postpartum constipation
Introduction
Introduction 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. The cause of maternal constipation is, on the one hand, long-term bed rest after childbirth, little activity, slowing of bowel movements, and at the same time, the abdominal wall is dilated during pregnancy, the abdominal wall is weak after delivery, and the abdominal pressure is lowered. This will make the contents of the intestines easily stagnant in the intestines and difficult to discharge. On the other hand, the main reason is that the postpartum diet is not well-fed, eating too much fine food, not eating or eating vegetables, fruits and other fiber-rich foods, and some people still drink less water. This will inevitably lead to constipation and induce anal fissure.
Cause
Cause
There are four reasons for postpartum constipation:
1. Due to the weakening of gastrointestinal function during calving, the intestinal peristalsis is slow, and the intestinal contents stay in the intestine for a long time, so that the absorption of water causes dry stool.
2. After excessive expansion of the abdomen of the pregnancy, the abdominal muscles and the pelvic floor tissue are relaxed, and the defecation force is weakened.
3, postpartum human weakness and weakened bowel movements. Therefore, constipation often occurs after childbirth.
4, the diet structure is not reasonable, vegetables, fruits eat less.
Examine
an examination
1. Cytological examination of membranous 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. Chorionic gonadotropin (HCG): Human chorionic gonadotropin is 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, spinal fluid bilirubin: a method of examination of cerebrospinal fluid.
5, the porphyrin in the stool: stool examination.
6, Vitrin D (VitD): the body's essential vitamins.
7. Tumor gene P53 antibody (P53-AB): The P53 gene is a gene that has been extensively studied. P53 antibodies can be used for early diagnosis of various tumors and screening tests for tumors.
8, 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, phosphate phosphate: stool phosphate test, a project in stool routine. It mainly reflects the phosphate content in people's daily diet.
10, red blood cells: fecal red blood cell examination, is a routine routine stool, you can understand the function of digestion, absorption, and help diagnose digestive diseases.
11, white blood cells: fecal white blood cell examination is a project in the stool routine, can help understand the function of digestion and absorption, and help diagnose digestive diseases.
12, pus: fecal pus examination, the examination method is simple, the results are intuitive, can provide preliminary status of the digestive tract function or pathological changes, and indirectly determine the function of the gastrointestinal, pancreas, liver and gallbladder.
Diagnosis
Differential diagnosis
(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, intestinal fistula, mainly caused by chronic abdominal pain and constipation.
2, sexual 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 It can be mildly tender in the left lower abdomen and the sigmoid colon filled with feces and sputum. Anal finger examination of the rectum and abdomen without feces; 4 patients often accompanied by heartburn, abdominal distension, back pain, weakness, dizziness, palpitations and other symptoms.
Diagnostic points:
1 has the above clinical characteristics;
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 endocrine, rectal anal and other organic constipation, can be considered as laxative bowel disease. 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 Early symptoms of colorectal cancer are not obvious. Changes in bowel habits such as constipation or diarrhea, or alternating between them may be early manifestations of colorectal cancer; 2 hemorrhage, especially after defecation, is a common symptom of colorectal cancer; There may be persistent pain in the abdomen, constipation and urgency often exist simultaneously; 4 invasive colorectal cancer is prone to intestinal obstruction; 5 abdominal examination and anal finger examination sometimes touch the mass.
2, diagnosis based on patients over the age of 140 have the above clinical manifestations; 2 occult blood continues to be positive and no evidence of stomach disease; 3 abdominal examination along the colon or rectal examination revealed a mass; 4 carcinoembryonic antigen can be elevated, but no specificity 5 sputum 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: 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 tympanic colon, no colonic movement; 2 can cause chronic intestinal obstruction and cause malnutrition; 3 mild symptoms are not obvious, can be diagnosed until puberty; 4 anal finger examination anal sphincter is normal, There is no feces in the rectum of the rectum.
(2) Diagnostic basis: 1 has the above clinical manifestations; 2 anal finger test rectal ampulla without a feces; 3x line abdominal plain film can be seen in the dilated colon, barium enema has a narrow segment in the rectum, sigmoid colon, and the upper colon significantly expands Accumulation; 4 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 personality changes and incontinence due to habitual constipation (so-called contradictive diarrhea).
Diagnosis basis: 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 colon expansion of the entire colon, gas in the right colon Mixed with feces; in children, the entire colon is dilated and 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.
