Constipation

　　Constipation can be divided into organic and functional types according to the etiology. Functional constipation accounts for 50% of the constipation population, and the etiology is not yet clear. Its occurrence is related to many factors.

　　1. Organic etiology
　　(1) Organic lesions of the intestinal tract: tumors, inflammation, or other causes of intestinal lumen stenosis or obstruction.
　　(2) Rectal and anal lesions: rectal prolapse, hemorrhoids, rectal prolapse, puborectalis hypertrophy, pubo-rectal separation, pelvic floor disease, and so on.
　　(3) Endocrine or metabolic diseases: diabetes, hypothyroidism, parathyroid disease, and so on.
　　(4) Systemic diseases: systemic sclerosis, lupus erythematosus, and so on.
　　(5) Neurological diseases: central nervous system diseases, stroke, multiple sclerosis, spinal cord injury, and peripheral nerve lesions, etc.
　　(6) Smooth muscle or neurogenic lesions of the intestinal tract.
　　(7) Colonic neuromuscular lesions: pseudo-obstruction, congenital megacolon, megarectum, and so on.
　　(8) Neuro-psychological disorders.
　　(9) Drug factors: iron, opiate drugs, antidepressants, antiparkinsonian drugs, calcium channel blockers, diuretics, and antihistamines, etc.

　　2. Functional etiology
　　(1) Insufficient intake of food or lack of fiber or insufficient water, reducing the stimulation of colonic movement.
　　(2) Due to work stress, fast pace of life, changes in work nature and time, mental factors, and other factors that interfere with normal defecation habits.
　　(3) Due to disordered colon movement caused by colonic and sigmoid colon spasm, it is common in irritable bowel syndrome. In addition to constipation, it also has abdominal pain or bloating, and some patients may manifest alternating constipation and diarrhea.
　　(4) Insufficient abdominal and pelvic muscle tension, insufficient force to push stool out, difficult to expel stool from the body.
　　(5) Abuse of laxatives, forming drug dependence, causing constipation.
　　(6) Elderly weakness, insufficient activity, intestinal spasm can cause difficulty in defecation, or due to the length of the colon.

　　Once constipation occurs, especially long-term constipation, it can trigger a variety of diseases.

　　1. Causes of anal and rectal diseases
　　During constipation, defecation is difficult, the stool is dry, which can directly cause or exacerbate anal and rectal diseases. Such as proctitis, anal fissure, hemorrhoids, and so on.

　　2. Gastrointestinal nervous dysfunction
　　During constipation, feces are retained, and the absorption of harmful substances can cause gastrointestinal nerve function disorders, leading to symptoms such as loss of appetite, abdominal distension, belching, bitter taste in the mouth, and frequent anal排气.

　　3. Forming fecal ulcers
　　Hard fecal masses compress the intestinal lumen, causing narrowing of the intestinal lumen and structures around the pelvic cavity, obstructing colonic expansion, and causing the rectum or colon to be compressed, forming fecal ulcers. In severe cases, it can cause intestinal perforation.

　　4. Suffering from colon cancer
　　It may be due to constipation causing carcinogens in the intestines to be unable to be eliminated for a long time. According to data, about 10% of severe constipation patients suffer from colon cancer.

　　5. Inducing cardiovascular and cerebrovascular diseases
　　There is an increasing trend year by year in clinical cases of cardiovascular and cerebrovascular diseases caused by increased abdominal pressure due to constipation and straining to defecate. Such as the onset of angina, myocardial infarction, intracerebral hemorrhage, stroke sudden death.

　　1. Less defecation urge, less defecation frequency.

　　2. Less defecation urge, less defecation frequency.

　　3. Difficult defecation, effortful defecation.

　　4. Constipation is accompanied by abdominal pain or discomfort.

　　5. Some patients may also have sleep disorders, irritability, dreams, depression, anxiety, and other psychological and psychological disorders.

　　About 50% of the population with constipation are functional constipation, which can be prevented.

　　1. Avoid overly refined foods, which reduce the stimulation of colonic movement and cause constipation.

　　2. Avoid interference with defecation habits: Due to factors such as mental factors, changes in life routine, excessive fatigue from long-distance travel, and failure to defecate in time, constipation is likely to occur.

　　3. Avoid the abuse of laxatives: The abuse of laxatives can weaken the sensitivity of the intestines, form dependence on certain laxatives, and cause constipation.

　　4. Reasonably arrange work and life, achieve a balance between work and rest. Appropriate physical activities, especially the exercise of the abdominal muscles, are beneficial to the improvement of gastrointestinal function, which is more important for sedentary workers and those with high mental concentration.

　　5. Develop good defecation habits, defecate at a fixed time each day, form a conditioned reflex, and establish a good defecation routine. Do not ignore the urge to defecate and defecate in time. Make the environment and posture of defecation as convenient as possible to avoid suppressing the urge to defecate and destroying defecation habits.

　　6. It is recommended that patients drink at least 6 cups of 250ml water daily, engage in moderate-intensity exercise, and develop the habit of regular defecation (twice a day, each for 15 minutes). The action potential activity of the colon is enhanced upon waking up and after meals, pushing the feces towards the distal end of the colon, so the morning and after meals are the most convenient times for defecation.

　　7. Timely treatment of diseases such as anal fissures, perianal infection, and adnexitis of the uterus.

　　The examination of constipation generally includes fecal examination and imaging examination.

　　Fecal examination
　　Observe the shape of the feces excreted by constipated individuals and whether there is mucus or blood adhering to it. Rectal constipation is characterized by large, hard feces, often accompanied by rectal inflammation and anal injury, with mucus and a small amount of blood adhering to the feces.

　　Imaging examination
　　Digital rectal examination: Carefully observe for the presence of external hemorrhoids, anal fissures, anal fistulas, and other lesions. During palpation, pay attention to the presence of internal hemorrhoids, whether the anal sphincter muscle is spasmodic, whether the rectal wall is smooth, and whether there are ulcers or neoplasms.
　　Barium Enema X-ray Examination and Abdominal Plain Film: Barium enema X-ray examination is of great help in diagnosing colonic and rectal tumors, colon stricture or spasm, megacolon, and other lesions.
　　Colonoscopy: Colonoscopy is of great help in diagnosing various colonic lesions that cause constipation, such as colon cancer, rectal cancer, intestinal polyps, and organic intestinal stricture, etc.

　　1. Do not make food too refined, and do not have a preference for certain foods. Increase the fiber content in the diet, such as grains, vegetables (radish, chives, raw garlic, etc.), and fruits (apple, jujube, banana, pear, etc.).

　　2.摄取足够水分。每日进水量约2000毫升。每天清晨空腹饮1杯淡盐水或白开水或蜂蜜水，均能防治便秘。

　　3. Consume an appropriate amount of plant fats in the diet, such as sesame oil, soybean oil, or eat hard fruits rich in vegetable oils, such as walnuts, sesame seeds, etc.

　　4. Appropriately consume foods that help lubricate the intestines, such as honey, yogurt, etc.

　　5. Regularly consume some porridge with a preventive and therapeutic effect on constipation, such as sesame porridge, walnuts, spinach porridge, sweet potato porridge, etc.

　　6. Eat less strongly stimulating and heat-producing foods, such as chili, curry, and other spices, and avoid drinking alcohol or strong tea.

　　Patients with constipation need to adopt comprehensive treatment according to the severity of constipation, etiology, and type. This mainly includes general lifestyle treatment, drug treatment, biofeedback training, and surgical treatment to restore normal defecation physiology.

　　1. Lifestyle Treatment
　　(1) Develop the habit of defecating at regular times; quit smoking and drinking; avoid excessive medication.
　　(2) Promote a balanced diet, increase dietary fiber moderately, and drink plenty of water.
　　(3) Moderate exercise, mainly medical gymnastics, can be combined with walking, jogging, and self-massage of the abdomen.

　　2. Drug Treatment
　　(1) Laxatives
　　①Bulk-forming Laxatives: Mainly include soluble fiber (pectin, plantago, oat bran, etc.) and insoluble fiber (plant fiber, lignin, etc.). Bulk-forming laxatives have a slow onset of action and few side effects, making them safe and effective for constipation during pregnancy or mild constipation, but they are not suitable for rapid relief of temporary constipation. ②Lubricant Laxatives: They can lubricate the intestinal wall, soften stool, and facilitate defecation, making them easy to use. Examples include glycerin suppositories, mineral oil, or liquid paraffin. ③Saline Laxatives: Such as magnesium sulfate, magnesium milk, these drugs can cause serious adverse reactions and should be used with caution in clinical practice. ④Osmotic Laxatives: Commonly used drugs include lactulose, sorbitol, and polyethylene glycol 4000. They are suitable for fecal impaction or as temporary treatment measures for chronic constipation, and are a good choice for patients with constipation whose efficacy is poor with bulk-forming mild laxatives. ⑤Stimulant Laxatives: Include plant laxatives containing anthraquinones (rhubarb, frangula cortex, senna leaves, aloe), phenolphthalein, castor oil, and bisacetylmorphine, etc. Stimulant laxatives should only be used when bulk-forming and saline laxatives are ineffective, as some are quite strong and not suitable for long-term use. Long-term use of anthraquinone laxatives can cause black stool disease or laxative colitis, leading to atrophy and injury of smooth muscle and the intestinal myenteric plexus, which can worsen constipation. The effects are reversible after discontinuation of the drug.
　　(2) Prokinetic Agents
　　Motilium and Itopride have the effect of promoting gastrointestinal motility; Pucalapril can selectively act on the colon and can be selected according to the situation.

　　3. Instrument Assisted
　　If the stool is hard and stuck near the anal orifice in the rectum or if the patient is elderly and weak, or has poor defecation power or lacks it, colonic hydrotherapy or clean enema can be used.

　　4. Biofeedback Therapy
　　It can be used for patients with constipation due to rectal and anal dysfunction or pelvic floor muscle dysfunction, and it has a good long-term therapeutic effect.

　　5. Cognitive Therapy
　　Severe constipation patients often have psychological factors or disorders such as anxiety and even depression. Cognitive therapy should be provided to help patients eliminate tension, and antidepressant and anti-anxiety treatment should be given when necessary, and a mental health specialist should assist in diagnosis and treatment.

　　6. Surgical Treatment
　　All treatments for severe refractory constipation are ineffective. For patients with constipation due to colonic transit dysfunction and severe conditions, surgical treatment may be considered, but the long-term effects of surgery are still controversial, and the selection of cases must be cautious. Among the vast group of constipation diseases, the number of patients who truly need surgical treatment is still very small.