traditionally thought of as laxatives, and they are difficult to relieve. In addition to fiber preparations, some mild-acting osmotic laxatives are preferred. Osmotic laxatives use small molecules that cannot be absorbed by the body, but can absorb water into the intestinal lumen through the intestinal wall. Because the mechanism of action is simple and does not affect the physiological function, it is safer and less likely to produce dependence, and discontinuation of the drug does not aggravate the original constipation. The cause of outlet obstruction constipation is special, and after conventional methods are ineffective, a biofeedback device can be considered for correction. The patient sits in front of a computer and, as if playing a computer game, controls a small animal on the screen over an obstacle, but instead of using a handle or touch screen, the control method is the anal sphincter. Finally, it is important to emphasize that constipation requires the necessary consultation, examination and inspection under the guidance of a medical professional to exclude constipation caused by structural changes before functional constipation can be considered. Ordinary people may not be able to distinguish whether they have a slow transmission type or an outlet obstruction type. There is a simple way to make a rough distinction, and that is the presence or absence of bowel movements. In the slow-transit type, because of the weak peristalsis of the colon, the stool is small, hard and not smooth, and lacks effective stimulation, so most people do not have the urge to pass stool, while in the obstructive type, there is a strong urge to pass stool, but it cannot be passed. Then you can choose the appropriate treatment according to your situation.