Correctly understand functional constipation and determine the appropriate treatment
Functional constipation is a very common disease. About 30% of people have experience of constipation or long-term constipation. Functional constipation is a symptom that often manifests as difficulty in defecation or involuntary defecation, and reduced defecation frequency. When people suffer from constipation, they often take some laxatives to help defecate, which over time causes dependence on laxatives. What kind of examinations should I have if I have constipation? What are the different types of constipation? What is the cause? What should I do after getting constipation?
1. What kind of checkups are needed for constipation? Does everyone need colonoscopy and other inspections?
Generally speaking, most doctors will give some basic treatments to patients for the first visit, such as drinking more water, exercising more, eating more crude fiber food, and sometimes prescribing some laxative drugs and expansive laxatives such as lactulose, Polyethylene glycol helps defecation, and various tests are not immediately recommended. Only for certain “alarm factors” such as dark red bloody stools, alternate diarrhea and constipation, short-term constipation and abdominal distension, and people over 40 years old are recommended to undergo colonoscopy to rule out organic lesions in the colorectal; only for constipation For those who take a long time and the effect is not good after taking the medicine, it is recommended to perform anorectal manometry, defecography and colonic transit test to determine the type of constipation and choose a suitable treatment plan. The significance of anorectal pressure measurement is mainly to evaluate the muscle activity and pressure of the anus. The significance of defecography is to simulate the activity of various muscles during defecation. The colonic transmission test is mainly to evaluate the movement of stool in the colon to understand the movement of the colon. Happening.
2. What are the types of functional constipation? How to treat?
According to the above three examinations, functional constipation can be divided into slow transit constipation, outlet obstructive constipation and mixed constipation. Slow transit constipation refers to the decline of colonic transit function. Patients often show involuntary bowel movements and abdominal distension. They often defecate once every 3-5 days. The stools are dry, but they can defecate when they are willing to defecate. There is no obvious abnormality in defecography; outlet obstructive constipation is often manifested as frequent bowel movements but low stool volume, incomplete defecation, or laborious defecation. Defecation imaging often shows that stool is not easy to pass, and the muscles are abnormally contracted. Anorectal pressure measurement often shows muscles. Abnormal operation, decreased sensory function; most patients have both slow colonic transit and outlet obstruction, which is called mixed constipation, and the treatment is more complicated.
1. Colonic slow transit constipation: It is a common type, and the reason is often unclear. Some people have incentives such as taking weight loss drugs, changing dietary habits, and changing lifestyle habits, and some people may take some drugs to cause the disease. Patients often show a decrease in the frequency of defecation, 1-2 defecation a week, low stool volume or involuntary bowel movement. The examination often shows slow colonic transit, but the anorectal pressure measurement and defecation imaging are normal. The first choice for treatment is basic treatment such as drinking plenty of water, exercising more, eating more crude fiber food, and developing regular bowel habits. If it can’t be improved, you can take some swelling laxatives such as polyethylene glycol, lactulose or wheat cellulose. Traditional Chinese medicine laxatives such as Maren Pills and Cistanche laxative oral liquid have certain effects, but it should be noted that long-term use may have certain side effects, and avoid using irritating laxatives such as senna, rhubarb and other anthraquinone ingredients Lubricating laxatives have certain effects on dry stools. Osmotic laxatives are generally not recommended for routine use, only for a short time or intestinal use before colonoscopy. The treatment of slow transit constipation is a long-term process. It will get better soon after not using drugs. It is recommended to exchange different drugs to reduce the side effects of drugs. The long-term treatment of slow transit constipation is ineffective, and total colectomy can be considered. The operation is very traumatic and 70% of the effect is good. However, some patients will develop outlet obstructive constipation during the development process, which leads to a decline in the effect. Therefore, it must be performed before surgery Full evaluation.
(1) Pelvic floor relaxation syndrome: It is the most common pelvic floor dysfunctional disease (pelvic floor dysfunctional disease, PFD). It is more common in middle-aged and elderly women, especially those with a history of childbirth and pelvic surgery. The main reason is During pregnancy and childbirth, muscle damage is caused by excessive stretching of the pelvic muscles. At a young age, there are often not many symptoms. With age, the muscle strength gradually decreases, resulting in the relaxation and weakness of the supporting structure of the entire pelvic floor. Pelvic floor hernia, uterine vaginal prolapse, stress urinary incontinence, rectal protrusion (called posterior vaginal bulge in gynecology), defecation disorder, loose rectal mucosa, causing anal swelling and incomplete defecation. Pelvic floor laxity is a common symptom. Patients often go to the anorectal department according to the patient's constipation and anal bulging as the main symptoms; those with uterine and vaginal prolapse go to the gynecology department, and those who have stress urinary incontinence as the main symptoms. In urology, in terms of treatment, different specialists often only pay attention to their own specialties and ignore the treatment of other symptoms, resulting in poor patient satisfaction with treatment. At present, multidisciplinary joint diagnosis and treatment has become the basic mode of diagnosis and treatment of pelvic floor diseases. More questions.
For patients with pelvic floor relaxation syndrome, the above-mentioned basic treatment should be carried out first. For patients with anal bulging, some hemorrhoids can be used to embolize the anus to relieve symptoms. Second, biofeedback therapy can be used for pelvic floor muscle training. The effective rate of biofeedback therapy is 70%. %, but the long-term effect remains to be observed. In recent years, foreign countries have used perineal support toilets to help patients with pelvic floor relaxation to defecate. The effect is obvious, and there are no obvious side effects. For those with poor efficacy, surgical treatment can be used. Protrusion, rectal protrusion repair surgery, the short-term effect is significant, but the long-term effect is not good, the literature reports that more than 80% of the rectal protrusion and constipation recurrence after 3 years; some recent transperineal sling surgery, including Certain curative effect, but the long-term curative effect needs to be followed up; the use of sling or patch to repair and raise the pelvic floor is a progress in recent years. The method is to suspend the middle pelvic cavity, namely the uterus and vagina, on the sacral promontory, so as to solve at the same time The problem of urinary incontinence in the anterior pelvic cavity, namely the bladder and urethra, has been solved, and the problem of rectal sagging and prolapse has been solved. Moreover, the implantation of the patch from the back of the vagina can strengthen the rectovaginal diaphragm and solve the problem of rectal protrusion. PPH surgery and punctate column ligation of the rectal mucosa can also help the symptoms of anal bulging. Therefore, the pelvic floor problem must be solved in a holistic view. Solving one aspect of the problem alone cannot achieve satisfactory results. The short-term effect of this operation is good, and the long-term effect is under observation.
(2) Pelvic floor dysfunction syndrome: This disease is common in men or young women, and often shows laborious defecation. Anorectal pressure measurement indicates that the anal muscle strength is still normal, but there is abnormal surgery. Defecation imaging indicates that the puborectal muscle may appear "Shelf syndrome", the treatment is based on basic treatment, and when necessary, use some drugs such as Kaisailu. The biofeedback treatment has better curative effect and better long-term curative effect. For severe symptoms, partial puborectectomy surgery has progressed in the past. However, the long-term effect is not ideal, and there is a risk of incontinence, so it must be used with caution.
3. Mixed constipation: It is the most common type of constipation. Therefore, when choosing a treatment plan, both the problems of slow transmission and outlet obstruction should be taken into account. Especially during surgical treatment, it needs to be dealt with. When surgery is performed due to slow transmission constipation, resection After the intestines, repair the pelvic floor at the same time, the effect may be better.
4. Irritable bowel syndrome constipation type: It is more common in young women, and diarrhea and constipation are often present at the same time. There are often no abnormal findings during the above-mentioned examinations. For such patients, it is mainly to adjust the intestinal function, especially the dietary factors. Patients with conditions can be tested for food intolerance.
3. How should patients with constipation see a doctor?
If you have constipation, you may not go to the hospital right away. You can drink more water, eat bananas, sesame oil, honey water and other foods, and defecate regularly to see if it can be relieved. Use lifestyle changes and dietary adjustments to treat constipation The most fundamental method of treatment; if the patient is still unable, especially those who get worse after remission, go to the hospital for treatment. If there is no “alarm signal”, some expansive laxatives and lubricating laxatives are generally used first. If it can be relieved, you can Maintain for a period of time. If it cannot be relieved, it may be recommended to perform anorectal pressure measurement, defecography and colonic transfer test. According to the three examination results, determine the treatment plan. Generally speaking, first conservative, then surgery, surgical treatment as the last step of treatment , And the effect of surgery is not very certain.