Intestinal maintenance of patients after colorectal surgery is a very important issue, which not only has great significance for the patient's quality of life, but also has a major impact on the maintenance of the effect of surgery, so it is a compulsory course for this type of patient. We usually train patients through bedside education after surgery. Most patients have good compliance. However, some patients gradually forget about it in their long-term life, or encounter new problems after they are old and have serious problems. Intestinal dysfunction. Recently, there have been many similar consultations, and some patients with anus preservation even have the idea of abdominal wall fistula. Therefore, it is necessary to write articles to popularize relevant knowledge so that relevant personnel can read.
1. Anterior resection syndrome
Anus-preserving surgery for rectal cancer restores the continuity of the intestines while removing the tumor, avoiding the psychological and physical harm of abdominal wall stoma. Due to the surgical removal of part or all of the defecation reflex arc receptor-the rectal ampulla, and the low anastomosis may damage the internal sphincter, the operation may also cause peripheral nerve damage, anastomotic stenosis and scars, etc., often causing patients to have diarrhea, A series of symptoms such as frequent defecation and incontinence. These are called low anterior resection syndromes.
After most or all of the rectum is removed, the anastomosed intestine is often the sigmoid colon, descending colon, or terminal ileum. Blood circulation can be restored, but it is difficult for the respective innervating nerves to establish consistent coordination functions. As time goes by, the symptoms of most patients improve, and a small number of patients will have serious complications, and even the damage to the quality of life exceeds the harm of the abdominal wall stoma.
2. Self-evaluation of bowel function
1. The evaluation of the frequency of defecation is normal---the number of defecation per day is less than 4; slightly increased---the number of defecation per day is 5-8 times; moderately-increased---the number of defecation per day is 9-12 times; severely increased ---The number of bowel movements per day exceeds 12 times.
2. Anal incontinence score: I degree---stool occasionally stained clothes; degree II—cannot control loose stools and gas, and stool overflow often contaminates clothes; degree III—complete incontinence.
Three, bowel management
Objects of bowel management: People who have undergone colorectal resection due to various reasons and preserved anal or abdominal fistula, of course, also need family members to participate. The goal of bowel management: control diarrhea, soft stools, 1-3 times a day to prevent constipation.
Intestinal management items: diet structure management, perineal or stoma care, auxiliary medication management.
1. Diet structure management
The function of the colorectal is mainly to ferment food, absorb water, shape and store stool. In patients after surgery, the intestines are shortened, or even no colon at all, so the corresponding shortage of functions must be compensated by corresponding adjustments. If the anus and fistula are the "export company", then the export company has problems. First of all, the "import company" must find the cause. It is not appropriate to blindly pursue the responsibility of the export, and even a bit of evasiveness. To manage an import company well is to manage the daily diet structure.
In addition to the role of vegetables to provide vitamins, there is also a role that everyone easily overlooks, intake of fiber. Plant fiber can not only provide raw materials for fermentation, but also a good stool shaper. Therefore, it cannot be simply regarded as an optional food, but an unselectable medicinal material. Without fiber shaping, stool is difficult to form, bowel movement will be accelerated, glycolytic function cannot be performed, and the retention of intestinal flora is also a problem, and defecation is naturally poorly controlled.
We advocate a bowl of rice and a bowl of vegetables, to form a fixed ratio, and mostly leafy vegetables. Some elderly people have poor mouth and chewing ability when they reach a certain age, and gradually reduce vegetables, causing severe diarrhea that is difficult to control. This is to be avoided. Sometimes children will think that eating better and more refined is actually the best, not the delicacies of mountains and seas.
When bowel control is not good, avoid greasy foods, bananas and other fruits, which can easily cause intestinal peristalsis to speed up and make relevant efforts in vain.
2. Perineum or stoma care
After the operation, due to pain, most patients will experience perineal relaxation, and elderly people are prone to perineal relaxation. Once there is poor bowel control, hemorrhoids and erosion of the surrounding skin are more likely to occur, and then fear of eating, leading to a vicious circle and the phenomenon of "the tiger's butt cannot be touched".
In response to this situation, there are several measures.
The first is regular perineal muscle exercises to maintain the strength of the perineal muscles and improve the ability to feel and control bowel movements. 1) Perform anal contraction exercise: the patient performs regular levator levator ani lift and contraction exercises, 3 times/d, 5-10 minutes/time; (2) Guidance for feelings of bowel movement: such as low abdominal pain, abdominal distension, and anal swelling You should go to the toilet immediately to prevent fecal incontinence; (3) Defecation reflex training: go to the toilet 30 minutes after each meal, 3 times/d, 10 minutes/time, stop on time regardless of whether you have defecation or not; (4) Urination interruption training: Suddenly interrupt the flow of urine during urination, and then continue to urinate until the flow of urine is completely stopped. Interrupt 2-3 times each time, and train several times a day; (5) Hip-lifting and arching exercises: lying on the bed with hips and knees , Raise the hips and straighten the hips first, and then arch the abdomen, repeat about 10 times each time, 3-6 times a day.
The second is potassium permanganate bath, local hyperthermia, or shower with hot water from the shower head, usually keep the perineum dry and prevent perineal skin erosion after diarrhea; after skin pain, zinc oxide ointment can be used to protect it.
Third, for people with hemorrhoids, hemorrhoid cream should be used to reduce the symptoms during the edema period. After shrinking, slowly take the hemorrhoids into the anus after a bath or hot water shower, and then lift the anus to speed up the healing of the hemorrhoids.
Fourth, the stoma should protect the skin around the fistula. After diarrhea, zinc peroxide ointment should be applied to the surrounding skin to prevent intestinal juice from corroding the skin.
3. Auxiliary medication management
Generally, patients undergoing colorectal surgery will use Imodium, compound diphenoxylate, berberine and other drugs to assist in bowel control. These three drugs have their own advantages and disadvantages, and you need to understand the characteristics and use them selectively.
Each tablet of compound diphenoxylate (DA) contains diphenoxypyridine (DPX) 2.5 mg and atropine (ATR) 0.025 mg. Phenylpiperidine is a derivative of pethidine. It has a weak long-term opioid effect and has a morphine-like effect on the intestinal tract. It inhibits the intestinal mucosal receptors and reduces bowel movements. It is a non-specific antidiarrheal drug. Some sensitive people are prone to symptoms of poisoning and should not be used under 2 years old.
Imodium (loperamide hydrochloride) is used to prevent diarrhea by inhibiting gastrointestinal propulsion. Clinically, Imodium is widely used in the treatment of various diarrhea, and the curative effect of Imodium can reach 50% to 70%. However, adverse reactions should not be ignored. There is a tendency of repeated curative effects and dose-dependence, occasional unsmooth defecation, and defecation once every 2-3 days.
Berberine is an isoquinoline alkaloid extracted from the rhizomes of Coptis in the Ranunculaceae family. It has been used in the treatment of diarrhea for more than 3000 years. Berberine is an important alkaloid, a traditional Chinese medicine that has been used for a long time in China. It can be extracted from plants such as Coptis chinensis, Phellodendron amurense, Sankezha, etc. The commonly used berberine hydrochloride is also called berberine hydrochloride and belongs to the class of western medicine. Berberine can fight pathogenic microorganisms and is commonly used to treat gastrointestinal diseases such as bacterial gastroenteritis and dysentery. Recent studies believe that it is a calcium channel antagonist with definite efficacy and has been widely used in the treatment of digestive, cardiovascular, diabetes and other diseases. It has an inhibitory effect on a variety of bacteria such as Shigella, Mycobacterium tuberculosis, pneumococcus, typhoid bacillus and diphtheria bacillus. Among them, it has the strongest effect on Shigella bacillus. It is mainly used to treat bacillary dysentery and gastroenteritis. It has no drug resistance and side effect. The compound berberine tablets are composed of berberine hydrochloride, woody, evodia, and white peony. It not only has the antibacterial and calcium channel antagonistic effects of berberine hydrochloride, but also has the regulating effect of intestinal function, which is better than berberine hydrochloride tablets.
The usual recommended dosage of berberine is 2-4 capsules, 3 times a day. Our experience is that this dose is effective for general enteritis, but has little effect on patients with anatomical changes. The extreme daily dosage of berberine is 20 capsules, which can be used to control bacillary dysentery. Take it once a meal, or take 10 capsules once, twice a day. For those with a mild increase in the frequency of bowel movements, you can take 6 capsules 2-3 times a day; for those with moderate or severe bowel movements, you can try 10 capsules twice a day. Generally, it does not need to be taken continuously, and appropriate adjustments should be made according to the number of stools and the shape of the stools to explore their own rules. If you take large doses for several days, dry stools may occur, which should be avoided. It's like a vehicle stepping on the brake when it is going downhill. If the speed is too fast, it will take a longer time. Don't step on the brake when the speed is out of control, and don't step on it to death.
Everyone is welcome to provide personal experience!