Principles of treatment

1. 1 Acute constipation is mostly caused by intestinal obstruction, so it is mainly treated according to the etiology. If the patient has symptoms such as abdominal distension and dull pain, it can be treated with warm water enema; If it is pathological obstruction, it should be treated by surgery in time. 1.2 constipation is caused by diseases near the anus and rectum, such as acute constipation caused by anal fissure, anal fistula, perianal abscess, huge internal hemorrhoid complicated with infection, etc. These diseases should be treated actively, and at the same time, the method of softening stool or anal administration should be adopted to facilitate stool discharge. 1.3 If acute constipation is caused by taking some drugs with constipation side effects, such drugs should be reduced or stopped. If necessary, laxatives with little irritation to the intestine can be added. 1.4 Chronic constipation caused by some organic diseases should be treated after the cause is clear. 1.5 Patients with long-term constipation, even more than 1 year, or recurrent intermittent constipation (or constipation alternating with diarrhea) have been confirmed by various tests that there are no organic lesions in colon and rectum, and their general condition is good, their appetite is basically normal, and they have no emaciation, anemia and other manifestations. They can be considered as constipation with intestinal dyskinesia or irritable bowel syndrome. The treatment of this constipation is generally difficult. You can try the following treatment measures. 1.5 1 Encourage patients to do what they can, such as playing Tai Ji Chuan, doing gymnastics, jogging or walking; Patients can be instructed to do abdominal exercises (deep abdominal breathing) in bed every night before going to bed, every time 15 ~ 30 minutes; Self-abdominal massage can be performed, and the massage mode should be clockwise, from right to left, lasting 15 ~ 30 minutes. 1.52 Encourage patients to eat more fruits rich in cellulose, such as vegetables, bananas, pears, watermelons, etc., so as to increase the stool volume, and drink more water, and drink less irritating drinks such as strong tea and coffee. 1.53 can instruct patients to take honey orally frequently, and play a laxative role. 1.54 Only when patients get into the habit of defecating regularly every day can they gradually recover or re-establish defecation reflex. Busy in the morning or during the day can be arranged in the evening (it is generally better to arrange in the morning). 1.55 gastrointestinal motility agents such as mosapride can be selected to enhance intestinal motility and increase intestinal peristalsis, which has a good effect on slow transit constipation. Recently, it has been reported that tegaserod (trade name: ZeKyle) is a selective 5-HT4 receptor agonist, which can promote intestinal peristalsis, shorten colon transit time and increase stool frequency. 1.56 In principle, laxatives should not be used to avoid patients' dependence on drugs. At present, there are many kinds of cathartic agents to choose from, mainly including the following four categories. ① Volumetric laxatives: This kind of laxatives can increase the volume of feces to enhance the stimulation of feces on intestinal receptors. Commonly used laxatives include sodium carboxymethyl cellulose, lactulose, sorbitol, mannitol, polyethylene glycol 4000(forlax) and salt laxatives (magnesium sulfate and sodium sulfate, etc. ). lactulose, polyethylene glycol 4000, etc. Also known as osmotic laxatives. After application, it can increase osmotic pressure in intestinal cavity, reduce water absorption and increase fecal volume. 2 Lubricating laxatives: These laxatives are not absorbed in the intestine, but they can hinder the absorption of water, so they often play the role of lubricating the intestinal wall and softening feces (also known as feces softener). Liquid paraffin, glycerin and vegetable oil are commonly used. Because long-term application of this laxative will lead to the absorption of vitamins A, D, K, calcium and phosphorus, it is not suitable for long-term use. (3) Irritating laxatives: also known as contact laxatives, these laxatives have a strong laxative effect because they stimulate the intestinal mucosa and affect the absorption of water and electrolytes in the intestine. Radix et Rhizoma Rhei, Folium Sennae, Aloe and other plant laxatives contain anthraquinone glycosides, which can only play a laxative role after being decomposed into anthraquinone by bacteria in the intestine. Long-term use of laxatives with strong irritation will cause patients to rely on drugs. In addition, long-term use will also lead to melanosis coli. Because salt laxatives such as magnesium sulfate have a strong stimulating effect on the intestine, they can also be classified into this category. ④ Local irritant laxatives: glycerin/sodium chloride (kaisailu), glycerin suppository, etc. After being stuffed into the anus, it can make the patient defecate and cause defecation reflex, which is called anal local laxative and has good effect on patients with chronic outlet obstructive constipation. 1.56 1 In short, different laxatives (i.e. individualized treatment) should be selected according to the constipation characteristics of patients, and in principle, laxatives with good curative effect, safety, long-term application tolerance and low price should be selected. However, it must be pointed out that for any constipation patient, we should not rely too much on laxatives, but should consider adjusting diet, avoiding fatigue, strengthening exercise and forming the habit of defecation at regular intervals as the main treatment means. People with psychological disorders should be treated accordingly. 1.57 conditional patients can also use biofeedback therapy, aiming at increasing the peristalsis function of the intestine and facilitating the operation of feces.