Functional constipation accounts for about 50% of people with a history of constipation. 2. Functional etiology of functional constipation is not clear, and its occurrence is related to a variety of factors, including: (1) eating less or food lack of fiber or insufficient water, the stimulation of colonic motility is reduced. (2) Interference with normal bowel habits due to stressful work, fast pace of life, changes in the nature and duration of work, and mental factors. (3) Colonic motility disorders, commonly found in irritable bowel syndrome, caused by spasm of the colon and sigmoid colon, in addition to constipation with abdominal pain or abdominal distension, some patients may be constipated and diarrhea alternately. (4) Insufficient tension of abdominal and pelvic muscles, insufficient defecation propulsion, difficult to expel feces from the body. (5) Abuse of laxatives, the formation of drug dependence, resulting in constipation. (6) Elderly and weak, too little activity, intestinal spasms lead to defecation difficulties, or due to the length of the colon. Constipation according to the pathogenesis is divided into two main categories: slow transmission type constipation and outlet obstruction type constipation. Slow-transmission constipation is caused by a weakened contractile movement of the bowel, which slows the movement of feces from the cecum to the rectum, or by uncoordinated movement of the left half of the colon. It is most common in young women, occurring around puberty, and is characterized by decreased frequency of bowel movements (less than 1 per week), less urge to defecate, and hard stools, thus making defecation difficult; absence of feces or palpation of hard feces on anorectal palpation, with normal retraction of the external anal sphincter and straining to defecate; prolonged total gastrointestinal or colonic transit time; and a lack of evidence of the outlet-obstructive type such as a balloon expulsion test and anorectal manometry Normal. Nonsurgical treatments such as increased dietary fiber intake with osmotic laxatives are ineffective. Constipation associated with diabetes mellitus, scleroderma, and drug-induced constipation is usually of the slow-transmitting type. Exit-obstructive constipation is due to muscular incoordination of the abdomen, anorectum, and pelvic floor, resulting in obstruction of fecal elimination. It is particularly common in elderly patients, many of whom have failed conventional medical treatment. Outlet obstruction may have the following manifestations: straining to defecate, feeling of incompleteness or a sense of falling, small amount of defecation, and a desire to defecate or a lack of desire to defecate; there is a lot of muddy fecal matter in the rectum during anorectal examination, and the external anal sphincter may be paradoxically contracted when defecation is forcefully carried out; the whole gastrointestinal or colonic transmission time is normal, and most of the markers can be retained in the rectum; anorectal manometry shows that the external anal sphincter is paradoxically contracted or sensed on the wall of the rectum when defecating forcefully; the anorectal muscles are not coordinated with the abdominal muscles and pelvic floor. contraction or abnormal sensory threshold of the rectal wall, etc. Many patients with outlet-obstructive constipation also have a combination of slow-transmission constipation. [1] The incidence of constipation tends to increase with the change of dietary structure and the influence of psycho-psychological and social factors. The prevalence of constipation in the population is as high as 27%, but only a small percentage of constipated individuals will seek medical attention. Constipation can affect people of all ages. It is more common in women than in men, and more common in the elderly than in the young and middle-aged. Because of the high prevalence and complexity of the causes of constipation, patients often have a lot of frustration, and when constipation is severe, it can affect the quality of life. Symptoms of constipation are often manifested as: less intention to defecate, less frequent defecation; defecation is difficult, laborious; defecation is not smooth; dry stools, hard stools, defecation is not clean; constipation is accompanied by abdominal pain or abdominal discomfort. Some patients are also accompanied by insomnia, irritability, dreamy, depression, anxiety and other mental disorders. The "alarm" signs of constipation include blood in stool, anemia, weight loss, fever, black stool, abdominal pain and family history of tumor. If there are alarm signs, you should go to the hospital immediately for further examination. Disease hazards due to constipation is a more common symptoms, symptoms vary in severity, most people often do not pay special attention to, that constipation is not a disease, do not need to treat, but in fact, constipation is very harmful. 1. constipation in some diseases such as colon cancer, hepatic encephalopathy, breast disease, early senile dementia in the occurrence of a lot of studies in this regard. 2. constipation in acute myocardial infarction, cerebrovascular accident patients can lead to life-threatening accidents, there are many studies. Accidental patients can lead to life accidents, there are many tragic cases for us to be alerted.3. Part of constipation and anal and intestinal diseases, such as hemorrhoids, anal fissure and so on, have a close relationship. Therefore, early prevention and rational treatment of constipation will greatly reduce the serious consequences of constipation, improve the quality of life and reduce the burden on society and the family. Diagnosis and identification of clinical not every constipation patients need to be examined. Checks should be targeted, not the more checks the better. The implementation of too many unnecessary tests for patients with constipation will increase the burden on patients. We are opposed to the use of untargeted, "casting a wide net" type of examination for patients. Auxiliary examination in the diagnosis and differential diagnosis of constipation, according to clinical needs, should do the necessary examination. First of all, we should pay attention to whether there is the existence of alarm symptoms and evidence of the existence of other systemic organic lesions; for patients over 50 years of age, with a history of long-term constipation, short-term worsening of symptoms should be carried out colonoscopy to exclude the possibility of colorectal tumors; for long-term abusers of laxatives, colonoscopy can determine the existence of laxative colon (cathartic colon) or (and) colonic nigrostenosis; barium enema imaging Helps in the diagnosis of congenital megacolon. If OOC is suspected, anal examination and fecography are necessary. Special tests include: gastrointestinal transit test (GITT), anorectal anometry (RM), rectal-anal reflex, tolerance sensitivity, balloonexpulsion test (BET), pelvic floor electromyography (PFEM), and a blood test (BET). BET, pelvic floor electromyography, pubic nerve latency test, and anal canal ultrasonography, etc. These tests are chosen only in cases of refractory constipation. The following tests are commonly used for refractory constipation: 1. Stool routine and occult blood, which should be routine tests. 2. Tests related to biochemistry and metabolism. 3. If the clinical presentation suggests that the symptoms are due to inflammation, tumor, or other systemic disease, then hemoglobin, blood sedimentation, and relevant biochemical tests (e.g., thyroid function, calcium, glucose, and other relevant tests) are required.3. Anorectal fingerprinting can be used to find out if there is a mass or not, and the function of anal sphincter.4. Colonoscopy or barium enema can help to determine the presence of an organic cause of the disease. Especially when there is a recent change in bowel habit, blood in stool or other alarming symptoms (e.g. weight loss, fever), it is recommended that a full colonoscopy be performed to clarify the presence of organic pathology such as colon cancer, inflammatory bowel disease, and colonic stenosis.5. Gastrointestinal transmission test (GITT) is helpful in determining whether or not there is a slow transmission, and it is often performed with a film taken at 48h and 72h.6. Voiding imaging can dynamically visualize the anorectal Anatomical and functional changes. Fecography can assess the speed and completeness of rectal emptying, anorectal angle, and degree of perineal descent. In addition, fecography can detect organic lesions such as large rectal protrusions, rectal mucosal prolapse or condylomata, etc. 7. Anorectal manometry examines the presence of anorectal dysfunction.8. 24-h colonic pressure monitoring can be a guide to whether or not surgery is indicated. Lack of specific propulsive contraction wave (SPPW) and lack of colonic response to awakening and feeding indicate colonic weakness, and surgical resection may be considered.9 Anorectal manometry combined with ultrasonographic endoscopy can show the presence or absence of mechanical and anatomical defects of the anal sphincter, which can provide clues for surgery.10 The use of perineal nerve latency or electromyography can distinguish whether constipation is of muscular origin or of neural origin.11.Others For constipation, the use of perineal nerve latency or electromyography may be useful. Other investigations should be performed in patients with significant anxiety and depression to determine the causal relationship with constipation. Patients with constipation should be treated according to the severity, etiology and type of constipation, and comprehensive treatment should be adopted, including general life treatment, medication, biofeedback training and surgical treatment, in order to restore normal defecation physiology. Emphasis on life treatment, strengthen the patient's education, adopt reasonable dietary habits, such as increasing the content of dietary fiber, increase the amount of drinking water to enhance the stimulation of the colon, and develop good defecation habits, such as morning defecation, timely defecation with the intention of defecation, to avoid straining to defecate, and at the same time, should increase the activity. During treatment, attention should be paid to removing excessive accumulation of feces in the distal rectum; positive adjustment of the mind is needed, which is extremely important to obtain effective treatment. Life treatment 1. Analyze the causes of constipation and adjust the lifestyle. Adopt the habit of regular defecation; quit smoking and drinking; avoid abusing drugs. Avoid inhibiting defecation when you have the urge to have a bowel movement. Long-term and repeated inhibition of defecation can lead to increased defecation reflex threshold, loss of bowel movement, and constipation. 2. Promote a balanced diet, increase dietary fiber in moderation, and drink plenty of water. (1) High-fiber diet: Dietary fiber itself is not absorbed, can adsorb water in the intestinal lumen and thus increase the volume of feces, stimulate the colon and enhance the power. Foods rich in dietary fiber include wheat bran or brown rice, vegetables, pectin-rich fruits such as mangoes and bananas, etc. (Note: unripe fruits contain ellagic acid which can aggravate constipation)? (2) Hydration: Drink plenty of water, it is recommended to drink more than 1500ml of water per day, so that the intestinal tract maintains sufficient water, which is favorable for fecal discharge. (3) Supply sufficient amount of B vitamins and folic acid: Use food rich in B vitamins, which can promote the secretion of digestive juices, maintain and promote intestinal peristalsis, which is favorable for defecation. Such as coarse grains, yeast, beans and their products. In vegetables, spinach, cabbage, contains a lot of folic acid, has a good laxative effect. (4) Increase easy gas-producing food: Eat more easy gas-producing food, promote intestinal peristalsis to accelerate, favorable defecation; such as onions, radish, garlic mustard, etc.? (5) Increase the supply of fat: appropriate increase in high-fat foods, vegetable oil can directly laxative, and decomposition products of fatty acids have a stimulating effect on intestinal peristalsis. Seed kernels of dried fruits (such as walnuts, pine nuts, all kinds of melon seeds kernels, almonds, peach kernels, etc.), containing a large amount of oil, with lubrication of the intestinal tract, laxative effect.3. Moderate exercise to medical gymnastics, can be coupled with walking, jogging and self-massage of the abdomen. (1) medical gymnastics: mainly to enhance the strength of abdominal and pelvic muscles. Exercise method: standing position can do in situ high leg walking, deep squat standing up, abdominal and back movement, kicking movement and turn body movement. In the supine position, you can take turns to lift one leg or lift both legs at the same time, lift to 40°, and then lower it after a short pause. Flex both legs in turn to mimic bicycle pedaling. Lift the legs to make circles from inside to outside and sit-ups. (2) Walking and jogging at a fast pace: it can promote peristalsis and help relieve constipation. (3) Deep and long abdominal breathing: when breathing, the amplitude of diaphragm activity increases compared to normal, which can promote gastrointestinal peristalsis. (4) Abdominal self-massage: lie on your back, bend your knees, rub your hands together, put your left hand flat on your navel, put your right hand on the back of your left hand, and press and knead in a clockwise direction with your navel as the center. Do this 2 to 3 times a day for 5 to 10 minutes each time. Medications should be used under the supervision of a doctor. (1) Laxatives ① volumetric laxatives: mainly including soluble cellulose (pectin, psyllium, oat bran, etc.) and insoluble fiber (plant fiber, lignin, etc.). Volumetric laxatives slow onset of action and small side effects, safe, so the pregnancy constipation or mild constipation has a good effect, but not suitable for temporary constipation as a rapid laxative treatment. ② lubricating laxatives can lubricate the intestinal wall, soften the stool, so that the feces are easy to discharge, easy to use, such as Kaiser Permanente, mineral oil or liquid paraffin. ③ Salt laxatives such as magnesium sulfate, milk of magnesium, this type of drug can cause serious adverse reactions, the clinical should be used with caution. ④ osmotic laxatives Commonly used drugs are lactulose, sorbitol, polyethylene glycol 4000 and so on. It is suitable for fecal impaction or as a temporary treatment measure for chronic constipation, and is a better choice for constipated patients with poor efficacy of volumetric light laxatives.5 Stimulant laxatives: including anthraquinone-containing botanical laxatives (rhubarb, frangipani, senna, aloe vera), phenolphthalein, castor oil, and bis-esterphentin. Stimulant laxatives should be used only when volumetric and salt laxatives are ineffective, and some are stronger and not suitable for long-term use. Anthraquinone laxatives long-term application can cause colonic black stool disease or laxative colon, causing atrophy of smooth muscle and damage to the intestinal interosseous plexus, but aggravate constipation, reversible after stopping the drug. (2) pro-dynamic agents: Mosapride, Itopride has the effect of promoting gastrointestinal dynamics, and Procalcitonin can selectively act on the colon, which can be chosen according to the situation. Other treatments 1.Instrumental assistance if the feces hard knot, stagnation in the rectum near the anal opening or the patient is old and weak, defecation power is poor or lack of people, available colon hydrotherapy or clean enema method. 2.Biofeedback (biofeedback) therapy can be used for rectal-anal and pelvic floor muscle dysfunction of constipation patients, its long-term effect is better. Biofeedback therapy is the use of specialized equipment, the collection of their own physiological activity information to be processed, amplified, with people familiar with the visual or auditory signal display, so that the cerebral cortex and these organs to establish a feedback link, through the continuous positive and negative attempts to learn to control the physiological activities at will, deviating from the normal range of physiological activities to be corrected, so that the patient to achieve the purpose of "changing the self". The patient can achieve the purpose of "changing oneself". Biofeedback therapy can train patients to relax the pelvic floor muscles during defecation, so that the activities of abdominal muscles and pelvic floor muscle groups are coordinated during defecation; and for patients with abnormal voiding thresholds, emphasis should be placed on the reconstruction of defecation reflexes and the adjustment of the training of voiding perception. There is no specific specification for the training program, and the training intensity is high, but it is safe and effective. For patients with pelvic floor dysfunction, biofeedback therapy should be preferred to surgery.3. Cognitive therapy Patients with severe constipation often have psychological factors or disorders such as anxiety or even depression, and cognitive therapy should be given to eliminate tension, and antidepressant and anxiolytic therapy should be given if necessary, and psychologists should be asked to assist in the diagnosis and treatment.4. Surgical treatment is ineffective for severe intractable constipation. If the constipation is of the colon transmission dysfunction type and the condition is serious, surgical treatment can be considered, but the long-term effect of surgery is still controversial, and the selection of cases must be careful. However, the long-term effect of surgery is still controversial, and cases should be selected carefully. In the large group of constipation, those who really need surgical treatment are still in the minority. [2-3] Disease prevention 1. Avoid eating too little or too fine food, lack of residue, and reduced stimulation of colonic motility. 2. Avoid disturbances in bowel habits: failure to defecate in a timely manner due to psychiatric factors, changes in lifestyle, and excessive fatigue from long-distance travel can easily lead to constipation. 3. Avoid laxative abuse: laxative abuse can weaken the sensitivity of the intestinal tract and create a dependence on certain laxatives, resulting in constipation. 4. 4. Reasonable arrangement of life and work, to achieve a combination of work and rest. Appropriate cultural and physical activities, especially the exercise of abdominal muscles is conducive to the improvement of gastrointestinal function, for sedentary and highly concentrated mental workers is more important. 5. Adopt good defecation habits, regular daily defecation, the formation of a conditioned reflex, the establishment of good defecation pattern. Don't ignore the urge to have a bowel movement and defecate in time. The environment and posture of defecation should be as convenient as possible, so as not to inhibit the urge to defecate and disrupt the defecation habit.6. Patients are advised to drink at least 6 glasses of 250 ml of water per day, to perform moderate-intensity exercise, and to develop the habit of having regular defecation (2 times per day, 15 minutes each time). The action potential activity of the colon is enhanced when waking up from sleep and after meals, which pushes the feces towards the distal part of the colon, so morning and after meals are the easiest time to have a bowel movement.7. Timely treatment of anal fissures, perianal infections, uterine adnexitis, etc., and laxatives should be applied with caution, and strong stimulation methods such as bowel cleansing should not be used. Dietary attention to poor dietary habits or excessive partiality, should correct bad habits and adjust the content of the diet, increase the more fiber-containing vegetables and fruits, appropriate intake of rough and crumbly miscellaneous grains, such as standard flour, potatoes, corn, barley and so on. Oily and fatty foods, cool boiled water and honey are all helpful in the prevention and treatment of constipation, drink more water and beverages. Eat more food rich in B vitamins and laxatives, such as coarse grains, beans, silver fungus, honey, etc. Increase cooking oil appropriately when stir-frying. Avoid alcohol, strong tea, chili, coffee and other foods. Disease care detailed inquiry about the patient's diet is very necessary, because a considerable portion of the patient's constipation is caused by insufficient food fiber intake. Recording the amount of cereals, whole grain bread, rice, pasta, vegetables and fruits eaten by the patient is a rough way to calculate dietary fiber intake. The etiology of constipation is apparent in patients who consume only a small amount of dietary fiber daily. Ask the patient to gradually increase the dietary fiber intake to 25 g per day. initially the patient may feel bloated, but this usually improves gradually. Give the patient a recipe for fiber-rich foods and encourage him or her to eat the foods on the recipe. If the patient is unable to obtain sufficient fiber from regular diet, fiber supplements can be given. Commonly used fiber preparations are psyllium, methylcellulose, and polycarbophil. [4] Expert OpinionThe treatment of constipation lies in the establishment of reasonable dietary and living habits. Develop the habit of regular defecation, can drink cool boiled water in the morning to promote defecation, avoid inhibiting the urge to defecate; usually consume more food containing more fiber and drink more water, avoid sedentary, more relaxing exercise; regulate the mood and psychological state. Relevant examinations should be conducted when there are alarm symptoms. For some people with chronic constipation a short period of medication is necessary to help rebuild the normal bowel reflex.