constipate
Introduction
Introduction Constipation refers to a common symptom of a digestive tract that has too few bowel movements, or poor bowel movements, laboriousness, difficulty, and dry stools. Normally, the bowel movement is performed once or twice a day or 2-3 days, but the amount and stool of the feces are often affected by the type of food and the environment. Many patients have bowel movements <3 times/week, and severe cases last 2 to 4 weeks before defecation. Some daily platoons can be repeated many times, but defecation is difficult. The defecation time can be more than 30 minutes each time. The feces are as hard as sheep dung and the amount is very small.
Cause
Cause
First, organic constipation
(1) Colon, rectum and anal disorders:
1, benign and malignant tumors.
2, intestinal infectious inflammation: such as amoebic bowel disease, intestinal tuberculosis, colonic chamber inflammation.
3, inflammatory bowel disease: Crohn's disease, a small number of ulcerative colitis.
4, mesenteric vascular embolization.
5, hemorrhoids, anal fissure, extraintestinal mass compression, adhesion incarceration.
6, sexually transmitted lymphogranuloma.
(B) intestinal infectious diseases: such as peritonitis, infectious toxemia caused by intestinal paralysis and dehydration.
(C) endocrine and metabolic disorders: such as hypothyroidism, hyperparathyroidism and other causes of hypercalcemia, diabetes, diabetes insipidus.
(D) intestinal smooth muscle lesions:
1, intestinal smooth muscle weakness: old age, emphysema. Low potassium paralysis and so on.
2, intestinal smooth muscle spasm: chronic lead poisoning, blood and disease.
(5) Neurological diseases:
Paraplegia, multiple radiculitis, coma, diabetic neuropathy.
Second, functional constipation
1, lack of defecation power: such as levator ani muscle, diaphragm muscle, abdominal wall muscle weakness, multiple pregnancy J fat or sharp weight loss.
2, colon fistula: Most patients showed alternating diarrhea and constipation, found in irritable bowel syndrome.
3, rectal bowel reflex is slow or lost: if the defecation environment is inconvenient, often neglected, not developed into the habit of regular bowel movements, affecting bowel movements for a long time. Common in habitual constipation.
4. Others: If you eat too little or the food is too fine, the diet contains insufficient cellulose, which is not irritating to the movement of the colon.
Third, the impact of certain drugs
1. Abuse of laxatives: weakens the sensitivity of the intestines and forms a dependence on laxatives.
2, opioids: drugs acting on opioid receptors can relax the intestinal muscles, reducing the sensitivity to the response to defecation reflex.
3, other drugs: anticholinergic drugs, silver agents, sucralfate. Ganglion blockers, sedatives, antidepressants, etc. can cause constipation.
In addition, excessive mental stress or depression can inhibit constipation caused by natural bowel movements.
mechanism
The food is digested and absorbed in the digestive tract, and the residue that cannot be digested and absorbed is excreted in the form of feces. Under normal circumstances, the chyme entering the colon every day is about 500-1000 ml. There are two functions of the colon, one is the absorption function, the absorption of water and electrolytes, mainly in the proximal colon; the other function is the storage function, mainly in the distal colon. Defecation can be roughly divided into two steps:
1 The stool is pushed to the rectum. Under normal circumstances, the colon has several group peristalsis every day, which occurs after the meal (gastrointestinal reverse), so that the feces quickly enter the rectum, expand and stimulate the tympanic membrane of the intestine;
2 Rectal emptying, when the rectum is filled with feces, it will happen. Defecation is regulated by the lower central nervous system in the cerebral cortex and lumbosacral spinal cord. The feces are excreted by rectal contraction, anal sphincter relaxation, abdominal muscle and diaphragm contraction.
The following conditions are required to maintain normal bowel movements:
1 The amount of food and the amount of fiber contained are appropriate and there is sufficient moisture;
2 gastrointestinal tract is smooth, digestion, absorption, and peristalsis are normal;
3 There are normal bowel movements, and the abdominal muscles and diaphragm muscles have enough strength to assist the defecation movement. Any obstacles above any of the links can lead to constipation.
Examine
an examination
Related inspection
Manure volume and hardness Vitamin U Fecal porphyrin fecal traits
For stool examination, the form of feces discharged by constipation and the presence or absence of mucus or blood adhesion should be observed. Rectal constipation is a large piece of hard stool. Because of frequent rectal inflammation and anal injury, the stool often has mucus and a small amount of blood adhesion. When middle-aged and elderly patients often have a small amount of blood, special attention should be paid to colorectal cancer. In patients with colonic constipation, the feces are hard and lumpy like sheep dung. Irritable bowel syndrome often discharges a lot of mucus, but there are very few red blood cells and white blood cells in the mucus.
Film degree exam
1. Rectal examination:
Care should be taken to observe the presence or absence of external hemorrhoids, anal fissures and anal fistula. At the time of 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, and 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 can also have a comprehensive understanding of the colonic motor function (peristalsis). X-ray abdominal plain film, if found in multiple stepped liquid level, is important for 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, a diagnosis can be obtained.
Diagnosis
Differential diagnosis
Primary constipation:
It refers to constipation caused by the absence of organic diseases. Functional constipation, simple constipation and idiopathic constipation are primary constipation.
Simple constipation:
It is common to eat too little, food residue is insufficient, due to lack of fiber, the stimulation of colonic movement is reduced; the habit of defecation is disturbed, due to mental factors, changes in lifestyle, long-distance travel, etc., neglecting daily routine, failing to defecate in time; abuse of laxatives To weaken the sensitivity of the intestine and form a dependence on laxatives.
Idiopathic constipation:
Intractable constipation, also known as idiopathic constipation, is present in the absence of organic disease and the cause is still unclear.
Temporary constipation:
This may be caused by changes in the living environment such as travel, moving, or constipation caused by mental stress and trouble, or due to insufficient food intake and insufficient bowel movements in the stomach or colon.
Intractable constipation:
It is a type of disease that gradually causes difficulty in defecation at different ages due to congenital knot and rectal anatomical variation. It is a functional gastrointestinal disorder, that is, it can not find the physical lesions on the body. It is caused by nervousness, stress, gastrointestinal motility disorder, or constipation, which creates a vicious circle and leads to habitual constipation.
Constipation of infants:
It is a common condition, which means that the stool is dry and hard, and it is difficult to remove the stool. Simple constipation is caused by increased absorption of water and electrolytes in the colon. The newborn did not expel the fetus 24 hours after birth, and was highly suspected of obstruction. Further examination should be carried out such as taking a flat abdominal film. Constipation begins when the baby is born, and attention should be paid to the identification of thyroid dysfunction and congenital megacolon. In the latter, the barium enema examination showed segmental stenosis in addition to colonic expansion, while chronic constipation showed full expansion of the colon. Detailed medical examinations and necessary auxiliary examinations should also be performed for constipation in children in order to be differentiated from neurological or organic obstruction. Habitual constipation refers to long-term, chronic functional constipation, which occurs mostly in the elderly. However, some scholars believe that habitual constipation is not limited to functional constipation, but it also includes colon constipation and rectal constipation. People with long-term constipation, fainting and bloated, present an abnormal pathological appearance. Habitual constipation is common in the abnormal function of primary intestinal peristalsis, delayed delivery of stool and peristalsis.
Secondary constipation:
Constipation, which occurs on the basis of organic diseases or diseases, is called secondary constipation, also known as symptomatic constipation. There are many diseases with constipation symptoms. The diagnosis is mainly based on consultation and clinical examination, especially when observing feces and feces, it can be used to identify the symptoms, and if necessary, rectal examination and drug diagnosis can help to confirm the diagnosis.
Sexual constipation:
It is a functional constipation, which is caused by excessive colonic movement, causing colonic sputum, too narrow intestinal lumen, constipation caused by the inability to pass stool, also known as irritable bowel syndrome, which is characterized by constipation-diarrhea alternation, or Long-term diarrhea.
Postpartum constipation:
Maternal postpartum diet is normal, but the stool is not good for a few days or dry pain when defecation, difficult to solve, called postpartum constipation, or difficult to postpartum stool, is one of the most common postpartum diseases. Symptoms include less stool, dry and hard, fewer times, etc., and others may have no other symptoms. Partially intractable constipation can only be used for stools for more than ten days to one month. It can be accompanied by anal rectal pressure, and there is a sense of inconvenience in bowel movements. There may also be dull pain in the area around the perineum, buttocks, back of the thigh and hips, and disappear after defecation. In patients with papillitis complicated with hemorrhoids, anal fissure, and perianal ulcer, anal burning and blood in the stool may occur. Sometimes there are systemic symptoms such as dizziness, headache, anorexia, bad breath, and weight loss. In addition, there may be various clinical symptoms corresponding to various organic diseases.
