The diagnosis methods of chronic constipation include medical history, physical examination, related laboratory tests, imaging examinations and special examination methods.
Medical history: A detailed medical history, including the symptoms and course of constipation, gastrointestinal symptoms, accompanying symptoms and diseases, and medication can often provide very important information. Pay attention to (1), whether there are alarm symptoms (such as hematochezia, anemia, weight loss, fever, melena, abdominal pain, etc.), (2), the characteristics of constipation symptoms (time of stool, constipation, whether it is difficult or uncomfortable, and stool characteristics), ( 3) Accompanying gastrointestinal symptoms, (4), medical history related to the cause, such as abnormal intestinal anatomical structure or systemic disease, and constipation caused by drug factors, (5), mental and psychological status and social factors.
General inspection method:
(1) Digital anorectal examination can often help understand fecal impaction, anal stenosis, hemorrhoids or rectal prolapse, rectal masses, etc., and can also understand the functional status of anal sphincter.
(2) Blood routine, stool routine, fecal occult blood test are important and simple routines to rule out organic diseases of the colon, rectum, and anus. If necessary, conduct biochemical and metabolic inspections.
(3) For patients with suspicious anal and rectal disease, proctoscope or sigmoidoscopy/colonoscopy, or barium enema can observe the intestine directly or display imaging data.
Special examination method: For patients with chronic constipation, the following related examinations can be selected as appropriate.
1. Gastrointestinal transit test (GITT): Commonly used opaque X-ray markers. Swallowed with the test meal at breakfast, containing 20 markers, after a certain period of time (for example, after taking the markers 24h, 48h, 72h) Take a abdominal radiograph and calculate the discharge rate. 48-72h after taking the markers under normal circumstances, most of the markers have been discharged. According to the distribution of markers on the abdominal film, it is helpful to assess whether constipation is of slow transit type or outlet obstruction type, which is a simple and feasible method.
2. Anorectal manometry (anorectal manometry ARM): Commonly used perfusion manometry (same as esophageal manometry) to detect the resting pressure of the anal sphincter, the systolic pressure of the external anal sphincter and the relaxation pressure during force discharge, and after gas injection in the rectum Whether there is anorectal suppression reflex, the sensory function of the rectum and the compliance of the rectal wall can also be measured. It is helpful to evaluate the anal sphincter and rectum for motor and sensory dysfunction.
3. Colonic pressure monitoring: Place the sensor in the colon and monitor the changes in colonic pressure continuously for 24-48 hours under relatively physiological conditions. It has guiding significance for the treatment of determining the presence or absence of colon weakness.
4. Balloon expulsion test (BET): Place a balloon in the rectum, inflate or fill it with water, and let the subject expel it. It can be used as a screening test for the presence or absence of excretion disorders. For positive patients, further examination is required.
5. Barium defecography (BD): The simulated feces are poured into the rectum, and the functional changes of the anus and rectum during defecation are dynamically observed under radiation, so as to understand whether the patient has accompanying anatomical abnormalities, such as prerectal bulge, intestine Nesting and so on.
6. Others: Such as pelvic floor electromyography, which can help determine whether the lesion is myogenic. The pudendal nerve latency measurement can show whether there is abnormal nerve conduction. Anal ultrasound endoscopy can understand whether the anal sphincter is defective or not.