How do I Treat Chronic Constipation?

Chronic constipation is manifested by a reduction in the number of bowel movements, dry stools, and / or difficulty in defecation. Patients have less than 3 defecations per week. They have difficulty in defecation, difficulty in defecation, or incomplete defecation. The course of the disease is at least 6 months.

Basic Information

English name: chronic constipation
Visiting department: Gastroenterology

Common causes: Causes of rectal and anal diseases, endocrine or metabolic diseases, neurological diseases, etc.
Common symptoms: Reduced bowel movements, dry stools, and laborious defecation

Causes of chronic constipation

Chronic constipation has functional and organic causes. Organic causes can be caused by gastrointestinal diseases, systemic diseases involving the digestive tract, such as diabetes, scleroderma, and nervous system diseases. Many drugs can also cause constipation.

Rectal and anal lesions

Rectal prolapse, hemorrhoid disease, prerectal bulge, puborectalis hypertrophy, pubic separation, pelvic floor disease, etc.

2. Endocrine or metabolic diseases

Such as diabetic bowel disease, hypothyroidism, parathyroid disease and so on.

3. Nervous system diseases

Such as central brain disorders, stroke, multiple sclerosis, spinal cord injury and peripheral neuropathy.

4. Intestinal smooth muscle or neuronal lesions

5. Colon neuromuscular disease

Pseudointestinal obstruction, congenital megacolon, megarectum, etc.

6. Mental and psychological disorders

7. Drug factors

Aluminum or calcium-containing antacids, irons, opioids, antidepressants, anti-Parkinson's disease drugs, calcium channel antagonists, diuretics, and antihistamines.

8. Other

Patients with less exercise, special occupations, or who have undergone abdominal or pelvic surgery after taking special drugs.

Clinical manifestations of chronic constipation

Chronic constipation usually has no obvious symptoms, but those who are nervous can complain of gastrointestinal symptoms such as loss of appetite, bitterness, bloating, belching, paroxysmal hypogastric pain, and excessive gas. Symptoms may be related to intestinal peristalsis dysfunction, and may be related Related to mental factors

Because the stool is dry or sheep-like, the patient may experience discomfort such as lower abdominal cramps and sensation of falling. Sometimes the spasm of the sigmoid colon can be touched in the left lower quadrant.

Most chronic constipation is a functional disease, including functional constipation, functional defecation disorder, and constipation-type irritable bowel syndrome.

According to the pathophysiology mechanism, clinically, constipation caused by functional diseases is divided into slow transmission type, defecation disorder type, mixed type and normal transmission type. Slow-onset constipation manifests as an increase in colonic transit time, the main symptoms of which are reduced bowel movements, dry stools, and laborious defecation; defecation-constipated constipation is manifested by the inability of the abdominal muscles, rectum, anal sphincter, and pelvic floor muscles to coordinate movements Inadequate rectal propulsion leads to obstruction of rectal emptying. Common clinical symptoms are laborious defecation, incomplete defecation, anorectal blockage during defecation, and manual defecation. There is evidence of delayed colonic transmission and anorectal defecation disorders in mixed constipation. Normal transmission type is more common in patients with constipation-type irritable bowel syndrome, and the incidence is related to mental and psychological abnormalities.

Chronic constipation test

Fecal examination

The constipation should be observed in the form of feces and mucus or blood adhesion. Rectal constipation is a large, hard stool. Because it is often accompanied by rectal inflammation and anal damage, the stool often has mucus and a small amount of blood adhesion. When small amounts of blood often appear in middle-aged and elderly patients, special attention should be paid to colorectal cancer. Colonic spastic constipation, the stool is hard and granular like sheep feces. People with irritable bowel syndrome often expel a large amount of mucus, but there are very few red blood cells and white blood cells in the mucus.

2. Imaging examination

(1) The digital rectal examination should carefully observe the presence of external hemorrhoids, anal fissures, and anal fistulas. When palpating, pay attention to internal hemorrhoids, anal sphincter spasms, smooth rectal walls, and ulcers or new organisms.

(2) X-ray barium enema examination and abdominal plain film X-ray barium enema examination are of great help in the diagnosis of colon, rectal tumors, colonic stenosis or spasm, giant colon and other diseases, as well as colon motor function (peristalsis). Can have a more comprehensive understanding. If there are multiple step-shaped fluid levels in the plain X-ray abdomen film, it will be very helpful for the diagnosis of intestinal obstruction.

(3) Colonoscopy Colonoscopy is extremely helpful in the diagnosis of various colon diseases that cause constipation, such as colon, rectal cancer, and polyposis in the intestinal cavity. Get a confirmed diagnosis.

3. Examination of intestinal motility and anorectal function

Including colon transmission test, anorectal manometry, balloon ejection test, defecation imaging, etc. These tests are necessary for the evaluation of anorectal function, constipation typing and treatment options.

Diagnosis of chronic constipation

The diagnosis of chronic constipation is mainly based on symptoms. The Rome III diagnostic criteria set the diagnostic criteria for chronic functional constipation as:

1. Must include the following 2 or more

At least 25% of the defecation is laborious; at least 25% of the defecation is dry bulbous or hard feces; at least 25% of the defecation is incomplete; at least 25% of the defecation has anorectal obstruction and / or blockage; % Defecation requires manual assistance, and defecation is less than 3 times a week.

2. Fewer stools rarely occur when laxatives are not used .

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

The symptoms appear for at least 6 months before diagnosis, and the symptoms meet the above diagnostic criteria in the past three months.

Chronic constipation treatment

1. Treatment of primary disease

After clear diagnosis of the detected primary disease, adopt corresponding measures for active treatment.

2. Adjust your lifestyle

Reasonable diet, drink plenty of water, exercise, and establish good bowel habits.

3. Drug treatment

(1) Volumetric laxatives play a cathartic effect by increasing the water content and volume of feces. It is mainly used in patients with mild constipation.

(2) Osmotic laxatives form a hypertonic state in the intestine, absorb water, stimulate intestinal peristalsis, and are used in patients with mild to moderate constipation.

(3) Stimulant laxatives act on the intestinal nervous system and enhance intestinal motility to stimulate intestinal secretion. Animal experiments have shown that long-term use may cause irreversible enteral nerve damage. Long-term use should be avoided.

(4) Promote gastrointestinal motility drugs to act on intestinal nerve endings, release motor neurotransmitters, and have good results for slow transmission type.

4. Surgical treatment

There are fewer chronic constipation patients who really need surgery, mainly caused by organic lesions of the colon, rectum and anal canal.