2021年2月23日星期二

hemorrhoids natural remedy,Reasonable diagnosis and treatment of chronic constipation

    What is chronic constipation?

    Chronic constipation is a common clinical complex symptom rather than a disease. It mainly refers to long-term dry stool, difficulty or incomplete defecation, and reduced defecation frequency. Food is usually digested and absorbed through the gastrointestinal tract, and the residue is discharged within 24 to 48 hours. If the interval between bowel movements exceeds 48 hours, it can be considered as constipation.

    Is chronic constipation common?

    With the changes in people's diet and the influence of mental, psychological and social factors, the incidence of constipation tends to increase. The prevalence of constipation in the population is as high as 27%, but only a small percentage of constipation patients will see a doctor. Constipation can affect people of all ages. There are more women than men, and more old people than young and middle-aged people. Due to the high incidence of constipation and the complicated etiology, patients often have a lot of distress, and severe constipation will affect the quality of life.

    What are the hazards of constipation?

    Since chronic constipation is a relatively common symptom, the symptoms vary from severity to severity, and most people often do not go for special

    Regardless, I think that constipation is not a disease and does not need treatment, but in fact, constipation is very harmful.

    1. Chronic constipation plays an important role in the occurrence of some diseases such as colon cancer, hepatic encephalopathy, breast disease, and Alzheimer's disease. There are many research reports in this area.

    2. Constipation can lead to life accidents in patients with acute myocardial infarction and cerebrovascular accidents. There are many painful cases

    We are alert.

    3. Part of constipation is closely related to anorectal diseases such as hemorrhoids and anal fissure.

    Therefore, early prevention and reasonable treatment of constipation will greatly reduce the serious consequences of constipation and improve

    The quality of life reduces the burden on society and families.

    What is the cause of chronic constipation? How to classify?

    Chronic constipation can be divided into two categories: organic and functional.

    1. Organic causes

    mainly includes:

    (1) Intestinal organic disease: Intestinal stenosis or obstruction caused by tumor, inflammation or other reasons.

    (2) Rectal and anal lesions: internal rectal prolapse, hemorrhoids, anterior rectal bulge, puborectalis hypertrophy, puborectalis separation, pelvic floor disease, etc.

    (3) Endocrine or metabolic diseases: diabetes, hypothyroidism, parathyroid disease, etc.

    (4) Systemic diseases: scleroderma, lupus erythematosus, etc.

    (5) Nervous system diseases: central brain disease, stroke, multiple sclerosis, spinal cord injury and peripheral neuropathy, etc.

    (6) Intestinal smooth muscle or neurogenic disease.

    (7) Colonic neuromuscular disease: pseudo-obstruction, Hirschsprung's disease, giant rectum, etc.

    (8) Neuropsychological disorders.

    (9) Drug factors: iron, opioids, antidepressants, antiparkinsonian drugs, calcium channel antagonists, diuretics and antihistamines.

    If chronic constipation has no clear cause such as the above, it is called chronic functional constipation (CFC). Among people with a history of constipation, functional constipation accounts for about 50%.

    2. Functional etiology

    mainly includes:

    (1) Excessive mental stress.

    (2) Eat less, especially the dietary fiber content is too low.

    (3) Or excessive obesity.

    (4) Less exercise.

    What are the manifestations of chronic constipation?

    Chronic constipation often manifests as: less urge to defecate, less frequent defecation; difficult and laborious defecation; poor defecation; dry stool, hard stool, unclean feeling; constipation accompanied by abdominal pain or abdominal discomfort. Some patients also have mental and psychological disorders such as insomnia, irritability, dreaminess, depression, and anxiety.

    Which symptoms of constipation patients are "alarm" symptoms?

    Alarm signs include hematochezia, anemia, weight loss, fever, melena, abdominal pain, etc. and family history of tumors. If there are alarm signs, you should go to the hospital immediately for further examination.

    Which patients with constipation need colonoscopy?

    It is generally believed that colonoscopy should be done in any of the following situations

    1. Over 50 years old

    2. There are alarm signs

    3. Refractory constipation

    How to diagnose chronic functional constipation?

    First of all, constipation caused by organic diseases should be clearly excluded.

    The current diagnostic criteria for chronic functional constipation use the internationally recognized Rome III criteria:

    1. Must include 2 or more of the following:

    (1) At least 25% of bowel movements feel laborious

    (2) At least 25% of defecation is dry ball and hard feces

    (3) At least 25% of bowel movements have incompleteness

    (4) At least 25% of bowel movements have anorectal obstruction/blockage

    (5) At least 25% of bowel movements require manual assistance

    (6) Defecation less than 3 times a week

    2. Rarely loose stools without laxatives

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

    *Symptoms appear for at least 6 months before diagnosis, and meet the above diagnostic criteria in the past 3 months

    What is intractable constipation?

    The severity of constipation can be divided into mild, moderate, and severe. Mild means that the symptoms are mild, do not affect life, and can get better after general treatment, without medication or less medication. Severe refers to the persistent symptoms of constipation, the patient is abnormally painful, which seriously affects the life, the drug cannot be stopped or the treatment is invalid. Moderate is somewhere in between. The so-called refractory constipation is often severe constipation, which can be seen in outlet obstructive constipation, colon weakness, and severe constipation-type irritable bowel syndrome (IBS).

    Is constipation necessary for a comprehensive examination?

    Clinically, not every patient with constipation needs to be checked. Inspections should be conducted in a targeted manner, not that the more inspections, the better. Too many unnecessary examinations for patients with constipation will increase the burden of patients. We are opposed to untargeted, "casting a big net" type of examination for patients.

    In the diagnosis and differential diagnosis of chronic constipation, necessary inspections should be done according to clinical needs. First of all, pay attention to whether there is evidence of alarm symptoms and other organic diseases of the whole body; for patients over 50 years of age, with a history of long-term constipation, and short-term symptoms, colonoscopy should be performed to eliminate the possibility of colorectal tumors; for long-term abuse of diarrhea Colonoscopy can determine whether there is cathartic colon or (and) melanosis of the colon; barium enema can help diagnose Hirschsprung's disease. If OOC is suspected, digital anal examination and defecography are necessary. Special inspection methods include: gastrointestinal transit test (GITT), rectal and anal manometry (ARM), rectal-anal reflex test, tolerance sensitivity test, balloon expulsion test (bal2loon expulsion test) BET), pelvic floor electromyography, pudendal nerve latency measurement test, and anal canal ultrasound examination, etc. These examinations are only selected for refractory constipation.

    What are the commonly used inspection methods for intractable constipation?

    1. Stool routine and occult blood.

    2. Checks related to biochemistry and metabolism.

    3. Digital anorectal examination, can understand whether there is a mass and the function of anal sphincter.

    4. Colonoscopy or barium enema helps to determine whether there is an organic cause.

    5. Gastrointestinal transit test (GITT) is very helpful for judging whether there is slow transit, and it is often taken at 48h and 72h.

    6. Defecography can dynamically observe the anatomical and functional changes of the anorectum.

    7. Anorectal manometry can check the anorectal function without barriers.

    8.24h colonic pressure monitoring has certain guiding significance for whether to operate. If the lack of specific propulsive systolic wave (SPPW) and the colon's lack of response to waking up and eating, both indicate colon weakness, and surgical resection may be considered.

    9. Anal pressure measurement combined with ultrasound endoscopy can show whether the anal sphincter has mechanical or anatomical defects, which can provide clues for surgery.

    10. The application of perineal nerve latency or electromyography can distinguish whether constipation is myogenic or neurogenic.

    How to treat and prevent constipation?

    1. Analyze the causes of constipation and adjust your lifestyle. Develop regular bowel habits; quit smoking and alcohol; avoid drug abuse.

    2. Promote a balanced diet, increase dietary fiber appropriately, and drink more water.

    (1) High-fiber diet: Dietary fiber itself is not absorbed, and can absorb water in the intestinal lumen to increase stool capacity, stimulate the colon, and enhance motivation. Foods rich in dietary fiber include wheat bran or brown rice, vegetables, fruits rich in pectin such as mangoes, bananas, etc. (Note: immature fruits containing tannic acid will increase constipation). 

    (2) Supplement water: drink plenty of water and beverages to keep the intestinal tract with sufficient water and facilitate the excretion of stool.

    (3) Supply sufficient amount of B vitamins: Using foods rich in B vitamins can promote the secretion of digestive juice, maintain and promote bowel movements, and facilitate defecation. Such as coarse grains, yeast, beans and their products. Among vegetables, spinach and cabbage contain a lot of folic acid, which has a good laxative effect.

    (4) Increasing gas-producing foods: eating more gas-producing foods can accelerate bowel movements and facilitate defecation; such as onions, radishes, garlic sprouts, etc. 

    (5) Increase fat supply: appropriately increase high-fat foods. Vegetable oil can directly moisturize the intestines, and the decomposition product fatty acids have the effect of stimulating bowel movements. The kernels of dried fruits (such as walnut kernels, pine nut kernels, various melon seeds, almonds, peach kernels, etc.) contain a lot of oil, which has the effect of lubricating the intestines and laxative.

    3. Appropriate exercise: Medical gymnastics are the main ones, which can be combined with walking, jogging and abdominal self-massage.

    (1) Medical gymnastics: mainly to enhance the strength of abdominal muscles and pelvic muscles. Practice method: standing in place can do high-leg walking, squat, abdominal and back exercises, kicking exercises and turning exercises. In the supine position, you can raise one leg in turn or raise both legs at the same time, raise it to 40°, and then lower it after a short pause. The legs take turns in flexion and extension to imitate cycling. Raise your legs in a circle from the inside to the outside and sit ups.

    (2) Brisk walking and jogging can promote bowel peristalsis: help relieve constipation.

    (3) Deep and long abdominal breathing: When breathing, the amplitude of diaphragm activity is increased than usual, which can promote gastrointestinal peristalsis.

    (4) Abdominal self-massage: Lie on your back on the bed, flex your knees, and rub your hands together, place your left hand flat on your belly button, and your right hand on the back of your left hand, centering your belly button and rubbing in a clockwise direction. Do it 2 to 3 times a day for 5 to 10 minutes each time.

    4. Device assistance If the stool is hardened and stagnated in the rectum near the anal orifice, or the patient is elderly, weak, poor or lacking in defecation motivation, colon hydrotherapy or cleaning enema can be used.

    5. Medication

    (1) Prokinetic agent: Mosapride can promote gastrointestinal motility.

    (2) Laxatives

    ①Volume laxatives: magnesium sulfate, sodium sulfate, methylcellulose, agar, etc.; ②irritating laxatives: senna, castor oil, diesterphenine, etc.; ③stool softeners: liquid paraffin, lactulose, etc.; ④Intrarectal administration: glycerin suppository, Kaisailu, etc.

    6. Biofeedback therapy may be effective for some patients with constipation who have dysfunction of the rectal anus and pelvic floor. Biofeedback therapy is the use of special equipment to collect information about your own physiological activities to process and amplify, and display it with familiar visual or auditory signals, so that the cerebral cortex can establish a feedback connection with these organs, and learn to control at will through continuous positive and negative attempts Physiological activity, to correct the physiological activity that deviates from the normal range, so that the patient can achieve the purpose of "change self".

    7. Cognitive therapy Patients with severe constipation often have psychological factors or disorders such as anxiety or depression. Cognitive therapy should be given to relieve the tension of the patient, and antidepressant and anti-anxiety treatments should be given if necessary.

    8. Surgical treatment The above treatments are not effective for severe and intractable constipation. If the colonic transit dysfunction is chronic constipation and the condition is severe, surgical treatment may be considered. However, the long-term effect of the operation is still controversial, and case selection must be cautious.

    What is Melanosis?

    Colonic melanosis is caused by long-term use of anthraquinone laxatives, which leads to colonic epithelial cell apoptosis and intra-macrophage pigmentation, colonic mucosa is covered with brown spots, and colonoscopy shows leopard skin-like changes. Melanosis of the colon is generally considered harmless and reversible. Most people disappeared 6 months after stopping anthraquinone laxatives.

    I used to have normal stools, but I often have constipation recently. What should I do?

    1. If this occurs in the middle-aged and elderly people, first be alert to colon tumors, pay attention to observe whether there is blood in the stool, whether the stool is deformed, whether there is weight loss, fatigue, etc. You should see a doctor right away and do repeated stool occult blood tests. Do colonoscopy if necessary.

    2. If you have recent changes in your life pattern, excessive fatigue or depression, and eat less food, you can take a rest first, focus on diet adjustment, eat more high-fiber and laxative foods, and drink more water.

    3. If hemorrhoids and anal fissures have occurred recently, constipation may also occur due to the suppression of normal bowel movements. Hemorrhoids should be treated first, and if they do not get better, seek medical attention in time for colonoscopy.

    4. If you take certain drugs recently, including sedatives such as Valium, chlordiazepoxide, etc.; analgesics such as morphine, etc.; antacids such as aluminum hydroxide; antispasmodics such as 652-2, atropine, etc.; and iron , Antidepressants, antiparkinsonian drugs, calcium channel antagonists, diuretics and antihistamines. You can stop the drug first and observe whether it can be corrected. If it cannot be corrected, seek medical attention in time.

    Why do patients with constipation have diarrhea?

    The thickness of feces is related to its water content. If the intestine moves too fast, the water in the intestinal contents will not be absorbed in time, and the stool will become thinner. Patients with constipation often experience diarrhea after taking laxatives. There are also a small number of outlet obstructive constipation whose clinical manifestations are similar to "colitis", with diarrhea and incontinence as the main complaints. Doctors often mistake constipation as treatment for "colitis" and perform antidiarrheal treatment. Therefore, digital anorectal examination for patients with constipation is very necessary.

    Can irritant laxatives be used for a long time?

    Laxatives are one of the important methods in the treatment of functional constipation. However, long-term use of irritant laxatives is not appropriate. It will cause laxative colon, or (and) colonic melanosis, which is manifested by damage to the intestinal submucosal neurons and intestinal muscular layer, and the ability of intestinal peristalsis is severely affected. Injury, the intestine becomes tubular and expands, and the colon pocket disappears. For patients with slow transit constipation whose gastrointestinal transit time is significantly slowed, it is best to use some prokinetic drugs first, which can help defecation. If the effect is not good, use laxatives appropriately. Now more volumetric or osmotic laxatives are used. Such as polyethylene glycol 24000 (Fosong) or lactulose (Dumic). It is not advisable to use a laxative for a long time. If you really need to use it, it is recommended to use different drugs alternately to avoid adverse reactions and dependence on one drug.

    Can surgical removal of part of the colon prevent constipation?

    Some patients are often troubled by constipation and require surgical removal of part of the colon to treat constipation. But the results of surgery vary.

    At present, there are mixed opinions on the efficacy of surgical treatment of constipation, and there are different opinions on the timing and indications of surgery. The basic consensus now is: if strict non-surgical treatment, including psychological treatment, is still ineffective, and various special examinations show clear pathological anatomy and conclusive functional abnormalities, surgical operations can be performed, and indeed Achieve satisfactory results.

    The indications for surgery include secondary megacolon, part of the colon is lengthy, colon weakness, severe prerectocele, rectal intussusception, and rectal mucosal prolapse.

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