(1) What is the general principle of treating constipation?
1. Eliminate the cause: Constipation, as a symptom, is the information and reflection of pathophysiological changes in the human body. Whether it is organic constipation or functional constipation, the causes are very complicated. Therefore, the treatment of constipation, like the treatment of any disease, must first find out the cause. Treatment of the cause is the fundamental principle of treatment of constipation. For example, lead poisoning constipation, lead poisoning treatment must be taken to relieve the constipation gradually; for the constipation caused by proliferative intestinal tuberculosis, systematic anti-tuberculosis treatment and even surgical treatment must be adopted to achieve good results. The same is true for the treatment of functional constipation. For example, habitual constipation caused by bad habits must start with changing bad habits, such as changing foods that are too fine, drinking less water, not defecation on time, tolerating bowel movements, and too little activity. These measures are essential for the treatment of habitual constipation. Therefore, people suffering from constipation must first go to the hospital to be examined by a specialist in anorectal surgery to find out the cause of the constipation, and then follow the doctor’s instructions to take the cause of treatment, and do not blindly treat the symptoms with laxatives.
2. Prevention of micro-duty: It emphasizes early detection and early treatment. Even if it is mild constipation, don't ignore it. Find out the cause, take active and effective treatment measures, and correct it in time. Otherwise, it will become heavier over time. When intractable constipation causes a lot of pain, it is not easy to treat it.
3. Patient treatment: some functional constipation, such as habitual constipation or intractable constipation, is very difficult to treat. The patient must cooperate with the doctor to formulate a systematic comprehensive treatment plan, including daily life, diet therapy, physical exercise, medical sports, training of good bowel habits, and drug-cooperative treatment. For systematic and planned treatment, you must be patient And confidence, perseverance, do not be anxious, often the more anxious, melancholy, and anxious, the more constipation.
4. Do not abuse drugs: especially laxatives cannot be abused. Many patients with constipation abuse laxatives without the guidance of a doctor. As a result, the gastrointestinal function becomes more disordered, constipation is aggravated, or they become dependent on laxatives.
5. It is not easy to use enema to relieve constipation. When using enema to induce bowel movement, the indication must be selected. Generally speaking, only those patients with severe constipation, who are ineffective by general treatments, and are very painful, should use enema to laxative for emergency symptomatic treatment. This is only a stopgap measure.
In short, using laxatives as an auxiliary treatment method, mainly relying on changing life and eating habits to eliminate constipation, is the shortcut and good way to treat constipation.
(2) Why can't we use laxatives randomly?
The same is constipation, which can be divided into several categories according to the cause and symptoms, such as functional constipation, organic constipation, flaccid constipation, spastic constipation, etc. The treatment methods are also different. Therefore, laxatives cannot be used altogether, and laxatives cannot be abused.
The so-called abuse of laxatives refers to patients with constipation who, without a doctor’s diagnosis and guidance, indiscriminately take laxatives for laxatives when they see the constipation without knowing the cause of the constipation and the effects of laxatives. As everyone knows, overuse of laxatives has three major harms: 1. It can lead to the habit, dependence, and even addiction of taking laxatives, and it will be more difficult to defecate after stopping the drug. 2. It can cause drug resistance. Due to frequent laxatives, it often stimulates the intestinal mucosa and weakens its stress. In this way, the use of laxatives will continue to passively increase in order to take effect. For example, two bezoar detox tablets or fruit guide tablets can be used to laxate at the beginning. Later, it is difficult to pass 4-6 stools each time. There are many such examples. 3. Laxatives, especially stimulant laxatives, produce frequent and repeated stimulation of the intestines, which can cause gastrointestinal dysfunction and indigestion, except for upper abdominal fullness, warming, nausea, vomiting, bowel, and excessive exhaust. , It will also aggravate loss of appetite, which will further aggravate constipation and lead to a vicious circle.
1. Lifestyle adjustment: A reasonable diet, drinking more water, increasing exercise (especially focusing on abdominal muscles and pelvic floor muscle exercise) and establishing good bowel habits are the basic treatment measures for patients with chronic constipation. It is necessary to increase fiber in the diet, and the recommended daily intake of dietary fiber is 25-35 g. Fiber content of common foods: wheat bran 31%; cereals 4-10%, arranged from most to less wheat, barley, corn, soba, barley noodles, sorghum rice, black rice; oatmeal 8-9%; oats Slices 5-6%; potatoes, sweet potatoes and other potatoes have about 3% cellulose content; beans 6-15% (arranged from more to less into soybeans, green beans, broad beans, kidney beans, peas, black beans, adzuki beans, mung beans ); Vegetables: bamboo shoots have the highest content. The cellulose content of dried bamboo shoots reaches 30-40%, and peppers exceed 40%. The rest contain more cellulose, fern, cauliflower, spinach, pumpkin, cabbage, rape; fruits : The highest content is dried red fruit, the cellulose content is close to 50%, followed by dried mulberries, cherries, wild dates, black dates, jujubes, jujubes, pomegranates, apples, and pears. All kinds of meat, eggs, dairy products, all kinds of oil, seafood, alcoholic beverages, and soft drinks do not contain cellulose; the cellulose content of various infant foods is extremely low.
Drink at least 1.5-2.0 liters of water daily.
Moderate exercise: It is more beneficial to elderly patients who have been bedridden for a long time and have little exercise. Sit-ups, levator anus and other exercises can be used to purposefully exercise defecation-related muscles, which is not only good for defecation, but also can prevent diseases such as hemorrhoids.
Establish good bowel habits: Colon activity is most active during morning waking and after meals. It is best for patients to try to defecate within 2 hours after waking up in the morning or after meals. Concentrate during defecation, reduce the interference of external factors, and establish good bowel habits. , Will help completely solve the problem of constipation.
2. medical treatement
Volumetric laxatives (bulking drugs) act as laxatives by retaining water in the feces, increasing the water content and volume of the feces, and are suitable for patients with mild constipation. Drink plenty of water when taking the medicine. This class of drugs includes psyllium, polycarbophil, wheat bran and so on.
Osmotic laxatives can form a hypertonic state in the intestine to absorb water, increase stool volume, and stimulate intestinal peristalsis. It can be used for patients with mild to moderate constipation. The drugs include polyethylene glycol and unabsorbed sugars (such as lactulose). ) And salt laxatives (such as magnesium sulfate). Polyethylene glycol is not absorbed by the intestinal tract after oral administration, and its sodium content is low and adverse reactions are few. Lactulose can be broken down into lactic acid and acetic acid in the colon, which can promote the growth of physiological bacteria. However, excessive use of salt laxatives can cause electrolyte disturbances, so the elderly and those with impaired renal function should be used with caution.
Stimulant laxatives act on the enteric nervous system to enhance intestinal motility and stimulate the secretion of intestinal juice, including bisacodyl (Bensaicin), phenolphthalein (fruit guide tablets), anthraquinone drugs (rhubarb, senna, aloe, etc.) and Castor oil, etc. Among them, phenolphthalein was found to have carcinogenic effects in animal experiments, and the drug has been withdrawn from the market. Long-term use of stimulant laxatives may cause irreversible enteric nerve damage. Long-term use of rhubarb and other laxatives can cause darkening of the colon mucosa (melanosis), which may be related to colon cancer. Therefore, stimulant laxatives are only recommended for short-term and intermittent use. It should be noted that many weight-loss health products on the market are cathartic drugs mainly containing anthraquinone drugs, which are not suitable for long-term use.
Prokinetic drugs act on the intestinal nerve endings, promote muscle contraction of the intestinal wall, and increase intestinal motility, such as mosapride and tegaserod. However, since such drugs may potentially affect the blood supply to the heart, it is necessary to pay attention to this aspect of the clinical use.
Secretagogues, including lubiprostone, linaclotide, stimulate the secretion of intestinal fluid and promote bowel movements. This class of drugs is not currently on the market in China.
Enemas and suppositories are administered in the anus to lubricate and stimulate the intestinal wall, soften the stool, and make it easy to discharge. It is suitable for temporary use by patients with dry stool and fecal impaction. Such as Kaisailu, compound carrageenate preparations and so on.
3. Psychotherapy: Psychological guidance and treatment are very important for chronic constipation patients with mental and psychological disorders and sleep disorders. To make patients fully aware of the importance of a good mental state and sleep in relieving constipation symptoms, antidepressant and anxiety medications can be given to patients with obvious psychological disorders; patients with severe mental disorders should be transferred to the psychiatric department for specialist treatment.
4. Biofeedback: Biofeedback is an effective treatment method for constipation caused by pelvic floor muscle dysfunction. It can continuously improve patients' constipation symptoms, psychological conditions and quality of life.
5. Other treatment methods: It is reported in the literature that probiotics such as bifidobacteria can improve the symptoms of chronic constipation, and some Chinese medicines (including proprietary Chinese medicine preparations and decoctions) can effectively relieve the symptoms of chronic constipation. Acupuncture, massage, and massage can promote gastrointestinal peristalsis and help improve constipation symptoms.