Stool hardened like sheep dung
Introduction
Introduction Elderly constipation patients can be prominently manifested as difficulty in defecation, defecation time can be more than 30min, or multiple bowel movements every day, but the discharge is difficult, the fecal induration is like sheep feces, and the number is small. The colonic movement of the elderly is slow, the sensitivity and responsiveness of the receptors around the anus are decreased, and cerebral arteriosclerosis is prone to cerebral cortical inhibition, weakening of the stomach and colon, and other factors such as drugs, so constipation is prone to occur.
Cause
Cause
(1) Causes of the disease
The causes of constipation are intestinal lesions and systemic diseases, and some patients with constipation are idiopathic constipation. Intestinal lesions include inflammatory bowel disease, tumor, sputum, and rectal prolapse. Systemic diseases include diabetes, uremia, cerebrovascular accidents, and Parkinson's disease. Frequent use of certain drugs can cause constipation, such as opioid analgesics, anticholinergics, antidepressants, calcium antagonists, diuretics, etc. In addition, the reduction of activities in the elderly and the lack of cellulose in the diet are all factors contributing to constipation.
Normal bowel movements include two processes of creating a bowel movement and a bowel movement. After the meal, the stomach colon is reflected, the colon movement is enhanced, and the feces are advanced to the distal part of the colon. When the rectum is filled, the internal sphincter of the anus relaxes, and the external anal sphincter contracts, causing the intra-orbital pressure to rise. When the pressure stimulation exceeds the threshold, it will cause constipation.
This impulsive impulse travels along the pelvic and sub-abdominal nerves to the defecation center of the lumbosacral spinal cord, and then through the thalamus to the cerebral cortex. If the environment permits, the puborectalis and anus internal and external sphincters are loose, the levator ani muscles on both sides contract, the abdominal muscles and tendons also coordinate contraction, and the abdominal pressure is increased to promote the discharge of feces.
(two) pathogenesis
Constipation occurs due to abnormalities in the nervous system or intestinal smooth muscle lesions. The colonic movement of the elderly is slow, the sensitivity and responsiveness of the receptors around the anus are decreased, and cerebral arteriosclerosis is prone to cerebral cortical inhibition, weakening of the stomach and colon, and other factors such as drugs, so constipation is prone to occur.
Examine
an examination
Related inspection
Fecal stone stool fecal faeces color
1. The main manifestations of constipation are the reduction of the number of bowel movements and difficulty in defecation. Many patients have fewer than 2 bowel movements per week, and severe cases last 2 to 4 weeks before defecation. However, the reduction in the number of times is not the only or necessary performance of constipation. Some patients can be prominently manifested as difficulty in defecation. The time of defecation can be as long as 30 minutes or more, or multiple bowel movements every day, but the discharge is difficult, and the feces are hardened like sheep feces. And the number is small. In addition, there is abdominal distension, reduced food intake, and improper use of laxatives to cause abdominal pain before defecation. In the left lower abdomen, there is an intestinal fistula with feces, and there is a fecal mass in the anus.
2, constipation may be the only clinical manifestation, it may also be one of the symptoms of a certain disease. For patients with constipation, you should understand the medical history, physical examination, and further examination if necessary to determine whether there is mechanical obstruction of the digestive tract and whether there is dyskinesia.
3, ask the medical history should know in detail the onset time and treatment of constipation, the recent changes in bowel habits, ask the number of bowel movements, whether there is difficulty in defecation, effort and whether the stool has blood. Whether it is accompanied by abdominal pain, bloating, upper gastrointestinal symptoms and other systemic diseases that can cause constipation, especially the elimination of organic diseases. If the course of the disease has not changed for more than a few years, it will prompt functional constipation.
4, physical examination can find some evidence of constipation, such as the presence or absence of dilated bowel in the abdomen, whether it can touch the intestinal sputum. Anal and rectal examinations can be found for rectal prolapse, anal fissure pain, anal canal stenosis, presence or absence of caulking feces, and changes in anal canal tension at rest and during forced bowel movements.
Diagnosis
Differential diagnosis
According to the situation, some special examinations should be selected. Firstly, the constipation caused by organic diseases such as colon cancer and stenosis should be excluded. The abdominal plain film can show the expansion of the intestine and the retention of feces and the gas-liquid level. Endoscopy or imaging should be performed to understand the structure of the colon and rectal lumen. Fiber sigmoidoscopy can observe the mucosa of the rectosigmoid and the presence or absence of lesions and stenosis in the cavity. Melanosis coli can also be found. The latter is a manifestation of lipofuscin caused by long-term use of steroidal laxatives.
