constipate
Introduction
Introduction to constipation Constipation is a symptom of many diseases, not a disease. Constipation has different meanings for different patients. The common symptom is that the number of defecations is significantly reduced, every 2 to 3 days or more, irregular, dry and hard, often accompanied by pathological phenomena of difficulty in defecation. basic knowledge Sickness ratio: 0.1% Susceptible people: good for the elderly Mode of infection: non-infectious Complications: anal fissure, angina pectoris, myocardial infarction, intestinal obstruction
Cause
Cause of constipation
Acute constipation (35%):
(1) anal, painful lesions near the rectum: anal fissure, anal fistula, abscess around the anus, proctitis or rectal ulcer, massive internal hemorrhoids or internal hemorrhoids combined with infection, bleeding and other lesions can cause anal sphincter spasm or patients fear bowel movements, defecation The reflection disappears and leads to constipation.
(2) colonic obstructive lesions: intestinal torsion, intestinal adhesions, intussusception, intestinal parasitic diseases, intestinal tumors, mesenteric vascular embolism or thrombosis can cause intestinal obstruction, so that the upper end of the obstruction can not pass the obstruction, It can lead to constipation.
(3) Intestinal motor reflex inhibition: the normal peristaltic function of the intestine is significantly weakened, which can be seen in visceral inflammatory diseases such as appendicitis, acute pancreatitis, cholecystitis, peritonitis, acute secondary megacolon, etc. Constipation can also occur due to intestinal paralysis, cholelithiasis, kidney stones and other painful diseases.
(4) taking certain drugs: after taking aluminum hydroxide, atropine, oxytetracycline and bismuth subcarbonate (barium carbonate), sucralfate and other drugs, some patients may have constipation.
Chronic constipation (35%):
(1) Organic diseases:
1 Chronic colonic obstruction: such as colon stenosis, benign or malignant colorectal tumors, omental adhesion syndrome (transverse colon is pulled, forming an acute angle, leading to difficulty in the passage of contents) and other chronic colonic obstructive diseases.
2 congenital megacolon: constipation due to high intestinal lumen expansion, intestinal paralysis, intestinal muscle contraction, peristaltic function disappeared.
3 extra-intestinal lesions, especially the rectum, sigmoid extra-colon lesions, such as pelvic tumors, ovarian cysts, prostate tumors, large tumors or masses in the abdominal cavity, ascites, etc. can compress the intestines.
4 brain and spinal cord lesions: such as myelitis, various types of encephalitis, brain tumors, etc., can cause normal reflex arcs of defecation, resulting in constipation.
5 Chronic lead, arsenic, mercury and phosphorus poisoning: poisoning can cause bowel movements to disappear and cause constipation.
6 chronic systemic diseases: such as mucinous edema, hypothyroidism, etc., can disappear due to defecation, slow bowel movements and constipation.
(2) Functional constipation and constipation-type irritable bowel syndrome (IBS):
1 Abdominal muscles, anal muscles or colon smooth muscle and intermuscular plexus dysfunction, often cause debilitating dysmotility and constipation, more common in multiple pregnant women, chronic emphysema, malnutrition, weakness, senile and abdominal viscera Drooping.
2 rectal dilatation, contraction of bowel movements is slow or disappear, more common in the failure to develop daily regular bowel habits, at this time because of the feeling of no fecal stimulation, so the normal bowel movements are significantly weakened, patients can lead to intractable constipation over time.
3 If you eat too little diet, or eating habits, changes in diet types, environmental changes and other factors can cause bowel movements to weaken and cause constipation.
4 emotional changes, tension, anxiety and other factors can lead to weakened bowel function, and constipation, but more common with diarrhea, known as irritable bowel syndrome (constipation type), patients often accompanied by abdominal pain Or abdominal discomfort.
5 Abuse of strong laxatives can lead to normal bowel movements to reduce or disappear, so constipation can also occur, repeated use of strong laxatives will inevitably make constipation more serious, and even cause a vicious circle, even secret - strong laxative - constipation.
At present, it is generally believed that there are two types of functional constipation: 1 slow transit constipation, that is, intestinal feces are retained in the colon, can not be discharged according to the normal rhythm, time, 2 functional outlet obstruction type, that is, due to anal sphincter dysfunction or Pelvic floor muscle dysfunction and other causes the feces to drain from the rectum and anus.
Other factors (10%):
Differences in personal physique and environmental impact.
Pathogenesis
After the food is empty and the ileum is digested and absorbed, the remaining chyme residue that can no longer be absorbed is discharged from the small intestine to the colon with the peristalsis of the intestine. The colon mucosa further absorbs water and electrolytes. The feces are gradually formed in the transverse colon and finally transported to the sigmoid colon. The rectum and rectal mucosa are mechanically stimulated by fecal filling and expansion, producing sensory impulses. Impulsive movement through the pelvic nerve, lumbosacral spinal cord is transmitted to the cerebral cortex, and then the nerve is transmitted to the rectum, causing contraction of the rectal muscle and anal sphincter relaxation. Then, the abdominal muscles and the diaphragm contract at the same time, so that the feces are excreted from the anus. The above is the normal process of defecation reflex. If there is any obstacle in any part of the defecation reflex process, constipation can be caused. The following factors are constipation. important reason:
1. The intake of food or water is too small, so that the amount of chyme residue or feces in the intestine is also small, which is not enough to stimulate the normal peristalsis of the colon.
2. The peristalsis of the intestine is weakened or the muscle tone of the intestine is reduced.
3. There are stenosis or obstruction in the intestinal lumen, which hinders normal intestinal peristalsis, resulting in feces not being able to lie down, such as intestinal obstruction or left colon cancer.
4. Constipation can occur when there is any obstacle or lesion in the process of defecation reflex, such as weakened feeling of mechanical stimulation of rectal mucosa, pelvic nerve, lumbosacral spinal neuropathy, anal sphincter spasm, weakening of abdominal muscles and diaphragmatic contraction.
Prevention
Constipation prevention
(1) Constipation prevention
Because feces are mainly composed of food after digestion, it is a simple and easy way to prevent constipation through diet adjustment. First, pay attention to the amount of diet. Only enough amount is enough to stimulate bowel movements and make feces pass normally. Excreted from the body, especially for breakfast, second, pay attention to the quality of the diet, the staple food should not be too fine, should pay attention to eat coarse grains and miscellaneous grains, because coarse grains, miscellaneous grains after digestion, more residue, can increase the amount of stimulation of the intestine, conducive to stool Run, non-staple food should pay attention to eat more vegetables containing more cellulose, because normal people need 90-100 mg of cellulose per kilogram of body weight to maintain normal bowel movements, you can eat more vegetables, leeks, celery, oysters, etc., because the fiber rope is not easy to be digested Absorption, a large amount of residue, can increase the volume of the intestine, increase the pressure inside the intestine, increase bowel movements, is conducive to defecation, and also need to drink more water, especially heavy physical workers, because of sweating, breathing, Water consumption is high, and the water in the intestine must be absorbed in a large amount. Therefore, it is necessary to prevent the stool from drying and drink plenty of water. Drink a glass of water before breakfast or after getting up. Mild laxative effect, enough water to drink, so that the intestines get enough water can facilitate the passage of intestinal contents, and can also intentionally eat more fat-containing foods, such as walnuts, peanuts, sesame seeds, rapeseed oil, peanut oil Etc., they all have a good laxative effect.
(2) Actively exercising
Stools, walking, running, deep breathing exercise, practicing qigong, tai chi, turning waist and lifting legs, participating in stylistic activities and physical labor can strengthen gastrointestinal activities, increase appetite, diaphragm, abdominal muscles, anal muscles get exercise Improve the power of defecation, prevent constipation, the rural elderly who work frequently are rarely constipated, and those who are lazy in activities and pampered in urban areas have more constipation, which explains this truth.
Complication
Constipation complications Complications anal fissure angina pectoris myocardial infarction intestinal obstruction
Constipation often causes people to change their emotions, upset, distracted, affecting daily life and work, and is related to the occurrence and development of many diseases as described below.
Constipation can often lead to anal colorectal complications. Long-term constipation can cause carcinogens produced by intestinal bacterial fermentation to stimulate intestinal mucosal epithelial cells, leading to abnormal growth and easy to induce cancer. Constipation causes perianal diseases such as proctitis and anal fissure., because of constipation, difficulty in defecation, dry stool, can directly cause or aggravate anorectal disease, harder fecal block obstructing the intestinal lumen to narrow the intestinal lumen and oppress the structure around the pelvis, hinder colonic peristalsis, compress the rectum or colon And cause blood circulation disorders, can also form fecal ulcers, severe cases can cause intestinal perforation, colonic diverticulum, intestinal obstruction, gastrointestinal nerve dysfunction (such as loss of appetite, abdominal fullness, belching, mouth pain, anal platoon More gas, etc.)
Constipation can also induce intestinal complications, such as stroke, affecting brain function (memory decline, distraction, slow thinking), sexual life disorders, etc., in hepatic encephalopathy, breast disease, Alzheimer's disease, etc. It also plays an important role in the occurrence. Clinically, it is necessary to increase abdominal pressure due to constipation. The incidence of cardiovascular disease caused by breath holding and defecation has increased year by year, such as angina pectoris and myocardial infarction.
Symptom
Symptoms of constipation Common symptoms will be red blood is dripping... Fecal dry knot is calculated abacus-like laxative constipation fecal volume less secondary constipation constipation with abdominal mass irritable bowel syndrome intestinal paralysis constipation with severe abdominal pain stool habit change
Most patients with constipation only have difficulty in defecation, dry feces, and defecation once in a few days or even 1 week. There may be left abdomen pain and falling feeling during defecation. Some patients complain of bitterness, loss of appetite, abdominal distension, lower abdominal discomfort, and exhaust. More or dizziness, headache, fatigue and other neurological symptoms, but generally not heavy, acute in the original rules of bowel habits, no special reasons, constipation in the short term, especially the elderly should pay special attention to the rectum and Colon cancer, accompanied by severe abdominal pain, vomiting or blood in the stool, should consider constipation caused by acute intestinal obstruction, general physical examination can often touch the intestines or feces in the descending colon or sigmoid colon, but disappear after defecation Intestinal obstruction often has abdominal distension, abdominal pain, intestinal type and intestinal peristalsis.
Examine
Constipation check
Fecal examination, should observe the form of fecal excretion and the presence or absence of mucus or blood adhesion, rectal constipation is a large piece of hard feces, often accompanied by rectal inflammation and anal injury, feces often have mucus and a small amount of blood adhesion, middle-aged Patients often have a small amount of blood, should pay special attention to colorectal cancer, colonic constipation, stool is hard and granular like sheep feces, irritable bowel syndrome often discharge a lot of mucus, but very few red blood cells, white blood cells in the mucus.
Film degree exam
1. Rectal examination: Care should be taken to observe whether there are external hemorrhoids, anal fissures and anal fistula. When palpation, attention should be paid to the presence or absence of internal hemorrhoids, whether the anal sphincter has sputum, whether the rectal wall is smooth, whether there are ulcers or new organisms.
2. X-ray barium enema examination and abdominal plain film: X-ray barium enema examination is helpful for the diagnosis of colon, rectal tumor, colon stenosis or sputum, megacolon and other diseases, and the colonic motor function (peristalsis) Can have a more comprehensive understanding, X-ray abdominal plain film if found a number of stepped liquid level, it is important to the diagnosis of intestinal obstruction.
3. Colonoscopy: Colonoscopy is extremely helpful in the diagnosis of various colonic lesions causing constipation, such as colonic, rectal cancer, intestinal polyps and other organic intestinal stenosis, combined with biopsy , can be diagnosed.
Diagnosis
Constipation diagnosis
diagnosis
History
The patient's diet, living habits and work conditions, past medical history, surgical history, especially the presence or absence of nucleus, anal fistula and anal fissure history, recent history of medication, especially the history of long-term laxatives should be asked. For patients with middle-aged and above, changes in bowel habits occur. The stool is changed once or twice a day, gradually changing to every 3 days or several days. You should be alert to the possibility of left colon cancer.
2. Symptoms and signs
(1) constipation with severe abdominal pain, abdominal distension and vomiting, often suggestive of acute constipation, should consider the possibility of intestinal obstruction, abdominal obstruction, abdominal auscultation can be heard and bowel sounds hyperthyroidism or smell high-profile metal tone Intestinal paralysis can occur in the late stage.
(2) constipation with abdominal mass, may be colon tumor, intra-abdominal tumor compression colon, intestinal tuberculosis, Crohn's disease (Crohn's disease) or enlarged lymph nodes, left lower abdomen and a more active cord Or when the sausage is in the form of a sausage, it should be suspected to be sigmoid colon.
(3) constipation and diarrhea alternate, and there are umbilical or middle or lower abdominal pain, more suggestive of intestinal tuberculosis or intra-abdominal tuberculosis, Crohn's disease, chronic ulcerative colitis or irritable bowel syndrome.
(4) lower abdomen or rectum, anal pain and discomfort in the anus, hard to relieve the hard and thick fecal mass after the pain relief, more suggestive of rectal constipation (fainting stimulation weakened); left lower abdomen pain and discomfort, solution chestnut-like After the hard fecal mass, the pain relief, more suggestive of colonic or irritable bowel syndrome.
3. Laboratory tests and other auxiliary inspections.
Differential diagnosis
Colonic obstructive constipation
(1) In addition to constipation, patients often have abdominal distension, abdominal pain, nausea and vomiting.
(2) Colonic tumors, intestinal adhesions and other chronic intestinal obstruction, the onset is slower, constipation is gradually worsening, a small number of left colon cancer patients with stool can be fine; if acute intestinal obstruction, the onset is more rapid, Heavier conditions, abdominal pain, nausea, vomiting and other symptoms are more serious than constipation; acute mesenteric vascular infarction or thrombosis and other ischemic bowel disease patients, also with severe abdominal pain as the first symptom, may be associated with nausea and vomiting and constipation and other symptoms However, patients often have bloody stools.
(3) If the abdominal plain film is found to be stepped, it is important for the diagnosis of intestinal obstruction.
(4) X-ray barium enema or colonoscopy can detect polyps, cancer and other diseases.
2. Irritable bowel syndrome (constipation type)
(1) Constipation is often affected by factors such as emotional stress or anxiety. Patients often have a history of stage diarrhea, and only a few patients are only responsible for the main manifestation.
(2) Barium enema examination can sometimes find some intestinal segments showing a sputum change, but the intestinal wall is smooth.
(3) Colonoscopy sometimes finds that it is difficult to pass the bowel tube through the bowel tube, and the patient has pain and other discomfort, but no obvious organic lesions.
3. Tension-reducing constipation
(1) more common in the elderly, visceral drooping, or long-term malnutrition, constipation due to weakened bowel function, many of whom have a history of long-term use of laxatives.
(2) When the oral tincture is examined, the time for the expectorant to pass through the small intestine and the colon is significantly prolonged.
(3) Determination of colon transit time, usually using the Bouchoucha method, the time of passage of the radiopaque marker in the colon (DTT) is determined, and when the marker is not excreted after 72 hours, it can be considered as slow transit constipation.
(4) Colonoscopy often has no organic lesions.
4. Rectal constipation
(1) Because of anal fissure, fistula, sacral nucleus and other perianal lesions, patients have pain when they have bowel movements, so they are afraid of bowel movements. The long-term lack of convenience, the bowel movements are slow and constipation occurs, so that stools accumulate in the rectum, each time the stool is more It is thick and firm, and sometimes there is blood outside the stool.
(2) A small number of patients have dry stools like chestnuts, and there is pain in the left lower abdomen, which is caused by sigmoid colon.
(3) Anal periorbital nucleus, anal fissure and anal fistula can be found during anal examination.
(4) When the barium enema was found, the colon of the sputum was narrow, but the intestinal wall was smooth and free of defects.
(5) Rectal, intra-anal pressure measurement and intra-rectal EMG measurement, when the pressure or EMG abnormality, it is conducive to the diagnosis of outlet obstruction constipation.
(6) Colonoscopy In addition to perianal lesions, there were no organic lesions in the rectum and upper colon.
