1.Can functional constipation be prevented?
Functional constipation can be effectively prevented, mainly in the following areas.
(1) prevention of dietary management: light and easy to digest diet, increase dietary fiber intake such as fruits and vegetables, avoid spicy stimulation, tobacco, alcohol, strong tea, chili peppers and other stimulating foods.
(2) Prevention of environmental adaptation: adequate cognitive and psychological preparation of the environment and improvement of the ability to adapt to the environment.
(3) Prevention of sleep quality adjustment: develop a good biological clock, ensure adequate sleep, and drug intervention if necessary.
(4) Prevention of spiritual and psychological adjustment; good at relieving psychological burden and anxiety.
(5) prevention of drug application: develop the habit of regular bowel movement and active bowel movement, and apply laxatives such as polyethylene glycol bulking agent or lactulose prophylactically.
2.What is functional constipation?
Functional constipation is one of the common functional gastrointestinal diseases, which refers to functional gastrointestinal diseases with symptoms originating from the middle and lower gastrointestinal tract, manifested by persistent difficulty in defecation, reduced frequency of defecation or a sense of incomplete defecation, while not meeting the diagnostic criteria of irritable bowel syndrome and meeting certain time conditions. Chronic constipation can cause colonic diverticulosis, perianal disease, colonic black stool disease and laxative colonization, and is one of the common causes of cardiovascular diseases (myocardial infarction, cerebrovascular accident). Patients with severe constipation may also have psychological disorders such as insomnia, irritability, depression, irritability, obsessive-compulsive ideas and behaviors. Therefore, it is very important to improve the knowledge and treatment level of functional constipation of gastroenterologists.
3.What are the symptoms and manifestations of functional constipation or physical discomfort?
Patients with functional constipation mainly manifest as straining to defecate, wanting to defecate but unable to do so, having dry and bulbous stools or hard stools, feeling of incomplete defecation, feeling of obstruction or anorectal drop, reduced number of bowel movements <3 times/week, defecation volume <35g/day, or straining to defecate more than 25% of the time.
4.What factors can cause functional constipation?
At present, it is believed that functional constipation is mainly related to the following factors
(1) Diet and lifestyle: Roma et al. found that the fiber content in food is an independent factor affecting the prevalence of constipation. Low residue and low fiber can significantly reduce the amount of stool, and the pentose in dietary fiber has strong water absorption, resulting in increased stool volume, increased volume, effective stimulation of the intestine, increased and faster relaxation of the internal sphincter, and shorter stool residence time. Conversely, the lack of fiber in the food, the feces through the intestinal tract time significantly longer, the formation of constipation. Long-term fine food, may also lead to vitamin B1 deficiency, can lead to intestinal muscle weakness caused by constipation. An increase of 30g/day of plant fiber in food can significantly increase intestinal motility, which is called the fiber-like effect. In addition, frequent alcohol consumption and laxatives can weaken intestinal sensitivity and cause or aggravate constipation.
(2) Abnormal defecation kinetics: the literature reports that functional constipation is associated with abnormal colorectal dynamics, and colorectal dysmotility has been confirmed in a proportion of patients. Uncoordinated colonic peristalsis can lead to ineffective colonic contraction, which can also cause delayed colonic emptying. The prolonged transit time of feces in the colon may increase the absorption of water by the mucosa, leading to symptoms such as hardening of feces, straining to defecate and a sense of incomplete defecation.
(3) Pelvic floor muscle dysfunction: Some patients with constipation have abnormal rectal function, which is manifested by the inability to coordinate the activities of the external anal sphincter and pelvic floor muscles during defecation. This includes transverse muscle dysfunction, rectal smooth muscle dysfunction, rectal sensory impairment, and internal anal sphincter dysfunction.
(4) Spiritual and psychological factors: busy work, mental tension and unstable life and other factors lead to the inability to defecate regularly, which reduces the sensitivity of the rectum to fecal pressure over time, resulting in functional constipation. In addition, mental depression, excessive excitement or negative life events cause the body to become conditioned reflex disorder, the senior center to enhance parasympathetic inhibition, resulting in the distribution of sympathetic nerve in the intestinal wall increased, resulting in constipation.
(5) Abnormalities in hormones, neurotransmitters and other regulatory factors: With the advancement of research on gastrointestinal motility disorders, some studies have found that abnormal gastrointestinal dynamics in patients with functional constipation are associated with abnormal levels of specific gastrointestinal hormones. Hormones, neurotransmitters, messenger receptors, and other regulatory factors work together with the nervous system to complete the regulation of gastrointestinal motility. Gastrointestinal hormones are all peptides composed of amino acid residues whose main role is to regulate gastrointestinal motility and digestive juice secretion. These peptide hormones can also be found in brain tissue and are also known as brain-gut peptides. When these substances are secreted abnormally, it will cause intestinal motility disorder.
5.How to diagnose functional constipation? How can I determine if I have functional constipation?
The diagnosis of functional constipation depends on medical history. Detailed history taking and physical examination can provide important information for further diagnosis of chronic constipation. During the consultation, we should pay attention to the characteristics of the patient’s constipation symptoms (frequency of defecation, stool properties, degree of difficulty in defecation, bowel movements), concomitant symptoms, underlying diseases, as well as the patient’s dietary structure, lifestyle habits and medication use. Anorectal finger examination is easy and convenient, and it can understand the local structure (hemorrhoids, anal fissure, rectal prolapse, swelling, etc.), fecal impaction, whether the finger stains blood or not, and abnormal descent of the perineum during forceful defecation, and obtain first-hand information about the function of the anal sphincter and puborectal muscle. Stool routine and fecal occult blood should be used as routine examination, and special attention should be paid to whether the patient has alarm signs, such as blood in stool, positive fecal occult blood, anemia, wasting, abdominal mass, obvious abdominal pain, history of colorectal polyps and family history of colorectal tumor. For those who are 40 years old and have alarm symptoms, necessary laboratory, imaging and colonoscopy should be performed to clarify whether constipation is caused by organic lesions.
6, functional constipation needs to be differentiated from the following diseases.
(1) Constipation-type irritable bowel syndrome: patients only have clinical manifestations such as reduced number of bowel movements, hard stools that are not easily excreted and straining to defecate, while patients with constipation-type irritable bowel syndrome have symptoms such as abdominal pain and abdominal discomfort associated with defecation in addition to the clinical manifestations of functional constipation.
(2) Organic intestinal lesions: patients with colorectal cancer, inflammatory bowel disease, intestinal stricture and other organic intestinal lesions can exhibit different degrees of constipation, and there is corresponding clinical evidence of relevant examinations.
(3) Systemic pathologies: abnormal thyroid and parathyroid function, diabetes mellitus, scleroderma, uremia, etc.
(4) Neurological disorders: Parkinson’s disease, sacral nerve tumors, autonomic disorders, megacolon, etc.
(5) Drugs: opioids, anticholinergics, antitussives, antidepressants, antihypertensives, diuretics, etc. Some drugs can cause constipation after taking, and the symptoms can be relieved after stopping the drug.
7.What tests can help to confirm the diagnosis of functional constipation?
Colonoscopy, colon gas-barium contrast imaging can exclude intestinal tumors and intestinal inflammatory reactions and other diseases, and should be used as a routine examination for people aged >40 years and people with alarm symptoms. Intestinal dynamics and anorectal function tests should be performed to understand intestinal function and structural abnormalities. Colonic emptying test can help determine the type of constipation, i.e. slow transmission type, outlet obstructive type, or mixed type?
8.How to treat functional constipation?
The aim of treatment is to relieve symptoms and restore normal bowel reflex, following the principles of individualized and comprehensive treatment.
(1) General treatment helps patients fully understand the disease and relieve the psychological burden. Increase dietary fiber, drink more water and increase activity as appropriate, develop regular bowel habits and avoid laxative abuse.
(2) Dietary fiber supplementation: dietary fiber itself is not absorbed and can adsorb water in the intestinal cavity to increase stool volume and stimulate colonic dynamics, which is the preferred treatment for functional constipation. Dietary fiber-rich foods include bran or brown rice, vegetables, pectin-rich fruits such as mangoes and bananas (note that unripe fruits contain Q-acids, which can aggravate constipation), and it should be noted that large amounts of dietary fiber can cause abdominal distention and are prohibited in cases of suspected intestinal obstruction.
(3) laxative drug application: pay attention to drug safety and dependence. For patients with long-term constipation, it is appropriate to use mild action, less side effects, suitable for long-term use of laxatives such as volume forming drugs such as oxytocin or methylcellulose, osmotic laxatives polyethylene glycol 4000, non-absorbable sugars such as lactulose or sorbitol. These drugs mainly increase the volume of stool by water adsorption or osmotic effect to increase the water in the intestinal cavity, and the appropriate dose has little effect on electrolyte balance. On the basis of the application of these drugs, patients are encouraged to establish regular bowel habits, and it is possible to gradually stop using laxatives after one to several months. Stimulant laxatives such as phenolphthalein, anthraquinone derivative rhubarb or senna have multiple effects of inhibiting water absorption and increasing water secretion in the intestinal cavity and promoting intestinal dynamics. These drugs have strong laxative effects and are suitable for short-term, intermittent use. Long-term abuse, will lead to drug dependence and the dosage of the larger, but increase the persistence of constipation, and long-term application can cause colonic melanosis and increase the risk of colorectal cancer.
(4) prokinetic drugs: act on intestinal nerve endings, release motor neurotransmitters or direct action on smooth muscle to increase intestinal motility, but the use of drugs should pay attention to drug safety, certain drugs acting on 5-hydroxytryptamine is subject to drugs with potential cardiovascular disease risk.
(5) biofeedback therapy: may be effective for some people with constipation with rectoanal and pelvic floor muscle dysfunction, through treatment to enable patients to re-establish the defecation reflex.
(6) Surgery: strictly grasp the indications for surgery. For patients with severe intractable constipation for which the above treatment is ineffective and who are confirmed to have slow passage constipation with normal anorectal and pelvic floor function and normal small bowel dynamics, subtotal colectomy can be considered. Surgical treatment has a certain recurrence rate, and relevant medication is given after surgery.
9.What are the precautions in the drug treatment and prevention of functional constipation?
The effectiveness, safety and dependence of drugs should be noted in drug treatment, and long-term abuse of stimulant laxatives should be avoided. Because it will lead to drug dependence and the dosage is increasing, but increase the stubbornness of constipation, and long-term application can cause colonic melanosis and increase the risk of colorectal cancer; for fecal impaction can be taken to clean enema or rectal administration with light liquid paraffin oil.
10.What should be the dietary management in the prevention and treatment of functional constipation?
Patients with functional constipation should pay attention to increasing the intake of dietary fiber. Dietary fiber can change the nature of stool and bowel habit, and the fiber itself is not absorbed, which can make the stool swell and stimulate the colon dynamics. This is more effective for patients with constipation who have low dietary fiber intake. Patients with intestinal obstruction or megacolon and neurological constipation cannot use increased dietary fiber to achieve the purpose of laxation, and should reduce intestinal contents and regular defecation. It is advisable to use vegetables and fruits rich in crude fiber and foods rich in B vitamins, such as coarse grains and beans. Sesame seeds, honey, radish, banana, silver fungus, peanuts, corn, spinach, water spinach, celery, wheat bran, buckwheat, sunflower seeds, vegetable oil, figs, water chestnuts and other foods and Chinese herbal treatments such as cassia seeds, raw radix, angelica, etc. can be used. Avoid smoking, alcohol, spicy and stimulating foods, strong tea, coffee, garlic, chili pepper and other foods.