Obstructed

　　After digestion and absorption in the jejunum and ileum, the remaining indigestible residue that cannot be reabsorbed is excreted from the small intestine to the colon through intestinal peristalsis. The colon mucosa further absorbs water and electrolytes, and the stool is generally formed gradually in the transverse colon, and finally transported to the sigmoid colon and rectum. The rectal mucosa is stimulated mechanically by the filling and expansion of stool, producing sensory impulses. The impulses are transmitted to the cerebral cortex through the pelvic nerves and lumbar sacral spinal cord, and then transmitted to the rectum through efferent nerves, causing the rectal muscles to contract, the anal sphincter to relax, and then the abdominal muscles and diaphragm to contract simultaneously, causing stool to be excreted from the anus. This is the normal defecation reflex process. If any link in this defecation reflex process is obstructed, it can lead to constipation. The following factors are all important causes of constipation:

　　1, Insufficient intake of food or water, which makes the residual mass in the intestines or the amount of stool insufficient to stimulate the normal peristalsis of the colon.

　　2, Weak intestinal motility or reduced muscle tension of the intestinal muscles.

　　3, The presence of narrowing or obstruction in the intestinal lumen hinders normal intestinal peristalsis, leading to the inability of stool to pass, such as intestinal obstruction or left hemicolon cancer.

　　4, Constipation can occur at any stage of the defecation reflex process if there is any obstacle or lesion, such as weakened sensory stimulation of the rectal mucosa due to mechanical stimulation, lesions of pelvic nerves, lumbar sacral spinal nerves, spasms of anal sphincter muscles, weakened contraction of abdominal and diaphragmatic muscles, etc.

　　Constipation often causes changes in people's emotions, such as irritability, confusion, and distractibility, affecting daily life and work, and is related to the occurrence and development of many diseases.

　　1, Constipation often leads to complications such as anal, rectal, and colonic diseases. Long-term constipation can cause carcinogenic substances produced by bacterial fermentation in the intestines to stimulate the epithelial cells of the intestinal mucosa, leading to atypical hyperplasia, which is prone to canceration. Constipation can cause perianal diseases such as proctitis, anal fissure, and hemorrhoids. Due to constipation, difficulty in defecation, dry stools, it can directly cause or worsen anal and rectal diseases. The hard stool mass can block the intestinal lumen, causing the intestinal lumen to narrow and compress the surrounding structures of the pelvis, obstructing colonic peristalsis, causing compression of the rectum or colon, leading to circulatory disorders. It can also form fecal ulcers, and in severe cases, it can cause intestinal perforation, colonic diverticula, intestinal obstruction, and gastrointestinal nervous system disorders (such as loss of appetite, abdominal distension, belching, bitter taste in the mouth, excessive anal排气, etc.).

　　2, Constipation can also trigger extraintestinal complications such as stroke, affecting brain function (memory decline, attentional distraction, dull thinking), sexual dysfunction, and plays an important role in the occurrence of diseases such as hepatic encephalopathy, breast diseases, and Alzheimer's disease. Clinically, there is a trend of increasing incidence of cardiovascular disease due to increased abdominal pressure and straining during defecation, such as angina pectoris and myocardial infarction.

　　1. Constipation accompanied by severe abdominal pain, distension, and vomiting, often suggests acute constipation, and the possibility of intestinal obstruction should be considered. During intestinal obstruction, abdominal auscultation often reveals hyperactive bowel sounds or a high-pitched metallic sound, which can lead to intestinal paralysis in the late stage.

　　2. Constipation accompanied by abdominal mass, may be colon cancer, intraperitoneal tumor compressing the colon, intestinal tuberculosis, Crohn's disease, or enlarged lymph nodes, etc. When palpating a mobile cord-like or sausagelike intestinal tube in the left lower abdomen, it should be suspected as sigmoid colon spasm.

　　3. Alternating constipation and diarrhea, with hidden pain around the umbilicus or middle and lower abdomen, often suggests intestinal tuberculosis, abdominal tuberculosis, Crohn's disease, chronic ulcerative colitis, or irritable bowel syndrome and other lesions.

　　4. Abdominal or rectal and anal distension and discomfort, after exertion to defecate hard and thick fecal masses, the distension and discomfort decrease, which often suggests rectal constipation (weakening of defecation stimulation); left lower abdominal dull pain and discomfort, after defecating fecal masses shaped like chestnuts, the dull pain relieves, which often suggests colonic spasm or irritable bowel syndrome.

　　Defecation, walking, running, deep breathing exercises, practicing Qigong, Tai Chi Chuan, turning the waist and lifting the legs, participating in cultural and sports activities, and physical labor can strengthen gastrointestinal motility, increase appetite, and exercise the diaphragm, abdominal muscles, and anal muscles; improve defecation power, prevent constipation. It is rare for elderly rural people who often work to have constipation, while elderly people in cities who are lazy to move and indulge in luxury are more prone to constipation, which illustrates this point.

　　1. Laboratory examination:Fecal examination should observe the shape of the feces excreted by the constipated person and whether there is mucus or blood attached. Rectal constipation is characterized by large, hard feces, often accompanied by rectal inflammation and anal injury, with mucus and a small amount of blood attached. When middle-aged and elderly patients often have a small amount of blood, special attention should be paid to colorectal cancer. For patients with colonic spastic constipation, the feces are hard and granular like sheep dung. Patients with irritable bowel syndrome often excrete a large amount of mucus, but there are rarely red blood cells or white blood cells in the mucus.

　　2. Physical examination:It is necessary to conduct a comprehensive and systematic physical examination according to the requirements of diagnosis. It should not be considered a trivial matter to constipation and treated carelessly, leading to the omission of important lesions. Nor should the diagnosis of constipation be regarded as a difficult problem, using complex examination methods at will, while ignoring general routine examinations, so that the lesions that can be easily discovered are not detected in time. However, for most chronic constipation patients, due to the long course of the disease and many examinations in the past, abdominal signs are often not very obvious.

　　3. Visual examination:Whether there are anal fissures, fistulas, hemorrhoids prolapse, perianal inflammation, bloodstains, etc. Instruct the patient to perform defecation actions, and if there is descent of the perineum, it can be seen that the pelvic floor is prominently downward protruding around the anus; then instruct to contract the anus, for patients with severely damaged pelvic floor支配 nerves, the contraction ability may weaken or disappear.

　　4. Rectal examination:The observation should be careful to see if there are external hemorrhoids, anal fissures, and anal fistulas, etc. During palpation, attention should be paid to whether there are internal hemorrhoids, whether the anal sphincter muscle is spasmodic, whether the rectal wall is smooth, and whether there are ulcers or new growths, etc. It is strictly forbidden to be rough. The index finger should be fully lubricated and the patient's anus should be checked to make the examination painless and to minimize interference with the physiological state of the anal canal and rectum. The normal anal canal can accommodate one finger, with moderate tension. When the patient is asked to perform a defecation action, the external sphincter and pelvic floor muscles can be significantly relaxed. If the tension of the anal canal increases, it indicates that there may be刺激性 lesions near the anal canal. If the anal canal cannot pass a finger, it indicates that there is an organic stricture in the anal canal, which is common in low rectal tumors, post-anal canal surgery, or scar formation after improper sclerosing agent injection. Some patients may feel hard fecal masses in the rectal ampulla. If there is a large amount of feces retained in the rectum without the feeling of defecation, it indicates rectal weakness. In patients with rectal prolapse, a bag-like weak area can be felt above the anal sphincter and below the pubic symphysis during defecation. In patients with rectal intussusception, the rectal wall is relaxed, and a feeling of mucosal accumulation in the rectum can be felt during palpation, and occasionally the intussuscepted intestinal wall can also be felt. In patients with pelvic floor dystonia syndrome, a significant feeling of contraction can be felt in the pelvic floor muscles, puborectalis muscle, and external anal sphincter during defecation; in severe cases, the anal-rectal ring is significantly enlarged, thickened, rigid, and the range of movement is reduced, the tension of the anal canal is increased, and there is significant pain. By compressing the rectal ampulla in all directions with the index finger, the function of the pelvic floor sensation (i.e., rectal sensation) can be roughly estimated.

　　5. Anorectal examination:Internal hemorrhoids and low rectal masses can be observed. When the rectal mucosa has edema, erosion, and is difficult to explain as general inflammation, the possibility of rectal intussusception should be considered. If there is bloodstain of unknown origin, especially if it is an old bloodstain, one should be vigilant of the possibility of an above tumor.

　　Because feces are mainly composed of digested food, regulating diet to prevent constipation is a simple and easy method. First of all, attention should be paid to the amount of food intake. Only enough quantity can stimulate peristalsis, allowing feces to pass through and be excreted normally from the body. Especially breakfast should be sufficient. Secondly, attention should be paid to the quality of food intake. Starchy foods should not be too fine, and some coarse grains and mixed grains should be eaten. Because coarse grains and mixed grains have more residue after digestion, which can increase the stimulation of the intestinal tract, facilitating defecation. Side dishes should pay attention to eating vegetables rich in fiber, because a normal person needs 90-100 milligrams of fiber per kilogram of body weight to maintain normal defecation. Vegetables such as green vegetables, chives, celery, and taro can be eaten more. Because fiber is not easily digested and absorbed, the amount of residue is high, which can increase the volume of the intestinal tract, raise the pressure inside the intestinal tract, increase peristalsis, and benefit defecation. It is also necessary to drink plenty of water, especially for heavy laborers, due to excessive sweating, large breathing volume, and high water consumption, the water in the intestinal tract will be absorbed in large quantities. Therefore, to prevent constipation, it is necessary to drink more water. Drinking a glass of water before breakfast or after getting up has a mild laxative effect. Sufficient water intake can benefit the passage of intestinal contents. In addition, it is recommended to eat more foods rich in fat, such as walnuts, peanuts, sesame seeds, rapeseed oil, and peanut oil, which all have good laxative effects.

　　1. Acute constipation is mostly caused by intestinal obstruction, so the main treatment is targeted at the cause. If the patient has symptoms such as abdominal distension and hidden pain in the abdomen, warm water enema treatment can be adopted; if it is pathological obstruction, timely surgical treatment should be performed.

　　2. For acute constipation caused by lesions near the anus and rectum, such as anal fissure, anal fistula, perianal abscess, and giant internal hemorrhoids with infection, etc., it is necessary to actively treat these diseases and at the same time take measures to soften the stool or administer medication from the anus to facilitate the defecation.

　　3. If acute constipation is caused by taking certain drugs with constipation side effects, these drugs should be reduced or stopped. It is necessary to take mild laxatives that are not irritating to the intestines.

　　4. For chronic constipation caused by organic lesions, treatment should be targeted at the cause after the cause is clear.

　　5. For patients with constipation for a long time, even more than 1 year, or intermittent constipation (or alternating constipation and diarrhea), confirmed by various examinations that there is no organic lesion in the colon and rectum, in general good condition, appetite is basically normal, without symptoms such as weight loss and anemia, it can be considered as functional constipation due to intestinal motility disorders or irritable bowel syndrome. The treatment of such constipation patients is generally more difficult. The following treatment measures can be tried.

　　(1) Encourage patients to do physical exercises within their ability, such as Tai Chi, gymnastics, jogging, or walking; it is recommended to ask patients to lie flat on the bed and perform abdominal exercises (deep abdominal breathing) before going to bed each night, for 15-30 minutes; and self-massage of the abdomen can be performed, with the massage method preferably in a clockwise direction from the right to the left, for 15-30 minutes.

　　(2) Encourage patients to eat more vegetables rich in fiber and more fruits such as bananas, pears, watermelons, etc., to increase the volume of feces, and drink plenty of water, and avoid strong刺激性 drinks such as strong tea and coffee.

　　(3) It is recommended to ask patients to take honey regularly to help with bowel movement.