Analysis:
There are many kinds of constipation!
1, organic constipation: refers to organic diseases of organs (such as digestive tract diseases, endocrine and metabolic diseases, drugs)
Constipation caused by toxic substances and chemicals, nervous system diseases, etc. Such as intestinal adhesion and incomplete intestinal obstruction.
People can have constipation, which belongs to organic constipation. Patients with organic constipation must pay attention to it.
Treat the primary disease, otherwise constipation will not be solved in the end.
2. Functional constipation refers to lifestyle changes, emotional depression, dietary factors, bad defecation habits, drugs, etc.
Constipation caused by factors such as function, such as people traveling outside, due to changes in life rules and surrounding environment,
As well as fatigue and other factors, constipation often occurs, which belongs to functional constipation.
Patients with functional constipation, except irritable bowel syndrome, can live a regular life, eat reasonably,
Adjust the mood, develop good defecation habits, eliminate other reasons, and achieve the purpose of curing constipation. suffer
Patients with irritable bowel syndrome have functional constipation, but must they go to the hospital? Hesitation?
Check.
3. Refractory constipation is a disease that can't be cured by non-surgical treatment and drug treatment. fractious
Constipation is a kind of disease that causes difficulty in defecation at different ages because of congenital colon and rectal anatomical structure variation.
Gross. The essence of intractable constipation is chronic incomplete intestinal obstruction, which is classified as knot because of different obstructive sites.
Intestinal, rectal and mixed. Refractory constipation is not functional, but it has obvious organic changes in colon and rectum.
Lesions.
The second is prevention.
1. To clean * * * and rectum, you can choose a spray gun or the water inlet pipe of a washing machine, and then rinse * * * with tap water. If it is not emptied,
You can use full-time low-pressure flushing, inject a little water, and remove the accumulated feces like gargling.
2. Constipation patients can choose to kneel on the chest and knees 2-3 times a day, which can make the drooping sigmoid colon or transverse colon.
Move and adjust the right angle between B and splenic flexure to blunt the angle, so as to facilitate defecation and exercise mesenteric initiative. Youfeichang
The effect is good.
3. Always do levator ani exercises.
4. Don't use too much force when defecating.
Third, how to treat it?
Treatment of thoracic and knee suspension sclerosis atrophy
Indications: prolapse of rectal mucosa, various hemorrhoids
Transrectal adhesion between sacrum and rectum in thoracic and knee position
Indications: separation of rectocele and sacrum.
Transrectal excision of rectal flap
Indication, rectal valve is too wide, rectal bag formation
Transrectal valve thread-drawing therapy
Indications: Rectal valve is too wide.
Closed suture of rectal mucosa and internal hemorrhoid suture
Indications: moderate and severe rectal mucosal prolapse and large internal hemorrhoids
Manual anal dilatation
Abdominal sigmoidectomy
Abdominal left hemicolectomy
Abdominal subtotal colectomy
Single introduction
Lengthy sigmoid colon
Common, because the sigmoid colon is free, the mesentery is long, and the descending colon and rectum are relatively fixed. If the congenital sigmoid colon is too long and droops at an acute angle with the rectum, the sigmoid colon can gradually creep excessively, which will cause fatigue damage for a long time. If the sigmoid colon disappears, it can be preliminarily concluded that its peristalsis function is lost. Pathological specimens after surgical resection confirmed that most of the dilated myoganglia of sigmoid colon were missing, such as sparse muscle and intestinal muscle.
Sigmoid cirrhosis
X-ray defecography and barium can confirm that some sigmoid colon bends once or twice, and we can see it four times at most, and the discharge resistance increases. Because the abdominal pressure is vertical downward during forced drainage, the intestinal curvature can be angled in many places, which makes defecation more difficult.
Descending colon gyration
In clinic, we found that the descending colon bends once or twice.
Left colon duplication
After the descending colon droops, it turns upward to cause splenic flexure, and then turns downward to form a large reflex. The symptoms are not obvious when the function still exists. If the bag disappears, it presents intractable constipation.
Separation of sacrum and rectum
That is, the sacrum and rectum are separated, and the normal rectum should be parallel to the sacrococcygeal curve. If the sigmoid colon is long, the upper rectum is intussuscepted, the upper rectum valve is too wide or forms a ring valve, and the exclusion resistance is great. Excessive force during defecation can tear off the loose tissue between the rectum and the sacrum, and the parallel curve between the sacrum and the rectum is lost, resulting in the separation of the sacrum.
Long transverse colon
That is, splenic flexure syndrome, which was often said before, is due to the long transverse colon, part of which hangs down to the pelvic cavity, and the hepatic and splenic flexure is relatively fixed, forming an acute angle at the position of hepatic and splenic flexure, increasing the discharge resistance, and forming constipation due to long-term retention of stool. After a long time, the patient's transverse colon will gradually lose its function.
Colon inversion plus bending
In X-ray barium, we photographed 1 patient with intractable constipation. Patients with colon varus and colon gyration usually have tortuous colon and difficulty in defecation from childhood.
Total or partial loss of colon function
Acquired colon function is lost or partially lost, and the distal end of its pouch-like disappearance generally has a coiled, tortuous and cunning narrow segment. Due to the large discharge resistance and fatigue injury of the colon, the bag deformation disappears shallowly in the image and shows wax-like changes, which are common in sigmoid colon, descending colon, transverse colon prolapse and left semi-transverse colon. In the worst case, the ascending colon also expands and disappears in a bag shape.
Right colon duplication deformity
The patient's lower intestine droops, then rises to the vicinity of hepatic curvature, and then changes from transverse colon to splenic curvature.
Rectal mucosal prolapse
It is the most common outlet obstructive constipation, and the age of onset is not completely related to age. Our youngest patient has obvious mucosal prolapse at the age of 4, which is related to rectal stenosis caused by any reason, especially rectal variation. Because the relative inner diameter of rectum is narrow, the resistance of discharge channel increases, and the friction force on rectal mucosa also increases. On the premise of excessive defecation, the mucosa is separated from the rectal muscle layer, and wrinkles or hemorrhoids are formed in the rectal neck and anal canal, and stool can accumulate on the floor.
Rectal valves are too wide, too closely spaced and numerous.
Congenital rectal valves are too wide, too closely spaced and numerous. The physiological function of rectal flap is to prevent stool from falling too fast and gradually evolving into folds formed by local proliferation of rectus muscle. Generally crescent-shaped, the number is generally three. However, some of the valves we have observed in clinic occupy half of the intestinal cavity, which are annular valves, with a maximum number of 7-8. Because of the variation of rectal valve, the relative inner diameter of rectum becomes narrower, the discharge resistance increases, and stool often burps above the valve.
Rectal fold
It is rarely seen in the middle of rectum, where rectum is separated from sacrum. The reason is that the rectal valve is too wide, and the stool can not form an axial flow in the rectum, but can only form a bias flow. Due to mechanical factors, the rectum is separated from the sacrum, forming a fold. Through the adhesion between the rectum and the sacrum, the fold disappears after valve incision (thread hanging).
Rectal pouch formation
Because the rectal valve is too wide, the stool cannot form an axial flow, and a pocket is formed on the side wall above the rectal valve. The stool is wrapped in a pocket and then folded back to the rectum. The deepest pocket we saw was 3CM, and the patient eventually formed a complete rectal prolapse. The light valve can be solved after incision, and the heavy valve can be partially removed and anastomosed under the capsule.
Upper rectal intussusception
Because of the stenosis of annular valve in the rectal segment, annular intussusception is formed in the upper rectal segment, often accompanied by redundant sigmoid colon. In mild cases, suspension sclerotherapy can be used, especially injecting sclerosing agent above the valve to make the valve form a funnel shape, which is beneficial to the downward movement of stool. In severe cases, it is feasible to perform partial colectomy and keep the redundant sigmoid colon.
Anal canal stenosis and internal sphincter achalasia
It can be opened by manual anal dilatation or internal hanging myotomy.
Adolescent rectal syndrome
In our ten years of diagnosis and treatment, X-ray diagnosis showed that there were more than 40 cases of puborectalis syndrome, and only 1 case was diagnosed as infection-induced puborectalis myotonia. Constipation was relieved by rectal mucosal injection and valvulotomy. Therefore, puborectalis syndrome as one of the causes of constipation should be uncertain.
Prorectocele
Most scholars believe that the weak anterior wall of female rectum is the cause of rectocele. We believe that the weakness of the anterior wall of rectum is the characteristic of female physiological anatomy. Constipation is caused by relatively narrow lower rectum, such as wide rectal flap, prolapse of rectal mucosa, relaxation of internal sphincter, anal canal stenosis and many other factors. Because the posterior rectal wall is supported by sacrococcygeal bone or ligament, stool can only impact the weak anterior part, and the tissue of the anterior rectal wall in men is also dense. Only women's rectal septum is weak, forming rectocele. Therefore, we think that rectocele is a unique X-ray symptom of female outlet obstruction, and the treatment is mainly to dredge the drainage channel, that is, to solve the problems of rectal mucosal prolapse, too wide rectal flap, relaxation of internal sphincter and anal canal stenosis, so that rectocele can be relieved or even disappeared, and constipation symptoms can be relieved.
Solitary ulcer syndrome
When rectal mucosal prolapse is serious, it can cause mucosal ischemia and hypoxia and superficial ulcer due to the extrusion of hard stool. Its treatment is mainly to treat rectal mucosal prolapse, and generally the ulcer should be treated with drugs before operation.