2020年12月3日星期四

lidocaine for hemorrhoids,Essay "Constipation" ——Reread the 2016 American ASCRS Guidelines for Diagnosis and Treatment of Constipation

    Regarding constipation, I want to say something first.

    ·Correcting constipation is not a short-term behavior. You can't rush for quick success. If you want healthy stool, you need a healthy diet, daily life, and appropriate daily exercise.

    ·The intestine is an emotional organ, just like you don’t want to eat the same food every day, just like your mood is different every day, the bowel movement is not the same every day, the occasional frequency is messy, or the stool volume or the character is different, don’t care.

    ·Fiber intake, adequate water, and appropriate foods rich in fats have always been the first choice to ensure healthy stools.

    ·Ordinary people, because of diet, stress, and environmental changes, occasionally have difficulty defecation or dry stools, and do not understand the stool for many days, which is not considered a disease.

    ·Occasionally, if you don't understand for many days, you can temporarily use Kaisailu or take stimulant laxatives. Ordinary people cannot rely on these methods for long-term defecation.

    ·Tangle with constipation, too heavy mind, eager or disorderly medication, will make the problem even more troublesome.

    Constipation is related to two functions: abnormal contraction of the pelvic floor muscles during defecation or failure to relax (defecation coordination disorder), or insufficient bowel motility (defecation motivation)

    ·Sometimes it is difficult to defecate for many days, sometimes many times a day, it is intestinal dysfunction, belonging to irritable bowel syndrome.

    In the constipation population, there are more women than men. Outlet obstructive constipation caused by pelvic floor dysfunction (including pelvic floor muscle spasm and pelvic floor organ relaxation) caused by pregnancy and childbirth is more common in women.

    Functional constipation is a benign condition that affects the quality of life.

    Functional constipation, a functional intestinal disease characterized by persistent difficulty in defecation, decreased frequency of defecation, or incomplete defecation.

    For long-term constipation, a detailed medical history should be consulted by a doctor and relevant clinical examinations should be performed to rule out serious diseases that cause constipation and affect health.

    Medical history to be provided——

    Symptoms, duration of constipation, frequency of occurrence, excretion time and gestation time of bowel movements, stool characteristics, use of laxatives, whether there are behavioral changes, such as dietary changes, reduced activities, environmental changes, mental factors, etc. Whether there is blood in the stool, changes in stool shape, blood in the stool, weight loss, anemia, and family history of colorectal tumors. Medication history, whether there are opioids, antidepressants, anticholinergic drugs, calcium channel blockers and calcium supplements.

    The doctor will rule out the effects of other diseases-

    Mental diseases, neurological diseases, endocrine diseases, intestinal inflammation, intestinal obstruction, Hirschsprung's disease, urology, gynecological related diseases.

    The doctor will arrange relevant clinical examinations——

    Digital examination and anoscopy of the anus, colonoscopy, defecography, air bag expulsion test, colon transmission test, gynecological urology examination, anorectal pressure measurement, intrarectal ultrasound, pelvic MRI, lower abdominal CT and many more.

    Diagnose functional constipation:

    ·At least 6 months in the last 3 months with onset of symptoms, with the following two symptoms, at least 25% of defecation is struggling, or defecation is hard, or there is a sense of incomplete emptying or anorectal obstruction in defecation Feeling or defecation requires hand-assisted defecation (such as finger defecation, supporting pelvic floor), or defecation less than 3 times a week.

    · There is very little soft stool without laxatives.

    · Does not meet the diagnostic criteria for irritable bowel syndrome.

    Functional constipation includes normal transit constipation, slow transit constipation, outlet obstruction constipation and mixed constipation.

    To treat constipation, the first is the correction of long-term diet and living habits, the second is the use of graded drugs, the adjustment of the psychological state, and the last is the intervention of the surgeon-surgical treatment.

    Drug treatment and routine sequence:

    1. Expansive and volumetric laxatives, increase stool volume and promote stool excretion, are cellulose drugs, including wheat fiber particles, psyllium, polycarbophil calcium and so on.

    2. Osmotic laxatives, volumetric laxatives have no obvious effect, short-term temporary addition, after taking the intestinal osmotic pressure to retain water, make stool soft, stimulate bowel movements, such as lactulose, compound polyethylene glycol electrolyte powder, etc.

    3. Stimulating laxatives, when volumetric and osmotic laxatives are ineffective, short-term use can stimulate the sensory nerve endings of the intestinal mucosa, increase intestinal peristalsis, and stimulate intestinal secretion. Such as phenolphthalein, bisacodyl, rhubarb, aloe vera, senna, cassia seed and so on.

    4. Prokinetic drugs release agonistic factors from the enteric nerve endings and promote colonic peristalsis, suitable for slow transit constipation, such as Lilo, Mosapride, Cisapride, etc.

    5. Secretion promoting drugs are drugs that have recently been used clinically. They are used for severe constipation, when volumetric and osmotic laxatives have no effect, to promote secretion of intestinal juice, soften stools, accelerate bowel movements, and promote bowel movements. Such as docusate sodium.

    In addition, probiotics can regulate the intestinal microbial environment and improve the symptoms of constipation or diarrhea. There is also syndrome differentiation and treatment of traditional Chinese medicine.

    Note on medication:

    ·Drugs are adjuvant treatments, long-term use is not recommended, and doctor's guidance is required.

    ·Uncomprehensive for many days, anorectal swelling, requiring doctors to rule out stool impaction

    ·The elderly, pregnant women, infants and young children, treated under the guidance of a doctor.

    ·Pay attention to the mechanism of action, effectiveness and safety of the drug.

    ·Single medication is not effective, appropriate combination medication.

    ·Export obstructive constipation, medication, auxiliary biofeedback and sacral nerve stimulation and other physical therapy.

    Medical treatment is ineffective, consider surgical treatment:

    ·For patients with intractable colonic slow transit constipation, total abdominal colectomy and ileorectal anastomosis.

    ·Outlet obstructive constipation, there are transanal stapling rectal resection, apron band ligation.

    Constipation, from intermittent uncomfortable symptoms to illness, is a process. In this process, it is important to seek help from a doctor early and seek guidance on psychology, diet, lifestyle, and drug use. It is necessary to stop constipation from intermittent discomfort to illness. You cannot turn the symptoms of constipation into constipation because of the wrong treatment, especially intractable constipation.

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