old man constipation
Introduction
Introduction Constipation is more common in the elderly population. Due to constipation, the feces stay in the intestine for too long, and the toxic substances such as ammonia, hydrogen sulfide, hydrazine, and nitrosamines cannot be excreted in time, and are absorbed into the blood, causing certain harm to the body tissues.
Cause
Cause
There are many causes of constipation. In addition to organic diseases (such as gastrointestinal obstruction and intestinal tumors), the main causes of constipation are poor eating habits, lifestyle, and psychological factors.
(1) Insufficient intake of dietary fiber
With the improvement of China's economic development and living standards, people have increased the consumption of animal foods. Chickens, ducks, fish, meat and other foods are eating more and more, cereals are eating less and less, and rice is used. The main face is fine. As the food is too fine, the intake of dietary fiber is reduced, which makes the intestinal peristalsis slow and the bowel movements are not smooth, resulting in constipation. According to the National Nutrition Survey of our country, the average daily dietary fiber intake per person has dropped from 26 grams to 17 grams. Studies have shown that the lower the dietary fiber content in the feces, the longer the feces pass through the intestines. The feces of high-fiber diets absorb more water, are bulky, and are of higher quality. The time for feces to pass through the intestines is only 14 hours, while those with low-fiber diets can last up to 76 hours, and some even up to 144 hours (6 days).
(2) Bad eating behavior
Poor eating behaviors such as drinking alcohol, eating spicy food, drinking too little, and partial eclipse are related to the occurrence of constipation. Improper choice of food can also cause constipation. For example, eating more fruits can prevent constipation, but the unreasonable selection of fruit varieties may be counterproductive. Pears and bananas can promote bowel movements and help to improve constipation. Persimmons and apples are rich in tannic acid, which can often aggravate constipation.
(3) Bad lifestyle
For those who are sedentary and lack of exercise, constipation is often prone to occur. Older people who have irregular living conditions or who do not develop good bowel habits are also prone to constipation. For example, some people can't defecate regularly, and often endure the defecation time when they are willing to continue to deal with the matter at hand. Over time, it will cause constipation to be suppressed or disappeared. Others like to listen to radio, reading, reading newspapers or thinking about problems during defecation. This tends to distract attention, not only affecting the reflexive bowel movements, but also easy to form acne, which can increase constipation in the elderly.
(4) Mental stress, stress, insomnia
Mental factors are also closely related to constipation. According to a survey of more than 3,300 elderly people, it is found that elderly people with mental stress, psychological stress, insomnia or poor sleep quality have constipation compared with those without these symptoms. The risk is increased by 30% to 45%.
Examine
an examination
Related inspection
Gastric ultrasound examination of gastrointestinal function dynamics fiberscope
1. Cytological examination of serous effusion:
The surface of the serosal cavity is covered by a layer of mesothelial cells, which can invade and destroy the serosa and produce malignant effusion.
2. Human chorionic gonadotropin (HCG):
Human chorionic gonadotropin is a glycoprotein hormone secreted by the placenta.
3. Parathyroid hormone (PTH):
The main action of parathyroid hormone increases the activity and number of osteoclasts, increases blood calcium, inhibits the absorption of phosphorus by renal tubules, and promotes the absorption of intestinal calcium and phosphorus. Clinically, radioimmunoassay and immunochemical fluorescence assay are commonly used.
4, cerebrospinal fluid bilirubin:
A method of examination of cerebrospinal fluid.
5. Porphyrins in the feces:
Fecal examination.
6, vitamin D (VitD):
The essential vitamins of the human body.
7. Tumor gene P53 antibody (P53-AB):
The P53 gene is a gene that has been studied extensively. P53 antibodies can be used for early diagnosis of various tumors and screening tests for tumors.
8. Carcinoembryonic antigen (CEA):
Carcinoembryonic antigen was first found in colon cancer and fetal intestinal tissue, hence the name. Elevated serum CEA, in addition to gastrointestinal cancer, is also seen in other systems. Continuous monitoring of carcinoembryonic antigen levels can be used for therapeutic observation and prognosis of tumor therapy. The serum carcinoembryonic antigen level is generally decreased when the condition is improved, and the disease is elevated when the disease progresses.
9, stool phosphate:
Fecal phosphate examination, a project in stool routine. It mainly reflects the phosphate content in people's daily diet.
10. Fecal red blood cells:
Fecal red blood cell examination, a project of stool routine, can understand digestion and absorption functions, and help diagnose digestive diseases.
11, fecal white blood cells:
Fecal leukocyte testing is a project in the stool routine that helps understand digestion and absorption and assists in the diagnosis of digestive diseases.
12. Fecal pus:
Fecal pus examination, simple examination method, intuitive results, can initially provide information on the function of the digestive tract or pathological changes, as well as indirectly determine the functional status of the gastrointestinal, pancreatic, hepatobiliary.
Diagnosis
Differential diagnosis
Differential diagnosis of constipation in the elderly:
(1) Habitual constipation
In the medical history, there is generally a habit of eating a partial eclipse, not eating vegetables or eating too fine, or having not developed a habit of defecation on time. Inconvenient toilets or work environment are inconvenient for defecation, and emotional stress also affects habitual constipation. Physical examination, X-ray angiography or colonoscopy did not find organic lesions, which can be diagnosed as habitual constipation.
(2) Irritable bowel syndrome
There are three clinical manifestations of irritable bowel syndrome:
1 colonic spasm, mainly caused by chronic abdominal pain and constipation.
2 chronic intermittent painless watery diarrhea.
3 constipation and diarrhea alternate.
The clinical features of irritable bowel syndrome with constipation are:
1 chronic abdominal pain with constipation, or alternating diarrhea constipation.
2 patients often have intermittent abdominal cramps in the sigmoid colon area, relieved after deflation or defecation.
3 physical examination can be in the left lower abdomen and sigmoid colon filled with feces and sputum, with tenderness. Anal finger examination of the rectum and abdomen without feces.
4 patients often accompanied by heartburn, bloating, back pain, weakness, dizziness, palpitations and other symptoms.
Diagnostic points:
1 has the above clinical features.
2X line barium sputum or colonoscopy showed no positive findings, or only sigmoid colon, except for constipation caused by other causes.
3 in the left lower abdomen and the mass should be differentiated from colon cancer. The patient is defeated by enema or other means, and the mass disappears after the defecation as a dry stool.
(three) laxative enteropathy
Laxative enteropathy refers to difficulty in defecation caused by constipation or rectal or anal lesions. The patient began to use laxatives for the smooth discharge of bowel movements, and the long-term application of the dependence of defecation on laxatives was called laxative enteropathy.
Diagnostic points: 1 patients with constipation or difficulty in defecation, long-term frequent application of laxative history. 2 Except for endogenous, rectal anal and other organic constipation, can be considered as laxative enteropathy. If there is no history of medication, it is not possible to diagnose laxative bowel disease.
(four) colorectal cancer
Colorectal cancer includes colon and rectal cancer. There is information that colorectal cancer is more than 1/3 in the rectum, and 2/3 of the cancer is in the rectum and sigmoid colon.
1. Main clinical features
1 The early symptoms of colorectal cancer are not obvious, and changes in bowel habits such as constipation or diarrhea, or alternating between them may be early manifestations of colorectal cancer.
2 Blood in the stool, especially after defecation, is a common symptom of colorectal cancer.
3 can have persistent pain in the abdomen, constipation and urgency often exist at the same time.
4 invasive colorectal cancer is prone to intestinal obstruction.
5 Abdominal examination and anal finger examination sometimes touch the mass.
2. Diagnosis basis:
Patients over the age of 140 have the above clinical manifestations.
2 The occult blood continued to be positive without evidence of stomach disease.
3 abdominal examination along the colon or rectal examination revealed a mass.
4 Carcinoembryonic antigen can be elevated, but not specific.
5 barium angiography and colonoscopy is an important means of diagnosing colon cancer.
(5) Megacolon
Megacolon refers to a significant expansion of the colon with severe constipation or intractable constipation. It can occur at any age and can be acquired congenitally or acquired. Toxic megacolon is a serious complication of fulminant ulcerative colitis. There are several common types:
1. Congenital megacolon is a congenital dysplasia of the intestine. It is caused by the lack of ganglion, so it is also called the ganglion lacking sex megacolon. Seen in young infants, more men than women, have familial.
(1) Main clinical manifestations:
1 significant jejunum, no colon movement.
2 can cause chronic intestinal obstruction and cause malnutrition.
3 mild symptoms are not obvious, can be diagnosed until puberty.
4 anus examination of the anal sphincter is normal, the rectum ampulla has no accumulation of "dung.
(2) Diagnosis basis:
1 has the above clinical manifestations.
2 anal finger examination of the rectum and abdomen without feces.
The 3x line abdominal plain film showed dilated colon. The barium enema had a narrow segment in the rectum and sigmoid colon, and the upper end of the colon significantly expanded the feces.
4 confirmed diagnosis depends on the colonic biopsy of the disease section for histochemical staining showing no ganglion cells.
2, chronic idiopathic megacolon: often in the elderly children, or in the elderly over the age of 60, the cause is unknown. Patients often have habitual constipation, personality changes and incontinence (so-called contradictive diarrhea)
Diagnose based on:
1 "Elderly children or elderly people over 60 years of age have "contradictory diarrhea."
2 Anal finger examination can touch the feces in the rectum of the rectum.
3X line abdominal plain film, the elderly patients with the entire colon expansion, the right colon is mixed with gas and feces; in children, the entire colon is filled with feces, no stenosis.
4 biopsy ganglion is normal.
3, physical or mental megacolon: this disease is often associated with physical and mental abnormalities, neurosis or mental illness. Some patients imagine that they have constipation or obsessive-compulsive attitudes and behaviors. They are willing to feel the inhibition. They must take laxatives or enema to feel the smoothness of bowel movements. Otherwise, they will feel uncomfortable and restless. Long-term use of anthracene colon irritants (senna, bohemian and spleen, and reeds cause degeneration of the intermuscular plexus to produce colonic dilatation. Patients with schizophrenia or depression often have defecation and feel suppressed. Phenomena and imbalance between autonomic nerves. Commonly used eagle mites and diazepam, can directly or indirectly inhibit colonic movement through the central nervous system to cause constipation.
Diagnose based on:
1 has a significant medical history, clinically constipation and bloating.
2X line examination has colonic dilatation.
3 can exclude the organic disease of the intestines.
