Diagnosis and Treatment of Chronic Constipation in Elderly Healthy adults have 1~2 bowel movements per day or 1~2 bowel movements per day. Constipation refers to the number of bowel movements less than 3 times a week, and or defecation effort, defecation is not clean, the fecal matter is hard or hard ball. 60 years old and above the incidence of chronic constipation is higher than 15-20%, women are more than 4 times as much as men, and the mental factor is one of the risk factors. A common cause 1, secondary constipation endocrine and metabolic diseases: is one of the main reasons, including diabetes, hypercalcemia, hypokalemia, hypothyroidism, hypopituitarism. Neurological disorders: such as spinal injuries, cauda equina tumors, multiple sclerosis, Parkinson’s disease, cerebrovascular accidents, and brain tumors. Enteric neurologic disorders such as congenital megacolon. Organic diseases of the intestinal tract: such as intestinal tumors, inflammatory bowel disease, local ischemia, intestinal torsion, anal fissure, embolic internal hemorrhoids, and mucosal prolapse. Smooth muscle lesions: such as smooth muscle myopathy, tonic muscular dystrophy, etc. Medical constipation: such as opioids, calcium channel blockers, anticholinergics, antacids containing calcium or aluminum, antihistamines and non-steroidal anti-inflammatory drugs can cause constipation. Abdominal surgery can also cause or aggravate constipation. 2. Functional constipation (FC) Patients are categorized into three types according to the pathophysiological mechanism of FC: slow-transmission type (STC); outlet-obstruction type (OOC); and mixed type (MIX). Second, the pathogenesis 1. STC: the main mechanism is delayed colonic emptying, reduced colon dynamics; sigmoid colon compliance is reduced; rectal responsiveness is reduced, or even retarded; excessive absorption of water in the intestines, fecal dryness, aggravated defecation difficulties; colonic interosseous plexus cholinergic nerves significantly reduced and vasoactive peptide, substance P-ergic neuron dysfunction is related. 2. OOC: including transverse muscle dysfunction, rectal smooth muscle dyskinesia, impairment of rectal sensory function, dysfunction of internal anal sphincter, and temporary anatomical obstruction caused by mucous membrane, rectal prolapse or intussusception. Third, the examination method should be routinely done complete blood count, fecal routine and occult blood test, blood glucose determination, blood biochemical examination and thyroid function determination. If alarm symptoms such as weight loss, anemia, blood in stool, abdominal mass and family history of colon cancer are present, colonoscopy should be routinely done to rule out malignancy. Intestinal motility function examination helps in the typing of chronic constipation, specifically including the following items. 1.Colon transmission test: the examiner takes 20 grains of impermeable X-ray markers, and takes 1 flat abdominal film after 48 hours, and another flat abdominal film after 72 hours if necessary, in order to observe the discharge of markers from the intestines. 2, defecography: make differential diagnosis of functional and organic lesions in the rectum and anus, especially for the diagnosis of intractable constipation caused by functional elimination blockage, which is obviously better than barium enema and endoscopy. 3, Anorectal manometry: It is valuable for evaluating certain physiological reflexes, sensory functions, storage and retention functions and the functional status of internal and external sphincter. 4, Anorectal electromyography: it can provide valuable and objective data for the diagnosis and treatment of various pelvic floor function abnormalities. 5.Air sac expulsion test Reflects the ability of anorectum to expel air sacs, which is helpful for the diagnosis of colonic incompetence. Fourth, the diagnostic process and key points The diagnostic process of chronic constipation includes: the establishment of the diagnosis of chronic constipation; the exclusion of organic causes of chronic constipation; the functional factors of chronic constipation; the pathophysiological changes in the small intestine, colon and rectum. Diagnostic points: the diagnosis of chronic constipation should include etiology and triggers, type and degree. Functional constipation is defined as the presence of two or more of the following symptoms for at least 12 months when the patient is not taking a laxative: straining to pass stools more than 25% of the time; hard or globular stools more than 25% of the time; incomplete bowel movements more than 25% of the time; and bowel movements less than three times per week. Exit-obstructive constipation is defined as a feeling of obstruction to evacuation greater than 25% of the time, and prolonged bowel movement or manual assistance (if necessary). The severity of constipation can be divided into light, medium and severe: light refers to the symptoms are mild, does not affect life, the general treatment of improvement, no need to use drugs or less use of drugs; medium between the two; severe refers to the constipation symptoms continue, the patient is unusually painful, seriously affecting the life, can not stop the drug or treatment is ineffective. V. Treatment The purpose of constipation treatment is not only laxative, should also include the restoration of normal gastrointestinal transit and emptying, regulating the texture of feces to relieve constipation-induced discomfort, the establishment of normal defecation patterns and defecation behavior, as well as the removal of the cause of the disease and so on. (I) Non-pharmacological treatment 1. Educate patients to develop good defecation habits, i.e., to develop the habit of defecation in the morning and evening or to try to defecate about 30 minutes after meals. 2. 2. If conditions permit, some patients taking constipation-causing drugs should stop using them or replace them with other drugs. 3, Exercise: 30 minutes of walking after meals every day is beneficial, for patients with limited mobility, can also be replaced by in situ activities, such as strengthening the abdominal and pelvic floor muscles can increase the power of defecation. 4, fiber diet: high fiber content of food bran, fruits, vegetables, etc. can retain water, so that the stool becomes soft, fecal matter increased, but supplementation of fiber at the same time if you do not increase the amount of drinking water, can aggravate the symptoms of constipation. (B) Drug treatment Older people should avoid long-term use of laxatives, its potential adverse effects, including malabsorption dehydration, electrolyte disorders and fecal incontinence, so for the elderly, the correct use of laxatives is very necessary. 1, laxatives (1) puffing laxatives: mainly wheat bran, ochelle, etc., generally 12 to 24 hours onset of action. This kind of medicine can increase the volume of feces, retain water, mildly stimulate the intestinal mucosa, produce in line with the physiological defecation, generally does not lead to water, electrolyte disorders, especially for the elderly. (2) hypertonic laxatives: mainly including non-absorbable disaccharide preparations (such as lactulose), salt laxatives and polydiethanol 4000 (Fosamax). Non-absorbable disaccharide preparations such as lactulose have the least adverse effects and should therefore be the laxative of choice. After entering the colon in their original form, disaccharide preparations are broken down into small molecular weight organic acids, the latter of which absorb the water that penetrates the intestinal lumen and also lower the pH of the feces. Lactulose is usually given in a dose of 10 ml twice/day. Salt laxatives most commonly used is magnesium sulfate, magnesium salt can absorb the water penetrated into the small intestine and colon, and cause intestinal wall contraction, promote the release of cholecystokinin, the latter accelerates the movement of the small intestine and colon, but magnesium can cause dehydration, electrolyte disorders, and prolonged use can increase the risk of hypermagnesemia. (3) lubricating laxatives: paraffin oil is commonly used in China, which can soften the stool, accidental inhalation can cause lipid pneumonia, long-term oral mineral oil can cause fat-soluble vitamin malabsorption, it is reported that mineral oil may also cause exudative fecal incontinence. (4) stimulating laxatives: anthraquinones (such as rhubarb, senna, etc.), polyphenols, castor oil, deoxycholic acid, etc. are now commonly used stimulating laxatives. Their mechanism of action includes increasing water in the intestines and promoting intestinal peristalsis. Excessive use of stimulant laxatives can lead to fat and potassium malabsorption, the pathologic mechanism of which is unclear and may be related to long-term use of stimulant laxatives. Colonic melanosis is a common consequence of long-term application of these laxatives. Long-term use or abuse should be avoided as much as possible. (5) Enemas and suppositories: soapy water and phosphate enemas can damage the intestinal mucosa and are best not used. Glycerin suppositories and corkscrew can enhance gastrointestinal reflexes and stimulate the rectum to promote defecation. (6) pro-dynamic drugs: such as 5-H T4 agonists (such as mosapride) and some agonists (such as tegaserod, the trade name of Zemak), mainly through the stimulation of intestinal interosseous plexus release of ethylphosphatidylcholine to promote intestinal motility increase, on the colon through the slow-type and discharge-blocking constipation have a certain degree of efficacy, especially in the former is preferable. (7) Chinese patent medicines: such as six flavors of an elimination capsule and Ma Ren soft capsule. (2) Intestinal microecological agents, such as Rejuveno, Mia BM tablets, gold bifidum, etc., can supplement a large number of live bifidobacteria in the intestinal tract, correct the intestinal flora disorders, and improve the intestinal microecological environment, which is an auxiliary medication for constipation. 3. Anti-anxiety and depression drugs: such as Gelatin and Dalisin. (C) Biofeedback therapy By regulating the intensity, mode and coordination of physiological activities, some abnormal physiological indexes can be normalized so that normal physiological activities can be restored. The short-term efficacy of this therapy for pelvic floor spasm syndrome is certain. (D) Surgical treatment For patients with long-term severe constipation, partial colectomy can be considered when intestinal obstruction and diffuse intestinal peristaltic function abnormality are excluded, when it is clear that constipation is not related to anxiety, depression and other psychiatric abnormalities, when there is clear evidence of colonic atony and when there is sufficient tension in the anal canal. However, the long-term outcome after surgical treatment is poor, and the choice of surgical indications should be strict. In conclusion, constipation is a common and frequent disease in the elderly, combined with clinical manifestations and colorectal dynamics examination, to clarify the type of constipation, to take targeted treatment for an effective and economical method.