primary constipation
Introduction
Introduction Primary constipation refers to constipation caused by the absence of organic diseases. Constipation refers to the reduction of the frequency of bowel movements. The number of stools in a week is less than 2 to 3 times, or 1 to 3 days before stool. The amount of feces is small and constipation is called when dry. However, a small number of people have always had a bowel movement once every 2 to 3 days, and the stool characteristics are normal. This situation should not be considered as constipation; for the same person, if the stool is changed once a day or once every 2 days, 2 Constipation should be considered when the bowel movement is performed once a day or longer. Patients with constipation must be given enough attention to find the cause of constipation.
Cause
Cause
Cause:
Primary constipation is constipation caused by fecal components, mental factors, and decreased intestinal muscle strength. It is different from other organic lesions.
1 diet is too fine, the composition of feces is improper: mostly due to too little or too much diet, the food is seriously insufficient in cellulose and water, so that after the formation of feces, can not stimulate the intestinal wall to cause rectal peristalsis, so that the feces stay in the intestine Prolonged, the stool is dry and difficult to discharge. In countries with high fat and high protein as the main food, there are many people suffering from constipation, which is why.
2 years old and frail, defecation is weak: old and frail, long-term bedridden, maternal pregnant women, and people with too little activity, often due to decreased contractility of the diaphragm, abdominal muscles, anal sphincter, lower abdominal pressure, so that the defecation power is insufficient, Causes the feces to be easily discharged and constipation occurs.
3 mental stress, poor bowel habits: more due to increased mental stress, such as work and study tension, emotional sorrow and anxiety; or because of travel, lifestyle habits are disrupted; or tolerate, intentionally extend the time of defecation; or suffer from anal fissure Anal disease, fear of pain, and control of bowel movements. Repeatedly, the long-term can cause the rectum to reduce the sensitivity of the pressure, forming habitual constipation.
4 excessive water loss: a large number of sweating, diarrhea, vomiting, blood loss, high fever, can make the feces in the intestines reabsorbed too much water, forming dry manure and difficult to discharge.
Examine
an examination
Related inspection
Conventional fecal trait stool microscopy
Laboratory inspection:
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.
Other auxiliary inspections:
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 is ulcer or new organism.
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 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 , can be diagnosed.
Diagnosis
Differential diagnosis
Differential diagnosis:
(1) Acute constipation: Constipation in the near future is called acute constipation, including temporary sexual constipation and symptomatic constipation. Temporary functional constipation is caused by sudden changes in the living environment, temporary depression, and eating too little. Once the cause is eliminated, constipation can heal itself. Symptomatic constipation is an organic constipation, caused by disease, often sudden onset, accompanied by other symptoms, such as severe abdominal pain, vomiting. This type of acute constipation is more common in acute intestinal obstruction. This situation should be diagnosed and handled in a timely manner.
(2) Chronic constipation: Long-term repeated constipation is called chronic constipation. It can be divided into organic constipation and functional constipation, which is common in the elderly and infirm. Chronic constipation is caused by constipation for a long time and is harmful to the human body. It can seriously affect the quality of life of patients and can also cause serious consequences.
(3) Functional constipation: constipation caused by changes in gastrointestinal function, called functional constipation, due to changes in lifestyle, depression, dietary factors, poor bowel habits, and drug effects. For example, people who travel abroad may suffer from constipation due to factors such as changes in their living patterns, changes in their surroundings, and fatigue. This constipation is functional constipation; simple constipation and irritable bowel syndrome are functional. Constipation; if the course of disease has not changed for more than a few years, it is also more suggestive of functional constipation.
(4) organic constipation: constipation caused by direct or indirect effects on intestinal function due to the qualitative lesions in the body, called organic constipation. For example, intestinal obstruction, intestinal adhesions after surgery, large intestine, malignant tumors, large intra-abdominal tumors such as ovarian cysts and other constipation caused by organic constipation. In this case, constipation is often not the only symptom of the patient, and most patients will also have a primary disease. Patients with organic constipation must be treated for the primary disease, and some patients with constipation may even need surgery to finally resolve constipation.
(5) Colon constipation: feces are retained in the colon, called colon constipation. Often occur in people with weak constitution, accompanied by visceral sagging, and old age, major illness, or physical decline.
(6) rectal constipation: feces are retained in the rectum, called rectal constipation. When the feces have already reached the rectum, but because the nerve reaction is slow, it can not cause the intention, so that the feces stay in the rectum for too long and not discharged, so it is also called difficulty in defecation. This type of constipation occurs in people who have no normal bowel habits, hemorrhoids, anal fissures, and frequent enema. Severe rectal constipation, dry and hard fecal mass often embedded in the rectum, called fecal impaction.
(7) flaccid constipation: due to colon and rectal smooth muscle relaxation, intestinal contraction weakness, so that food residue in the colon is slow to occur constipation, called delayed constipation.
(8) spastic constipation: due to colonic exercise is too strong, causing colon and rectum smooth muscle spasm, the intestinal lumen is too narrow, so that constipation caused by the inability of the stool, called sputum constipation. For example, irritable bowel syndrome, due to mental and neurological factors, can cause intestinal smooth muscle tension or colonic spasm and constipation.
(9) mechanical obstructive constipation: mechanical constipation, mostly due to organic constipation, it is due to mechanical obstruction in the intestine or intestine, resulting in obstacles in the operation of intestinal contents. Intestinal obstruction is common in colonic obstruction caused by colon cancer, proliferative intestinal tuberculosis, and intestinal torsion. Extraintestinal compression obstruction is common in postoperative intestinal adhesions, tuberculous peritonitis, pregnancy and so on. This constipation is often accompanied by symptoms of the primary disease.
(10) outlet obstructive constipation: outlet obstructive constipation, also known as functional outlet obstruction constipation, and constipation caused by mechanical obstruction caused by organic disease, often with the rectum sigmoid junction excessive contraction, anorectal movement Abnormalities, decreased sensitivity to rectal bowel movements, and anal fistula are related.
(11) Colonic slow-output constipation: Colonic slow-output constipation is mostly colonic weakness, due to decreased colonic motility and decreased or disappeared colonic propulsive movement after eating, causing colonic emptying to slow down and causing constipation; The moisture in the contents (feces) is excessively absorbed, so that the stool is dry and the constipation is aggravated.
(12) Colon through normal constipation: this type of constipation is a minority, the passage time of intestinal contents in the colon is normal, constipation is mainly related to the increase of the threshold of the rectum for defecation receptors.
(13) Mixed constipation: Mixed constipation refers to constipation caused by the simultaneous presence of colon and slow discharge and stagnation.
(14) Secondary constipation: There are many reasons for secondary constipation, often secondary to constipation caused by intestinal diseases and extra-intestinal diseases. Organic constipation is secondary constipation.
(15) Habitual constipation: refers to long-term, chronic functional constipation, more common in the elderly.
diagnosis:
Functional constipation, simple constipation and idiopathic constipation are primary constipation.
1. 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, and the daily negligence is neglected due to mental factors, changes in life patterns, long-distance travel, etc. Timely defecation; abuse of strong laxatives, weakening the sensitivity of the intestine, forming a dependence on laxatives.
2. Idiopathic constipation: There is no organic disease, and the intractable constipation, which is still unclear, is also called idiopathic constipation.
