2020年10月18日星期日

hemorrhoids home remedies,Anorectal Disease Series Knowledge and Questions and Answers-Chronic Constipation

    Chronic constipation

    Chronic constipation is a long-term recurrent constipation. Its onset can be transformed from acute constipation for a long period of time, or it can be chronic constipation at the beginning of the onset. The latter is more common in constipation caused by chronic diseases. Constipation is a disease in which the constipation is blocked, the bowel time is prolonged or the desire to defecate is difficult. Constipation is temporary or long-term. Usually, long-term constipation is also called chronic constipation.

    Overview

    Chronic functional constipation is a common and frequently-occurring disease. The Rome II diagnostic criteria for chronic functional gastrointestinal diseases were again formulated at the World Gastroenterology Conference held in Rome in 1999, and the diagnostic criteria for chronic functional constipation were set as: at least 3 consecutive months in the past year Or intermittently appear with 2 or more of the following symptoms: (1) Less than 1/4 of the time there is laborious defecation; (2) Less than 1/4 of the time, there is dry stool; (3) Less than 1/ 4 Incomplete defecation within 4; (4) Anal obstruction or anorectal obstruction during defecation less than 1/4 of the time; (5) Manipulative assistance is required for defecation less than 1/4 of the time; (6) Less than 1/4 of the time, there are fewer than 3 bowel movements per week. There is no loose stool, nor does it meet the diagnostic criteria for irritable bowel syndrome; at the same time, constipation caused by intestinal or systemic organic causes and drug factors should be excluded.

    Causes of chronic constipation

    Chronic constipation has functional and organic causes. Organic diseases can be caused by gastrointestinal diseases, systemic diseases involving the digestive tract such as diabetes, scleroderma, neurological diseases, etc. Many drugs can cause constipation, as follows: Intestinal organic diseases such as tumors, inflammation or other causes Intestinal stenosis or obstruction caused.

    1. Rectal and anus lesions: internal rectal prolapse, hemorrhoids, anterior bulge, puborectal hypertrophy, puborectal separation, pelvic floor disease, etc.

    2. Endocrine or metabolic diseases: such as diabetic enteropathy, hypothyroidism, parathyroid disease, etc.

    3. Nervous system diseases: such as central brain disease, stroke, multiple sclerosis, spinal cord injury and peripheral neuropathy

    4. Intestinal smooth muscle or neuronal disease

    5. Colonic neuromuscular disease: pseudo intestinal obstruction, Hirschsprung's disease, giant rectum, etc.

    6. Mental and psychological disorders

    7. Pharmaceutical factors: aluminum antacids, iron agents, opioids, antidepressants, anti-Parkinson's disease drugs, calcium channel antagonists, diuretics, and antihistamines.

    8. Others: patients who exercise less, have special occupations, or have undergone abdominal or pelvic surgery and take special drugs.

    Types of chronic constipation

    Types of chronic constipation: divided into slow transit type, outlet obstruction type and mixed type. The constipation type of IBS is a type of constipation related to abdominal pain or bloating. At the same time, it may also have the following characteristics.

    1. Slow transit constipation (STC) has the following manifestations:

    (1) There is often a decrease in the frequency of defecation, less stools, and hard stools, which makes it difficult to defecate.

    (2) There was no stool or hard stool during digital anorectal examination, and the anal contraction and force excretion functions of the external anal sphincter were normal.

    (3) The passage time of total gastrointestinal or colon is prolonged.

    (4) Lack of evidence of outlet obstructive constipation, such as normal balloon expulsion test and normal anorectal manometry.

    2. Outlet obstructive constipation (OOC) can have the following manifestations:

    (1). The bowel movement is laborious, incomplete or falling, and the amount of bowel movement is small, and the bowel movement is intentional or lacking.

    (2) There are a lot of mud-like stools in the rectum during digital anorectal examination, and the external anal sphincter is contradictory contraction during force discharge.

    (3) The total gastrointestinal or colon transit time is normal, and most of the markers can be retained in the rectum.

    (4) The anorectal pressure measurement showed that the external anal sphincter showed contradictory contraction during force discharge, or the sensory threshold of the rectal wall was abnormal.

    3. Mixed constipation: It has the characteristics of 1 and 2 above.

    Chronic constipation is classified by location

    The etiology of chronic constipation is more complicated. According to the location of the disease, it can be divided into two types:

    1. Colonic constipation. Constipation caused by mechanical obstruction inside and outside the colon is called mechanical constipation. Constipation caused by weakened or lost colonic function is called asthenia constipation. Constipation caused by spasm of intestinal smooth muscle is called spastic constipation.

    2. Rectal constipation. Due to the weakened sensitivity of rectal mucosal receptors, fecal masses accumulate in the rectum. Seen in rectal cancer, perianal diseases, etc. Habitual constipation is more common in middle-aged and old women and women in labor.

    Causes of chronic constipation

    1. Less exercise: The elderly have little activity, weak abdominal muscles, slow gastrointestinal peristalsis, food and residues are not easy to push down, and are prone to constipation.

    2. Poor mental health: Most elderly people who are nervous and depressed have symptoms of constipation. This is due to the disorder of neuroregulation. Some chronic diseases, such as hypothyroidism, psychological disorders, etc. can cause symptoms of constipation.

    3. Drug factors: Many elderly people suffer from cardiovascular and cerebrovascular diseases and need long-term medication. Some antihypertensive drugs and diuretics can cause constipation.

    4. Lack of water in the body: Elderly people lose their ability to feel thirsty, and they do not feel thirsty when the body lacks water. This reduces the water in the intestinal tract of the elderly and causes dry stool.

    5. Dietary factors: The lack of foods with high fiber content in the diet, especially the lack of coarse grains and fruits, leads to the decrease of water in the large intestine and the imbalance of the flora, causing constipation.

    Clinical manifestations

    Chronic constipation usually has no obvious symptoms, but those who are nervous, may complain of loss of appetite, mouth pain, abdominal distension, belching, paroxysmal lower abdominal pain, excessive gastrointestinal symptoms, and may also be accompanied by dizziness, headache, fatigue and other nerves Symptoms of dysfunction. The occurrence of symptoms may be related to intestinal dysfunction, or may be related to mental factors. Because the stool is dry and hard, or sheep feces, the patient may have lower abdominal cramping pain, falling feeling and other discomfort. Sometimes the spasm of the sigmoid colon is palpable in the left lower abdomen.

    Chronic constipation can still be divided into organic constipation and functional constipation, which are more common in the elderly and frail people. Chronic constipation takes a long time and is harmful to the human body. Therefore, patients with chronic constipation must pay attention to its treatment.

    Treatment measures for chronic constipation

    1. Treatment of the primary disease: After the diagnosis of the primary disease has been identified, the corresponding measures shall be adopted for active treatment. If the anal fissure can be treated by local anesthesia, expansion of the anus or internal sphincter lateral resection; colon tumors can be treated with radical or palliative resection; if the constipation is caused by drugs, the drug should be discontinued or another drug that does not cause constipation should be stopped; psychosis, Constipation caused by endocrine and metabolic diseases should be treated accordingly to eliminate the impact of the original disease on intestinal function as soon as possible.

    2. General treatment: If the primary disease is difficult to correct or has no obvious primary factors, the general measures are beneficial to most patients with constipation.

    3. Drug treatment: There are many drugs that can be used for the treatment of constipation, but most of them are not suitable for chronic constipation patients, nor suitable for long-term application. At present, the abuse of laxatives is more common, resulting in a few iatrogenic constipation, and should be carefully selected clinically.

    4. Enema: The main indications are preoperative bowel preparation, fecal impaction, and acute constipation. Warm normal saline is more suitable because it has little irritation to the intestines. The soapy water should be avoided because it is too irritating to the colonic mucosa. In addition, frequent enema is dependent and should be paid attention to.

    5. Surgical treatment: The indications for surgical treatment are mainly constipation caused by organic or functional lesions of the colon, rectum and anal canal.

    Diet for chronic constipation

    Patients with chronic constipation should eat more fruits, especially in the season of lack of vegetables, eat 1 to 2 fruits a day, such as oranges, apples, pears, peaches, watermelons, etc., to increase multiple vitamins and help maintain smooth stool; Some people recommend drinking 1 to 2 cups of honey water every day, or sautéing sesame seeds and mixing them in food, which is beneficial to prevent constipation.

    Patients with chronic constipation should pay attention to the combination of thickness and coarse grains, such as corn flour, millet, buckwheat noodles, sweet potatoes, red beans, etc. The food has more formed parts, which is beneficial to stimulate the physiological peristalsis of the intestine and reduce constipation.

    For non-staple foods, use more cellulose-containing vegetables, such as radishes, leeks, celery, Chinese cabbage, rape, etc. In this way, more food residues passing through the intestine can increase the frequency of bowel movements. If you add some vegetable oils to the food, such as soybean oil, peanut oil, sesame oil, etc., it can also have a laxative function; add some soup to the diet, usually pay attention to drink more boiled water, if necessary, drink 1 cup of light salt water every morning , Helps to maintain moisture in the intestinal tract, helps to soften feces and relieves constipation.

    The dangers of chronic constipation

    Although constipation is not a serious disease, it is very painful and can lead to some complications. The stool accumulates in the intestines and continuously produces various poisonous gases and toxins, resulting in deterioration of the intestinal environment, gastrointestinal dysfunction, endocrine disorders, metabolic disorders, appetite and Poor sleep and nervousness. Stool compresses the intestinal wall, injures the intestinal mucosa, slows intestinal peristalsis, and leads to habitual constipation and intractable constipation. The foul smell produced by the stool causes bad breath and bad fart. The stool produces 22 toxins that are repeatedly absorbed by the intestine and reach through the blood circulation Various parts of the human body cause dull complexion, rough skin, dilated pores, brown spots, acne, fine wrinkles, obesity, fatigue, irritability, and toxins in the stool enter the blood, leading to high blood pressure, heart disease, hemiplegia, and old age. Dementia will also aggravate cardiovascular and cerebrovascular diseases in the elderly. For patients with hypertension and coronary heart disease, constipation is very dangerous. These patients often have sudden cerebrovascular accidents during defecation, which can worsen coronary heart disease and even die. For young people, constipation can cause endocrine disorders, bad temper, and facial acne sores. In addition, constipation can also cause high fever and persistent coughing. And for these diseases, through laxative treatment, miraculous results can be achieved.

    Constipation has a greater impact on women and may cause menstrual disorders and incorrect uterine position. This is because the rectum is over-filled with stool, the cervix is ​​pushed forward, and the uterus is tilted back. If retroversion of the uterus occurs repeatedly for a long time, the veins in the broad ligament will be compressed and blocked. Therefore, the uterine wall will also be congested and lose its elasticity, which in turn will keep the uterus in a backward tilt position for a long time, causing sacral pain, low back pain, menstrual disorders, and anorectal swelling during menstruation.

    What is chronic constipation and what is the harm?

    Constipation is a common condition caused by a variety of causes. Patients often experience dry stools, difficulty in defecation, or incomplete defecation. When laxatives are not used, the number of times to completely empty the stool is significantly reduced.

    The survey data on constipation in different countries have different methods. The prevalence of constipation in the U.S. population ranges from 2% to 28%. A survey of people over 60 years old in Beijing, Tianjin and Xi’an in China shows that the chronic constipation rate for people over 60 years old in China is as high as 15%-20 %. A randomized, stratified, and graded survey of adults aged 18-70 in Beijing showed that the incidence of chronic constipation was 6.07%, which is more than 4 times that of men in women, and mental factors are one of the high-risk factors.

    The hazards of constipation:

    With the change of dietary structure and the influence of mental, psychological and social factors, constipation has seriously affected the quality of life of modern people; and has an important role in the occurrence of diseases such as colon cancer, hepatic encephalopathy, breast disease, and Alzheimer's disease; Constipation can lead to life accidents in acute myocardial infarction, cerebrovascular accidents and other symptoms; some constipation is closely related to anorectal diseases such as hemorrhoids and anal fissures.

    Therefore, to avoid the harm of constipation, only early prevention and reasonable treatment of constipation will greatly reduce the serious consequences and social burden of constipation.

    Chronic constipation affects male sexual function

    Studies have shown that there is a certain connection between long-term constipation and sexual life. If a man suffers from constipation, it will cause a series of symptoms of sexual dysfunction.

    To explore the root causes of constipation affecting the lives of couples, we must also start with the principle of human defecation reflex. The defecation center that stimulates the human body to defecate is located in the sacral spinal cord. For people with chronic constipation symptoms, this set of central reflexes is not smooth, which not only causes long-term involvement of the rectum, causes unstable anal pressure, tight perianal contractions, and also causes problems around the rectum. The pelvic muscles are chronically stimulated, and the levator ani muscles, deep transversus perineum, urethral and vaginal structural muscles, and bulbocavernosum muscles can all exhibit spastic contraction. These muscle groups are closely related to the erection of the penis and the normal performance of ejaculation. In addition, long-term constipation is also a "catalyst" for the formation of anal hemorrhoids, which can cause perianal pain, bleeding, and infection, which brings great psychological pressure to patients. Anal hemorrhoids and chronic constipation often cause and effect each other, which easily forms a vicious circle.

    Experts remind that when sexual dysfunction occurs, you must pay attention to whether you have constipation, and you must not underestimate chronic constipation. In addition, some people who suffer from constipation often go to the pharmacy to buy laxatives by themselves, which is extremely undesirable. Because if the medication is improperly used, it can not only induce melanosis and neurogenic pseudo-obstruction, but also cause severe drug dependence.

    Traditional Chinese medicine treatment of chronic constipation

    2. Shaogan decoction to treat constipation: take 30 grams of raw white peony root, 20 grams of raw licorice, 15 grams of Citrus aurantium, add 2 bowls of water and fry into half a bowl, 1 dose a day, divided into 2 times. This prescription treats 95 cases of constipation caused by various reasons with satisfactory results. This method is especially suitable for elderly, chronically ill and frail adults with constipation, but pregnant women should use it with caution.

    3. Treatment of constipation with Forsythia: Take 15-30 grams of Forsythia, boil it as a tea, and take 1 dose a day. Children can be mixed with white sugar or rock sugar (the effect is better without sugar). Continue to take 1 to 2 weeks, you can stop taking. This prescription is especially suitable for post-operative constipation, women (pregnancy, menstruation, postpartum) constipation, post-traumatic (craniocerebral injury, lumbar fracture, paraplegia) constipation, hypertension constipation, habitual constipation, elderly weakness constipation, cerebrovascular disease Constipation and cancer constipation, etc.

    4. Treatment of constipation by Plantago Seed: Take 30g of Plantago Seed every day, add water and decoct to make 150ml, 3 times a day, take before meals, 1 week is a course of treatment. Generally, it can be cured after 1 to 4 courses of treatment. Stop taking other drugs during the medication. This prescription can not only treat constipation, but also lower blood pressure. It is especially suitable for patients with high blood pressure and constipation. In addition, the treatment of diabetic constipation patients mainly with Psyllium has obvious short-term and long-term effects.

    5.Treatment of constipation by Fatty Sea: Take 5 slices of Fatty Sea, put them in a tea cup or bowl, and brew with about 150 ml of boiling water for 15 minutes. When it grows larger, take a small amount of it and drink it frequently, and it will increase the fat The sea is also eaten slowly. Don't eat the nucleolus of the fat sea. Generally, the stool can be unblocked in 1 day.

    6. Treatment of constipation with Baizhu powder: Take a proper amount of Baizhu powder, crush it into very fine powder, and take 10 grams Baizhu powder 3 times a day. This method has a good effect on deficiency constipation. Generally, after 3 to 5 days of medication, the stool can return to normal, and the drug can be stopped after the stool is normal. After taking the medicine for 2 to 3 days every week, it can maintain normal stool for a long time.

    Chronic constipation diet adjustment program

    (1) The food should not be too fine, let alone partial eclipse, increase the fiber content in the diet, such as whole grains, vegetables (radish, leeks, raw garlic, etc.), fruits (apples, red dates, bananas, pears, kiwis, watermelons, oranges) , Grapefruit, jujube, mulberry and other fruits rich in dietary fiber).

    (2) Get enough water. Drinking 1-2 cups of light salt water or boiling water or honey water on an empty stomach every morning can prevent and treat constipation.

    (3) Intake appropriate amount of vegetable fats in the diet, such as sesame oil, soybean oil, etc., and eat hard fruits containing more vegetable oils such as walnuts and sesame.

    (4) Eat foods that help moisturize the intestines appropriately, such as honey and yogurt.

    (5) You can often eat some medicated porridge that can prevent and treat constipation, such as sesame porridge, walnut porridge, spinach porridge, and sweet potato porridge.

    (6) Eat less strongly irritating foods, such as chili, curry and other condiments, and avoid drinking alcohol or strong tea.

    What to do with chronic constipation

    Long-term chronic constipation: Find a specialist, analyze the cause, and provide individualized solutions.

    Laxative dependence: gradually change stimulant laxatives to osmotic or volumetric laxatives to restore intestinal motility;

    Diabetes: Control blood sugar and add dietary fiber to kill two birds with one stone;

    Fine diet: dietary fiber;

    Disturbance of the intestinal environment: dietary fiber and beneficial bacteria supplement;

    Psychological barriers: psychological counseling and adjustment

    There are still a considerable number of patients with long-term intractable constipation who need to find a specialist to find the disease through a special examination. The doctor asks the medical history in detail; defecography; colon transfer test; colonography; anorectal pressure measurement; pelvic floor electromyography, etc.

    Diet arrangements for chronic constipation

    Chronic constipation is a common disease of the elderly. Because the elderly have poor absorption capacity, the effect of drug treatment is obvious. However, if you can pay attention to the rational arrangement of diet for patients with chronic constipation, the effect is sometimes better than drug treatment.

    Because people who often eat fine foods such as rich flour and refined rice often have constipation, when choosing foods, under the premise of ensuring that they are easy to digest, they should pay attention to the combination of coarse and fine grains, such as corn noodles, millet, and soba noodles. , Sweet potatoes, red beans, etc., which have more formed foods, which are beneficial to stimulate the physiological peristalsis of the intestine and reduce constipation.

    For non-staple foods, use more cellulose-containing vegetables, such as radishes, leeks, celery, yuan cabbage, rape, etc. In this way, more food residues passing through the intestine can increase the frequency of bowel movements. If you add some vegetable oils to the food, such as soybean oil, peanut oil, sesame oil, etc., it can also have a laxative function; add some soup to the diet, usually drink more boiled water, if necessary, drink 1 cup of light salt water every morning , Helps to maintain moisture in the intestines, softens feces, and relieves constipation.

    Patients with chronic constipation should eat more fruits, especially in the season when vegetables are lacking, eat fruits every day, such as oranges, apples, pears, peaches, watermelons, etc., to increase multiple vitamins and help maintain smooth stool; some people recommend drinking daily Honey water, or stir-fried and crushed sesame seeds, mixed with food, is beneficial to prevent constipation.

    What are the common causes of chronic constipation?

    Chronic constipation is recurrent constipation for a long period of time. Its onset can be transformed from acute constipation that does not heal for a long time, or it can be chronic constipation at the beginning of the onset. The latter is more common in constipation caused by chronic diseases. Chronic constipation has the following common causes:

    1. Less physical activity: The elderly have weak abdominal muscles, slow gastrointestinal peristalsis, food and residues that are not easy to move downwards due to lack of activity, and are prone to constipation.

    2. Poor mental health: Most elderly people who are nervous and depressed have symptoms of constipation. This is due to the disorder of neuroregulation. Some chronic diseases, such as hypothyroidism, psychological disorders, etc. can cause symptoms of constipation.

    3. Drug factors: Many elderly people suffer from cardiovascular and cerebrovascular diseases and require long-term medication. And some antihypertensive drugs, diuretics, etc. can cause constipation.

    4. Lack of water in the body: Elderly people lose their ability to feel thirsty, and they do not feel thirsty when the body lacks water. This reduces the water in the intestinal tract of the elderly and causes dry stool.

    5. Dietary factors: The lack of foods with high fiber content in the diet, especially the lack of coarse grains and fruits, leads to the decrease of water in the large intestine and the imbalance of the flora, causing constipation.

    What are the characteristics of chronic constipation?

    Chronic constipation can be transformed from acute constipation that does not heal for a long time, or it can be chronic constipation at the beginning of the onset. The latter is more common in constipation caused by chronic diseases.

    The causes of chronic constipation can be gastrointestinal diseases, systemic diseases involving the digestive tract, such as diabetes, scleroderma, neurological diseases, etc. Many drugs can also cause constipation. Common causes include lack of defecation motivation, such as old age, infirmity, and obesity. Or obvious weight loss, multiple pregnancies, weakened abdominal muscles, intestinal smooth muscles, and levator ani muscles caused by the parturient; excessive nervousness, fatigue, and colonic dysfunction can cause constipation.

    Patients with chronic constipation have the following characteristics: the food residues of the patient cannot be discharged after 40 hours after eating, or they often rely on drugs or enema, and the spontaneous defecation reflex is weakened. Chronic constipation can still be divided into organic constipation and functional constipation, which are more common in the elderly and frail people. Chronic constipation takes a long time and is harmful to the human body. Therefore, patients with chronic constipation must pay attention to its treatment.

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