Colonic constipation
Introduction
Introduction Colonic constipation is caused by a decrease in colonic tone, that is, relaxation of the intestinal smooth muscle and weakening of the intestinal peristalsis, causing the food residue to run slowly in the colon, causing constipation. Colonic constipation occurs mostly in people with weak constitution and symptoms of visceral ptosis, as well as elderly aging, major illness, or decreased physical strength. Long-term persistent constipation of the colon can cause abdominal distension, abdominal pain, loss of appetite and other symptoms.
Cause
Cause
Colonic constipation is a disorder of colonic dysfunction, and its etiology is still unclear. Decreased intestinal ganglion is one of the main causes of colonic constipation. Colonic constipation has a family hereditary tendency, which is more common in women, indicating that the disease is a congenital part of the colon, and the intestinal ganglion is reduced. The lesion is very similar to the megacolon. The lesion with reduced ganglion first involves the sigmoid colon. And tend to develop upwards, involving the descending, transverse, ascending colon, and even the cecum and ileum. Only the degree and extent of intestinal ganglion reduction are different. The intestinal ganglion of the megacolon completely disappears in part of the intestine. However, the reduction of the intestinal ganglion will inevitably lead to the weakening of the intestinal tract and peristalsis, and the proximal intestinal tube tension is increased and passively expanded. Efforts to increase contraction to overcome the resistance of the sacral intestine, this chronic and persistent obstruction will eventually decompensate the proximal bowel and form intractable constipation.
Although constipation patients with long-term use of stimulant laxatives lead to acquired intestinal plexus damage, and even mucosal blackening, but the affected intestines are often the whole colon or the whole intestine, not limited to one or several parts of the colon. Not only neurodevelopmental abnormalities, but also abnormal morphological development, manifested as excessive length, excessive swimming, formation of flexion and angulation in the abdominal cavity or pelvic cavity, increasing the resistance of colonic transport, and undoubtedly one of the causes of colonic constipation. During the barium enema, it can be seen that the tincture is blocked at the angle of the bend. In the standing position, it is common to form an acute angle between the spleen of the colon and the rectum of the sigmoid colon, and the emptying of the transverse colon and the sigmoid colon is blocked. When the patient's head is low and the head is high, the two acute angles disappear and the colon emptying speeds up. In clinical treatment, we also noticed that most patients with colonic constipation often perform knee chest exercise to relieve constipation symptoms.
Examine
an examination
Related inspection
Lower gastrointestinal tract examination, rectal examination, fiberoptic colonoscopy
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
Rectal constipation: occurs in the morning without defecation time, hemorrhoids, anal fissure pain and frequent enema. Rectal constipation in patients with anal fissure can exacerbate anal fissure, as stools during rectal constipation tend to be particularly hard.
