Functional constipation is a very common condition, with about 30% of the population experiencing constipation or being chronically constipated. Functional constipation is a symptom that often manifests itself as difficulty in passing stools or the lack of a desire to pass stools, or a decrease in the frequency of bowel movements. When people suffer from constipation, they often take laxatives to help with bowel movements, which over time creates a dependence on laxatives. What tests should be performed for constipation? What are the different types of constipation? What are the causes? What should we do after getting constipation? What kind of tests should be done for constipation? Does everyone need colonoscopy and other tests? Generally speaking, most doctors will give some general basic treatments to the first-time patients, such as drinking more water, exercising more, eating more crude fiber food, and sometimes prescribe some laxative medicines and bulking laxatives, such as lactulose and polyethylene glycol to help defecation, and will not immediately recommend various tests. Only for some people with certain “alarm factors” such as dark red bloody stools, alternating diarrhea and constipation, short-term constipation and abdominal distension, and people over 40 years of age are recommended to undergo colonoscopy to exclude organic lesions in the colorectum; only for constipation of a longer period of time, and the effect of medication is unsatisfactory, will it be recommended to undergo anorectal manometry, fecal contrast and colonic transport test to examine the colon. Anorectal manometry, fecal imaging and colonic transport test are recommended only for those who have been constipated for a long time with poor results after taking medications, in order to determine the type of constipation and choose the appropriate treatment plan. The significance of anorectal manometry is to assess the muscle activity and pressure in the anus, the significance of fecography is to simulate the muscle activity during defecation, and the colon transport test is to assess the movement of feces in the colon to understand the movement of the colon. What are the different types of functional constipation? How is it treated? According to the above three tests, functional constipation can be categorized into slow-transmission constipation, outlet obstruction constipation and mixed constipation. Slow transmission constipation refers to the colon transmission function is reduced, the patient often manifests as no bowel movement, abdominal distension, defecation is often once every 3-5 days, the stool is dry, but can be defecated when there is a desire to defecate, the colon transmission test suggests that the colon transmission is slowed down but there is no obvious abnormality in the anorectal manometry and fecal imaging; the exit obstruction constipation is often manifested as frequent desire to defecate but the amount of defecation is small, the feeling of incomplete defecation or defecation is difficult to defecate, fecal imaging is often manifested as Feces is not easy to discharge, abnormal muscle contraction, anorectal manometry is often manifested as abnormal muscle surgery, sensory loss; most patients have both colon slow transmission and exit obstruction, which is called mixed type constipation, and the treatment is more complicated. 1, colon slow transmission constipation: is a common type, the reason is often not clear, some people have to take weight loss drugs, dietary habits change, change of life habits and other triggers, and some people may be taking some drugs lead to the disease. Patients often show a decrease in the number of bowel movements, 1-2 bowel movements a week, low stool volume or no bowel movement, and the examination often shows a slow transmission of the colon, but anorectal manometry and fecal imaging are normal. Treatment is preferred basic such as drinking more water, more exercise, more food with crude fiber, and develop the habit of regular defecation, if it can not be improved, you can take some swelling laxatives such as polyethylene glycol, lactulose or wheat cellulose, traditional Chinese medicine laxative medicines such as Ma Ren Pills, Cistanches Bowel Movement Oral Liquid, etc. have some efficacy, but pay attention to the long-term use of certain side effects may be, and avoid the use of stimulating laxatives such as senna, rhubarb and other anthraquinone-containing drugs, lubricating laxatives have a certain efficacy for those with dry stools, osmotic laxatives are generally not recommended for routine use, only a short period of time or bowel use before colonoscopy. Slow transmission constipation treatment is a long-term process, will not use the drug soon after the complete improvement, it is recommended to exchange the use of different drugs to reduce the side effects of drugs. Slow transmission constipation long-term treatment is ineffective, can be considered for total colectomy, the operation is traumatic, 70% of the efficacy is better, but some patients in the development process and will appear in the exit obstruction constipation, resulting in decreased efficacy, so before the operation should be fully evaluated. 2, outlet obstructive constipation: outlet obstructive constipation is a complex etiology, unique pathophysiology of defecation disorders, in the clinic is very common, the patient often shows frequent bowel movements, defecation effort or defecation powerlessness, defecation incomplete sensation, anus feeling of blockage, and other symptoms, and even patients because of the frequent bowel movements, to the intestinal outpatient clinic to look at the diarrhea; prolonged defecation, bowel movements, resulting in rectal feces embedded in a long period of time, and the feces are dry. The patient manifests anal incontinence, which is called “heat knot bypass” in Chinese medicine. This situation is mostly seen in older patients, and some of the patients come to the clinic with anal incontinence, often with a huge fecal mass palpable in the rectum, and edema and redness in the anus. According to the different pathophysiology, we divided the outlet obstruction constipation into pelvic floor relaxation syndrome constipation and pelvic floor failure retardation constipation (some people call it pelvic floor spasticity syndrome), which belongs to pelvic floor dysfunction disease. (1) Pelvic floor relaxation syndrome: it is the most common pelvic floor dysfunction (PFD), mostly seen in middle-aged and old-aged women, especially those who have a history of labor and delivery and pelvic surgery. The main reason is that the pelvic muscles are overly stretched and damaged during pregnancy and delivery, and there are often no symptoms when you are young, and as you grow older, the strength of the muscles gradually decreases, resulting in relaxation and weakness of the entire pelvic floor’s support structure. Looseness and weakness, manifested by pelvic floor hernia, uterovaginal prolapse, stress urinary incontinence, anterior rectal protrusion (gynecologically known as posterior vaginal dilatation), defecation disorders, rectal mucosal laxity leading to anal swelling, and a feeling of incomplete bowel movement. Pelvic floor relaxation is a common symptom, often patients according to the patient to constipation, anal swelling as the main symptom of the patient in the anorectal, uterine, vaginal prolapse in the gynecology, while the stress urinary incontinence as the main symptom of the patient in the urology, in the treatment of the different specialists tend to pay attention to their own specialties and ignore the treatment of other symptoms, resulting in poor patient satisfaction with the treatment, the current multidisciplinary Currently, multidisciplinary diagnosis and treatment has become the basic mode of pelvic floor disease diagnosis and treatment, in the hope that more problems can be solved by one operation. Pelvic floor relaxation syndrome patients should be treated with the above basic treatment firstly, for those with anal swelling, some hemorrhoidal suppositories can be used to alleviate the symptoms, and secondly, biofeedback therapy can be used to train the pelvic floor muscles, and the effective rate of the biofeedback therapy is about 70%, but the long-term efficacy is to be observed; in recent years, foreign countries have adopted perineal support toilet to help patients with pelvic floor relaxation to have defecation, which has obvious effects and no obvious side-effects. In recent years, foreign countries use perineal support toilet to help patients with pelvic floor relaxation to defecate, and the efficacy is obvious, and there is no obvious side effects; For those with poor efficacy, surgery can be used; for rectal proptosis, rectal proptosis repair surgery, short-term efficacy is obvious, but the long-term efficacy is not good, and it is reported that rectal proptosis and constipation recurring again after 3 years reaches more than 80%; Recently, there are some trans-perineal sling surgeries, which have a certain degree of effectiveness, but the long-term efficacy needs to be followed up; use of sling or patch to repair and repair the pelvic floor is not suitable. Pelvic floor repair and elevation surgery using slings or patches is an advancement in recent years. The method is to suspend the mid-pelvis, i.e., the uterus and vagina, on the sacral promontory, which simultaneously solves the problems of the anterior pelvis, i.e., incontinence of the bladder and urethra, and rectal laxity and prolapse, and the rectovaginal diaphragm can be strengthened by placing the patch from the posterior side of the vagina, which solves the problem of anterior proptosis of the rectum. Rectal mucosal punctal column ligation surgery can also help with the symptoms of anal cramping. Therefore, solving pelvic floor problems must be addressed with a holistic view, and solving one aspect of the problem alone cannot achieve satisfactory results. The near-term efficacy of this surgery is good, and the long-term efficacy is under observation. (2) Pelvic floor failure retardation syndrome: the disease is common in men or young women, often show defecation effort, anorectal manometry suggests that the muscle strength of the anus is still normal, but there are abnormal surgery, septography suggests that the puborectal muscle can be “shelf evidence”, the treatment of the basic treatment, the use of some of the necessary Keseluk and other drugs, biofeedback therapy is more effective. Biofeedback therapy efficacy is better, long-term efficacy is also better; for serious symptoms, the past progress of the puborectal muscle part of the incision surgery, but the long-term efficacy is not ideal, and there is a risk of incontinence, must be used with caution. 3, mixed constipation: is the most common type of constipation, so in the choice of treatment options to take into account both slow transmission and exit obstruction, especially when the surgical treatment, more need to be dealt with, in because of the slow transmission of constipation for surgery, resection of the intestinal tract, and at the same time, pelvic floor repair, the efficacy of the treatment may be better. 4, irritable bowel syndrome constipation type: mostly in young women, often diarrhea and constipation at the same time, in the above examination often have no abnormal findings, for such patients to regulate the intestinal function is the main, especially pay attention to dietary factors, for the condition of the patient can be food intolerance check. Third, constipation patients in the end how to consult the doctor? If there is constipation, not necessarily immediately to the hospital, you can first drink more water, eat some bananas, sesame oil, honey water and other foods, regular defecation, to see if it can be relieved, the use of lifestyle changes and dietary modification is the most fundamental means of treating constipation; if you can’t patients, especially after the relief of the aggravation of the person, to the hospital, if there is no “alarm signals If there is no “alarm signal”, usually use some expansion laxatives and lubricating laxatives, if can relieve, can maintain for a period of time, if can not be relieved, it may be recommended to carry out anorectal manometry, fecal imaging and colon transmission test, according to the results of the three tests, to determine the treatment plan, in general, first conservative, and then surgical treatment, surgical treatment as the last step in the treatment, and surgical efficacy is not very sure. Surgery is the last step in the treatment, and the efficacy of surgery is not very certain.