Diagnosis and treatment of chronic constipation

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Chronic constipation is one of the most common gastrointestinal symptoms. According to reports, the United States each year 2 million to 3 m


Chronic constipation is one of the most common gastrointestinal symptoms. According to reports, the United States each year 2 million to 3 million people who need to take medicine to help constipation, the incidence rate of about 2%, of which about 900 people died of constipation related diseases. Long term constipation can not only promote the occurrence of hemorrhoids and abdominal hernia formation, increase the patient's cardiovascular and cerebrovascular diseases, but also significantly increased the chances of suffering from Parkinson's disease. Long term constipation of harmful substances and then absorbed into the blood, can cause rough skin without light, the formation of acne, pigmentation, low libido and so on. Individual patients as a serious psychological and mental disorders, constipation can not be visible even hardly wished to live..

Definition of chronic constipation:

Refers to the patients in the past 1 years at least 3 months of the following symptoms in 2 or more of the constipation: (1) the process of defecation force is needed; (2) with mass or dry hard stool traits; (3) the process of defecation defecation is not the feeling of the net; (4). Have the anorectal obstruction feeling; (5) the need for manual assisted defecation; (6) the number of weekly defecation less than 3 times; (7) infrequent stools, diagnosis of irritable bowel syndrome conditions are not sufficient. If excessive exertion, bowel discomfort, defecation difficulties or fecal particles, even if the frequency of defecation is normal, can also be referred to as constipation".

Two, the etiology of chronic constipation:

Chronic constipation causes complex, including functional and organic etiology. Organic cause by gastrointestinal diseases, systemic diseases involving the digestive tract such as diabetes mellitus, scleroderma, nervous system diseases caused by, including: (1) intestinal pathological changes such as intestinal tumor, inflammation and other reasons caused by stenosis or obstruction; (2) anorectal lesions: rectum prolapse and hemorrhoids, rectal prolapse, puborectalis muscle hypertrophy, shame, pelvic floor disease direct separation; (3) endocrine or metabolic disease: Diabetic enteropathy, thyroid, parathyroid disease; (4) central nervous system diseases: such as brain disorders, stroke, multiple sclerosis, spinal cord injury as well as peripheral neuropathy; (5) the intestinal smooth muscle or neuronal lesions; (6) colon neuromuscular disease: intestinal pseudo obstruction, congenital megacolon, megarectum; (7) neuropsychological Disorder; (8) drug factors: Aluminum antacids, iron, opioids, antidepressants, anti Parkinson's disease drugs, calcium channel blockers, diuretics and antihistamines.

The function of the main cause of due to bad habits, social and psychological factors, including food intake (1) is too small, fine, high calorie foods, fruits and vegetables and less, drinking less, lack of stimulation of the intestinal tract; (2) lack of exercise, sedentary, bed, the lack of intestinal motility; (3) caused by bad bowel habits, as some pupils for short break time can cause constipation. (4) the work stress, sedentary, lack of exercise; (5) interpersonal tensions, family discord, the mood is long-term in a depressed state, can cause the plant nerve disorder, caused by inhibition of intestinal peristalsis or hyperthyroidism; (6) the law of life change, such as travel, hospitalization, emergency effects can lead to defecation changes in the law.

Three, chronic constipation patients with colonoscopy

If constipation patients with rectal bleeding, positive fecal occult blood, iron deficiency anemia, weight loss, intestinal obstruction symptoms, recent constipation, rectal prolapse or stool thickness change, should do a colonoscopy. Chronic constipation may be a risk factor for colon cancer. Therefore, for over 50 years of age have complained of constipation, and did not undergo screening for colon cancer patients should undergo colonoscopy for young patients can be sigmoidoscopy instead.

Four, the prevention of chronic constipation:

Chronic constipation hazards, early prevention will greatly reduce the serious consequences of constipation and social burden. The main measures include: (1) do not ignore the meaning, once there is a sense of defecation should be timely, can not tolerate stool. (2) the life and the bowel movement must have the rule, establishes the bowel movement condition reflex, forms the regular defecation habit. (3) such as travel, poor health conditions can cause constipation, can bring some fruit, laxative pills. (4) avoid sedentary, take part in physical exercise, in order to enhance the vitality of colon, promote intestinal peristalsis. (5) anorexia or eating too little, especially with too little fiber foods can cause constipation, it should be appropriate to eat fresh vegetable, edible wheat bran or whole wheat flour. However, patients with organic intestinal obstruction do not apply. (6) drinking water. Fiber need to absorb moisture in the intestinal cavity can play a laxative effect, daily drinking water 3000 ~ 5000 ml. (7) quit the habit of long-term use of laxatives. Long term use of laxatives can aggravate constipation. In addition, certain drugs, such as opium, calcium salts, aluminum salts and psychiatric drugs can cause constipation, should pay attention to. (8) organic lesions should be diagnosed and treated in time, such as colorectal cancer, megacolon, etc.. Systemic diseases, such as lead poisoning, hypothyroidism, electrolyte disorders, depression can cause constipation, should be treated for the primary disease. (9) to maintain a regular life, adequate sleep and cheerful mood, to prevent constipation is of great significance.

Five, the treatment of chronic constipation

1: general treatment for patients with functional constipation, food therapy is the first choice, which increase the fiber in the diet food, such as bran, fruits and vegetables; exercise is very helpful for normal defecation; correct tension of life, slow down the pace of work and can correct long-term bad habits will help to improve the symptoms of constipation.

2 drug treatment: Although application of the above method, but many constipation need to use laxatives to help defecation. For constipation even with laxatives are no adverse consequences, but the long-term use of laxatives, there may cause dependence. Generally divided into stimulant laxatives (such as rhubarb, senna, phenolphthalein, castor oil), cathartic salt (such as Magnesium Sulfate), osmotic laxatives (such as Gan Luchun), the expansion of laxatives (such as polyethylene glycol 4000 powder), lubricating laxatives (such as paraffin oil).

According to the severity of constipation in a targeted manner is very important to choose cathartic. Chronic constipation with laxatives expansion is appropriate, choose a stimulant only when necessary, not long-term use; acute constipation can choose salt laxatives, stimulant laxatives and lubrication, but not more than 1 weeks; for chronic constipation, especially caused by fecal impaction, enema enema method can be used. Liquid soap and saline water two, and compared with saline soapy water irritation is small.

Mosapride a new prokinetic drugs is the treatment of colonic constipation. Its mechanism is mainly to promote the release of acetylcholine in the myenteric plexus of intestine, which can enhance the movement of intestine and promote the operation of small intestine and large intestine. It can be used as an ideal drug for the treatment of colonic constipation. But for those with severe constipation, to achieve the desired therapeutic effect, may take 1 to 2 months.

Treatment of 3 fecal impaction: a method commonly used in clinic is the index finger (glove) is inserted into the anus, dry dung and cut into pieces, cut or discharged by Enema Glycerini stimulation, should be invalid under the local anesthesia group dig dung.

4 water therapy: This is an effective new treatment for intractable constipation. Through the instrument, the sterilizing and purifying brine infuse into the anus, after repeated washing, which accumulates in the large intestine feces, to remove toxins, bacteria and parasites in the gut, restore normal intestinal absorption and excretion function. Different from ordinary oral laxatives and hydrotherapy is the treatment without pain, wash thoroughly, suitable for all kinds of constipation, and has the effect of detoxification. Generally 1 to March every time, every time, 45 minutes each time, 1 minutes.

5: biofeedback therapy biofeedback therapy by manometry and electromyography equipment, the functional status in patients with visual perception of their defecation of the pelvic floor muscles, "tacit understanding" how to relax the pelvic floor muscles during defecation, defecation and increased intra-abdominal pressure to achieve therapy. Before the treatment, it is necessary to explain the anatomy and physiology of the pelvic floor to the patient. To master how to adjust the defecation action according to the pressure change and learn how to relax the pelvic floor muscles.

6 surgical treatment: Constipation after a period of conservative treatment is still invalid, can be checked by some means to see if there are organic lesions. The operation condition of slow transit constipation: no tension in the colon; no outlet obstruction. Colonic or subtotal resection. Outlet obstructive constipation: this kind of disease of defecography, diagnosis. Including: rectocele: solution wall or rectal wall repair the vagina; the internal rectal prolapse: treatment by ligation of rectal mucosa to shorten the length, can also be combined therapy sclerotherapy plus ligation; the pelvic spasm syndrome (also called Pelvic Achalasia Syndrome: surgical slow) methods available partial resection of the puborectalis muscle, but the effect is uncertain.

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