There are two types of constipation.

One is called "functional constipation". This is because the function of the large intestine or rectum is weakened, or constipation caused by always inhibiting defecation.

The other is "organic constipation (the morphological nature of organs seen through anatomical identification)". This is because of some kind of disease.

Constipation caused by illness leading to intestinal thinning or foreign body growing in large intestine, which makes it difficult for stool to pass through intestinal tract. In addition, there are cases of constipation caused by congenital abnormal morphology of large intestine.

In these two kinds of constipation, most people suffer from functional constipation. Functional constipation is divided into "temporary constipation" and "habitual constipation"

Temporary constipation caused by changes in living environment such as travel and moving, or mental stress and troubles is called "temporary constipation"; Due to the decrease of food intake, the defecation reflex of the stomach or colon is not sufficient, which is also the reason.

Constipation caused by the continuous decrease of large intestine excretion is called habitual constipation, that is, so-called chronic constipation, which can be divided into three types: procrastination, rectum and spasticity.

More than half of chronic constipation belongs to "chronic constipation". People with drooping internal organs or weak constitution are likely to cause this type of constipation.

"Spastic constipation" is constipation caused by emotional or emotional changes and mental stress, and it is a common type of people living in cities or engaged in mental work.

You may be surprised that people's mental state is actually related to constipation. But because the movement of the large intestine is controlled by autonomic nerves, it is greatly influenced by the brain.

This type of constipation is different from ordinary constipation, and it will not feel pain because of defecation, and there is no feeling of bloating. The shit pulled out is hard and hard, just like the shit of a rabbit. In addition, constipation and diarrhea are often repeated every day, which can also be said to be the characteristics of spastic constipation.

Constipation in the elderly

Constipation in the elderly refers to decreased defecation frequency, difficulty in defecation and dry stool. Normal people defecate 1 ~ 2 times a day or 1 times, while constipation patients defecate less than three times a week, which is laborious and hard and small. Constipation is a common symptom of the elderly. About13 of the elderly have constipation, which seriously affects their quality of life.

The common causes of many groups of elderly people in gastroenterology department of constipation clinic are related to common symptoms such as old age, bad living habits, mental illness, intestinal diseases, systemic diseases and drug abuse. The frequency of defecation is reduced, defecation is difficult, and the feces are hard and small; Abdominal distension, loss of appetite

The cause of disease

1. It is related to age.

The prevalence of constipation in the elderly is significantly higher than that in young adults, mainly because with the increase of age, the food intake and physical activity of the elderly are obviously reduced, the gastrointestinal tract secretes less digestive juice, the tension and peristalsis of the intestine are weakened, the abdominal cavity and pelvic floor muscles are weak, the internal and external sphincter of anus are weakened, the gastrocolon reflex is weakened, and the rectal sensitivity is reduced, which makes the food stay in the intestine for too long and causes constipation due to excessive absorption of water. In addition, the elderly often lose defecation reflex due to Alzheimer's disease or mental depression, causing constipation.

2. Bad living habits

(1) Dietary factors: the elderly have lost their teeth and like to eat fine food with low residue, or a few patients have a simple diet and lack of crude fiber, which reduces the volume of feces, increases the viscosity, slows down the movement in the intestine, and causes constipation due to excessive water absorption. In addition, because the elderly eat less, the calorie content of food is low, and the gastrointestinal transit time is slowed down, which will also cause constipation. It is reported that gastrocolonic reflex is related to food intake. 1000cal diet can stimulate colon movement, but 350cal has no such effect. Fat is the main food to stimulate reflex, but protein has no such effect.

(2) Defecation Habits Some elderly people do not develop the habit of regular defecation, and often ignore normal defecation, leading to inhibition of defecation reflex and constipation.

(3) Decreased activity. Older people have decreased activity due to certain diseases and obesity factors, especially those who are bedridden or in wheelchairs due to illness. Because of the lack of exercise stimulation to promote fecal movement, constipation is often prone to occur.

3. Mental and psychological factors

People with psychological disorders such as depression, anxiety and obsessive-compulsive disorder are prone to constipation.

4. Intestinal lesions

Intestinal diseases include inflammatory bowel disease, tumor, hernia, rectal prolapse and so on. These diseases lead to functional outlet obstruction and defecation disorder.

5. Systemic lesions

Systemic diseases include diabetes, uremia, cerebrovascular accident and Parkinson's disease.

6. Iatrogenic (laxative abuse)

Due to long-term use of laxatives, especially irritating laxatives, intestinal mucosal nerves are damaged and intestinal muscle tension is reduced, resulting in serious constipation. In addition, other drugs that cause constipation include opioid analgesics, anticholinergic drugs, antidepressants, calcium antagonists, diuretics and so on.

clinical picture

The main manifestations of constipation are decreased defecation times and difficulty in defecation. Many patients defecate less than three times a week, and in severe cases, defecate once every 2 to 4 weeks. Some patients may show difficulty in defecation, the defecation time can be as long as 30 minutes or more, or defecation is repeated every day, but it is difficult to discharge, and the feces are as hard as sheep dung, and the number is very small. In addition, there are abdominal distension, anorexia and abdominal pain before defecation caused by improper use of laxatives. Physical examination showed that there was a fecal ring in the left lower abdomen and a fecal lump in the anus.

Excessive defecation in the elderly will lead to changes in coronary artery and cerebral blood flow. Due to the decrease of cerebral blood flow, fainting may occur during defecation. Angina pectoris and myocardial infarction can occur in patients with insufficient coronary blood supply. Hypertensive people can cause cerebrovascular accidents, ruptured aneurysm or ventricular aneurysm, thrombus attached to the heart falling off, arrhythmia and even sudden death. Low muscular tension of colon can lead to Hirschsprung's disease. The increase of intra-abdominal pressure during forced defecation can cause or aggravate hemorrhoids, and the anal canal is damaged during forced defecation, which can cause perianal diseases such as anal fissure. Intestinal obstruction, fecal ulcer, urinary retention and fecal incontinence will occur after fecal impaction.

cheque

1. abdominal plain film

It can display intestinal cavity dilatation, fecal retention and gas-liquid level, and can determine constipation caused by organic diseases such as colon cancer and stenosis.

2. Barium enema

Can understand the structure of colon and rectum.

3. Colonoscopy and fiber sigmoidoscopy

You can observe whether there are lesions and strictures in the intestinal mucosa and cavity, and you can also find melanosis coli.

4. Anorectal pressure measurement

It can help to judge whether there is abnormal rectal pelvic floor function or abnormal rectal sensory threshold.

5. Balloon push-out test

It is helpful to judge whether the function of rectum and pelvic floor muscles is abnormal.

6. Pelvic floor electromyography

It can be judged whether there are myogenic or neurogenic lesions.

7. Colon transmission function experiment

Understand the colon transmission function.

8. defecography

It is helpful for the diagnosis of pelvic floor hernia and rectal intussusception.

diagnose

Learn more about the onset time and treatment process of constipation, recent changes in defecation time, ask about the frequency of defecation, whether defecation is difficult and laborious, whether defecation is bloody, whether it is accompanied by abdominal pain and bloating, the above gastrointestinal symptoms and other systemic diseases that can cause constipation, especially excluding organic diseases. If the course of the disease is more than a few years and the condition has not changed, it often suggests functional constipation.

treat cordially

1. Insist on taking part in exercise

According to the survey of the elderly over 60 years old, the incidence of constipation in people who seldom walk because of their old age and infirmity accounts for 15.4%, while the incidence of constipation in people who insist on exercising is 0.2 1%. Therefore, patients are encouraged to take part in exercises as much as they can, such as walking, walking or massaging abdominal muscles by hand several times a day to enhance gastrointestinal peristalsis. Qin Ying, a patient who has been bedridden for a long time, turns over for circular abdominal massage or hot compress.

2. Cultivate good defecation habits

Carry out health education to help patients establish normal defecation behavior. You can practice defecation once every morning, even if you don't intend to defecate, you can wait for a while to form a conditioned reflex. At the same time, to create a quiet and comfortable environment, choose a sitting toilet.

Reasonable diet

The elderly should eat more grains, vegetables, melons and beans containing crude fiber, and drink more water, at least 1500ml per day, especially drinking a cup of warm water every morning or before meals, which can effectively prevent constipation. In addition, we should eat some foods with laxative effect, such as black sesame, honey, bananas and so on.

4. Others

Preventing or avoiding the use of drugs that cause constipation, not abusing laxatives, actively treating systemic and perianal diseases and adjusting mental state are helpful to establish normal defecation reflex.

prevent

Adhere to proper physical exercise, cultivate good defecation habits, eat reasonably and pay attention to supplementing dietary fiber. Foods containing the most dietary fiber are wheat bran, fruits, vegetables, oats, corn, soybeans, pectin and so on. In addition, actively treating systemic and perianal diseases, preventing or avoiding the use of drugs that cause constipation, and cultivating a good psychological state are all conducive to the prevention and treatment of constipation.

Start with constipation

Constipation easily leads to high blood pressure and stroke. Because of constipation, cholesterol excretion is blocked, cholesterol content in blood rises, and blood vessels are easily attacked by cholesterol and become hard. Vascular sclerosis, narrowing of pipe diameter and increase of peripheral resistance lead to hypertension.

In the past two years, there has been a popular saying among people who pay attention to health: don't ask if the food is good, just ask if it is smooth. This sentence greatly overshadowed the China people asking everyone "Have you eaten?" . It can be seen that whether defecation is normal is more important to people's health than eating well. Therefore, protecting intestinal health, promoting intestinal peristalsis and preventing problems before they happen have attracted much attention in today's society.

Medical scientists believe that constipation is the source of all diseases. So, what diseases are constipation easy to cause?

The author interviewed Ms. Gu, a health expert in china health care association, and she said: First of all, constipation is easy to cause hypertension and stroke. Because of constipation, cholesterol excretion is blocked, cholesterol content in blood rises, and blood vessels are easily attacked by cholesterol and become hard. Vascular sclerosis, narrowing of pipe diameter and increase of peripheral resistance lead to hypertension. Excessive defecation in elderly hypertensive patients can also induce stroke or even sudden death due to constipation. If we only look at the superficial phenomenon, take antihypertensive drugs and simply treat stroke, it will become a temporary solution instead of a permanent cure.

Secondly, constipation is easy to cause intestinal cancer: the incidence of intestinal cancer in people who eat meat and have constipation is twice that of normal people. Constipation increases the contact time between intestinal mucosa and carcinogens, and increases the incidence of intestinal cancer. Constipation is easy to cause gallstones: normal people excrete a considerable amount of cholesterol from feces every day, while constipation is blocked in cholesterol excretion and easily deposits in the gallbladder to form gallstones, while constipation has a large number of gallstones.

What's more, constipation is easy to cause breast cancer. Scientific research data show that people who defecate less than twice a week have twice the incidence of breast cancer as those who defecate every day, and obese women with constipation have a higher incidence of breast cancer.

Experts further introduced the related diseases caused by constipation: constipation is easy to cause acne, and most patients with acne and constipation are found clinically. Constipation is easy to cause hemorrhoids, which is a fact recognized by the masses. The incidence of intestinal cancer in people who love meat and constipation is twice that of normal people. Constipation increases the contact time between intestinal mucosa and carcinogens, and increases the incidence of intestinal cancer. Finally, there are many female patients with migraine and vascular headache with constipation.

If hypertension, stroke, intestinal cancer, gallstones, breast cancer, hemorrhoids and acne occur, blindly taking medicine and surgery for these superficial symptoms will not only cost a lot of money, but also cause physical and mental pain. Therefore, prevention and treatment of constipation is the basis of treatment. So, how to prevent constipation?

Of course, cultivating good living and eating habits is the first priority. Don't worry if you are really constipated, but don't take medicine. Constipation is an intestinal problem, which can be relieved and eliminated without taking medicine at all. The stimulation of drugs will only make constipation more and more serious, and the purpose of medical and scientific development is by no means to make human beings unable to adapt to nature more and more. As long as the balance of intestinal flora is adjusted, the intestine can give full play to its own functions and will be healthier.

Constipation, as a common disease in daily life, is extremely harmful to people. It can not only induce many diseases such as breast cancer, but also affect children's intellectual development. Experts say that there are many reasons for constipation, including organic and functional. Among them, too thin diet, too much oil and too little exercise are the causes of functional constipation. Constipation is the "seed" of cancer

Constipation is very harmful to people's health, which will not only induce breast cancer and intestinal cancer, but also affect children's intellectual development. It is also one of the causes of life accidents in patients with acute myocardial infarction and cerebrovascular accident, which must be paid attention to. This is a reminder to the public by Professor Li Guodong, Vice President of Anorectal Branch of Chinese Medicine Association.

Some data show that 23.2% of the women with precancerous lesions have constipation symptoms, while only 5.1%have no constipation; There are five kinds of bacteria in human intestine that can ferment feces to produce cancer-causing mutants related to colon cancer, and constipation is closely related to colon cancer.

The results of medical experts' examination show that 1 human breast cell development is abnormal in 20 women who defecate once a day, and abnormal in 4 women who defecate less than twice a week.

Experts found that there is a mutagen in constipation feces. It was determined that the mutant was similar to several carcinogens known at present. These mutagens, after being absorbed by intestinal tract, can enter the breast tissue which is quite sensitive to them with blood circulation, so the possibility of breast cancer is obviously increased.

In addition, the toxins produced by food waste under the action of intestinal bacteria can reach the brain through blood circulation, stimulate the cranial nerves and affect the development of children's memory, logical thinking and creative thinking. Experts pointed out that although constipation itself rarely directly causes fatal danger, if you are older and suffer from cardiovascular and cerebrovascular diseases, constipation may be a fatal risk factor: constipation makes you have to exert yourself when defecating, which makes your blood pressure rise and your oxygen consumption increase, which easily leads to cerebral hemorrhage, angina pectoris and myocardial infarction, which is life-threatening. It is these hazards that make western medicine and Chinese medicine advise you to keep your stool unobstructed.

Eating too much is easy to cause constipation.

There are many reasons for constipation, both organic and functional. Among them, too thin diet, too much oil and too little exercise are the causes of functional constipation. Specifically, it can be roughly divided into several categories.

1, lack of dietary fiber

Defecation requires intestinal peristalsis, and intestinal peristalsis requires certain nerve stimulation. However, nowadays people's increasingly refined eating habits make the intestines "passive". Therefore, to relieve constipation, we must ensure the intake of crude fiber foods, such as corn, purple rice and sorghum.

2. Lack of vegetable oil

If you want to avoid constipation, you should eat an appropriate amount of oily food and keep your intestines lubricated. Therefore, vegetarians should not think that they can stay away from constipation. Beans such as red beans and black beans (soybeans have obvious flatulence, so it is best to eat less) or nuts such as pine nuts, walnuts and sesame seeds all contain vegetable oil that can moisten intestines, so you can eat more, but fried foods can not only moisten intestines, but also may aggravate constipation, so the consumption should be controlled.

3. Water shortage

People who are constipated have this feeling and it is difficult to get rid of it. Traditional Chinese medicine has the saying of "swimming with liquid", and the importance of water is self-evident. In addition to ensuring enough water every day, people without kidney disease can insist on drinking a glass of brackish water or soda water after getting up every morning, which may have a alleviating effect.

4. Eat too little

In order to lose weight, many young people eat too little or eat too much, which will not stimulate the intestines enough and affect their normal function. Over time, it may also cause constipation.

Farewell on the toilet-beware of constipation and sudden death of the elderly

In 20 18, Chen, son of Marshal Chen Yi, died of acute massive myocardial infarction at the age of 7 1 year. It is reported that the day before his death, Chen was still in good physical and mental condition. At about 2 1 20 pm, Chen is going to wash and sleep. When he defecated before going to bed, he had an accident and suddenly fell down because he used too much force. Although his wife immediately called 120 for an ambulance, Chen lost his breathing and heartbeat on the way to a nearby hospital.

Sue someone on the toilet

Professor Ren Donglin, the leader of anorectal surgery in the Sixth Affiliated Hospital of Sun Yat-sen University, said that there were not a few people who died of constipation in ancient and modern times: Jin suddenly felt abdominal distension in the Spring and Autumn Period, so he "went to the toilet and died"; 1760, King George II of England suffered a heart attack and died suddenly. 1796, Russian queen Catherine II fell into a coma during defecation and then died. Crosstalk masters Ma Ji and Hou also died suddenly in the toilet in the morning. ...

Nowadays, the pace of life and work is very fast, and many people are sedentary and lack exercise every day. As a result, more and more people are constipated. Many times, in order to hurry, you will get used to defecating hard. But you know what? Such a simple action may lead to "sudden death in the toilet"!

Women's special physical structure and physiological characteristics will also lead to a much higher incidence of constipation than men: women have a uterus in front of their rectum, while men only have bladder and prostate in front of their rectum. During the menstrual cycle, pregnancy and pregnancy, the uterus will change accordingly because of hormonal changes. Squeezing the rectum in the pelvic cavity will increase the curvature of the rectum and defecate more slowly than men. In addition, women's pelvic floor muscles are weaker than men's, the fetus is oppressed during pregnancy, and the strength of defecation is relatively insufficient, so constipation is prone to occur.

Chinese medicine says: "Constipation is the ancestor of all diseases." Constipation brings pain to patients. If the stool cannot be discharged and stays in the intestine, it will cause: deterioration of the intestinal environment, gastrointestinal dysfunction, endocrine disorder, metabolic disorder, long spots on the face, loss of appetite, poor sleep and mental stress over time.

Constipation will leave marks on the face.

In daily life, many elderly people are often troubled by constipation. According to the epidemiological survey in China, the incidence of constipation is about 9%- 13%, of which 25%-50% is senile constipation. Gastroenterology experts say that the tooth function of the elderly is gradually deteriorating, and it is not easy to chew the crude dietary fiber in food. Dietary fiber intake is too small, defecation is difficult, and extra prebiotics are needed.

Some gerontology research institutions have found that long-term constipation is one of the chief culprits that promote the mental decline of the elderly. According to statistics, about 80% of elderly constipation patients are prone to Alzheimer's disease.

Constipation is very dangerous for people with hypertension and coronary heart disease. These patients spend too much time squatting on the toilet when defecating, and defecation requires a lot of effort, which leads to an increase in abdominal pressure and blood pressure. At the same time, the acceleration of heart rate leads to the increase of myocardial oxygen consumption, which leads to severe and persistent acute myocardial ischemia and even develops into myocardial infarction. Constipation patients often hold their breath when defecating, squeezing internal organs, causing heart rupture, dissecting aneurysm or rupture of great vessels. It is also life-threatening. Constipation is one of the risk factors of acute myocardial infarction in patients with heart disease. When the patient forcibly defecates, the vascular pressure increases and the blood flow speed increases, which is easy to flush the plaque attached to the blood vessel wall into the blood flow, block the blood vessel, cause acute myocardial infarction and even sudden death.

Constipation not only induces serious heart disease, but also has multiple hazards, such as aggravating hemorrhoids, inducing anal fissure, forming abdominal hernia and causing gastrointestinal nerve dysfunction. Some patients don't pay attention to constipation. They go to the drugstore or clinic, take some laxatives, eat for a few days, and excrete their feces, thinking that everything will be fine and sit back and relax. However, laxatives did not fundamentally solve the patient's problem: at first, the patient took laxatives once or twice and then discharged smoothly. Then take four or five tablets, a dozen tablets, until the end, no matter how much medicine you take, your condition can't be alleviated.

Moreover, due to the strong action of drugs, it often leads to a series of adverse reactions such as colon blackening, intestinal smooth muscle atrophy, and even injury to intestinal nerves. In addition, some traditional Chinese medicines (such as rhubarb and senna leaves) and intestine-moistening tea contain a compound called anthracene, which can also lead to a large amount of pigment deposition in the intestinal mucosa, that is, melanosis coli.

The picture below shows the normal colon on the left and melanosis coli on the right. Melanosis coli is a benign and reversible disease. If constipation can be effectively relieved and anthraquinone laxatives can be stopped in time, most patients' diseases can subside by themselves within about 1 ~ 2 years. But if we don't pay attention to it, once the lesion continues to develop, it will increase the risk of colon cancer.

For intractable constipation, there is no better way than surgery.

Zhou Hai (male, pseudonym), a 22-year-old boy, was constipated since childhood. He was operated in Shanghai Tenth People's Hospital for more than 3 hours and took out 13 kg of Hirschsprung's disease.

Therefore, the elderly (especially those with bad hearts) must pay attention to the prevention and treatment of constipation, and the following methods can be adopted.

1. Stick to exercise;

2. Cultivate good defecation habits: you can practice defecation once every morning, even if you have no intention of defecation, you can squat for a while to form a conditioned reflex, and pay attention to creating a quiet and comfortable environment and choose a sitting toilet;

3. Reasonable diet: eat more grains and vegetables, melons and beans containing crude fiber, or choose prebiotics (instant astaxanthin prebiotics are a good choice); Drink plenty of water, at least 1500 ml per day, especially a cup of warm water in the morning or before meals;

4. Active treatment.

(Source: Instant Nutrition 20 18- 12-02)

Various methods for treating constipation

The main purpose of treatment is to relieve symptoms and restore regular defecation. Non-surgical treatment is the main treatment, supplemented by surgical treatment. After the systematic non-surgical treatment is ineffective, constipation symptoms are serious, which affects normal work, study and life, or surgical treatment is strongly required, and there is no mental abnormality, then surgical treatment can be considered, and surgical indications and contraindications must be strictly observed.

1. General therapy

Correct bad eating habits and eat more foods with high crude fiber content, mainly vegetables and fruits. Crude fiber can increase the weight and volume of feces, enhance the physiological stimulation of digestive tract, promote intestinal peristalsis and shorten the passage time of intestinal contents.

In addition, we should maintain a healthy mental state, develop good defecation habits and exercise regularly.

2. TCM treatment based on syndrome differentiation

Traditional Chinese medicine believes that difficulty in defecation, decreased defecation frequency and prolonged defecation time are the central symptoms of chronic transit constipation. The disease is in the large intestine. Although it is a visceral disease, it is closely related to other viscera, qi and blood, and body fluid. Therefore, the principle of treatment should start with regulating the yin and yang of zang-fu organs and treat them according to the deficiency and excess cold and heat. Can be divided into deficiency and excess, clinical treatment. Traditional Chinese medicine has mature experience in syndrome differentiation and treatment of this disease.

3. External treatment of traditional Chinese medicine

(1) Acupuncture Therapy At present, the acupuncture treatment of chronic functional constipation mainly focuses on the specific points of the large intestine meridian and the stomach meridian, and most of them are selected locally with Shu and Mu. On this basis, select points based on syndrome differentiation, regulate qi and dredge fu organs. The commonly used acupoints of the large intestine meridian, such as Shu Tian, Dachangshu, Dachangshu and Xiahe, are all virtual, and Zusanli, the stomach meridian with the function of regulating the spleen and stomach, is also commonly used. In addition, ear acupuncture can also achieve a certain curative effect. Commonly selected acupoints: stomach, large intestine, small intestine, sympathetic, endocrine, rectum, subcortical, and the above acupoints can be pressed or buried.

(2) Massage can enhance the body's sensitivity to external stimuli, improve gastrointestinal peristalsis, and strengthen defecation feeling and defecation reflex. It can be divided into abdominal massage, acupoint massage and foot massage.

(3) Chinese medicine enema method adopts high retention enema such as Chinese medicine decoction and Yiqi Runchang decoction to reduce the irritation to the stomach, and the medicine is directly absorbed through the intestinal mucosa to improve the symptoms.

(4) Acupoint sticking therapy can choose different drugs according to different symptoms, grind them into paste with honey, and stick them on Shenque, bilateral Shu Tian and bilateral Dachangshu. Through acupoint absorption, it acts on the intestine and stimulates intestinal peristalsis, thus achieving the purpose of relaxing bowels.

(5) Acupoint catgut embedding therapy: different types of catgut are selectively embedded into acupoints as needed, and the purpose of treating diseases is achieved through the continuous weak stimulation of catgut to acupoints (equivalent to continuous needle retention). Stimulating acupoints to trigger the regulation of channels and collaterals, changing the endocrine and neurohumoral balance of human body, is an effective treatment.

4. Drug therapy

(1) laxatives can relieve symptoms in some patients; Some patients take laxatives for a long time, and the dose is getting bigger and bigger, and the effect is getting worse and worse. The commonly used laxatives in clinic include stimulating laxatives and mechanical laxatives. The laxative treatment should follow the principles of small dosage, short course of treatment and reasonable drug selection.

(2) Cisapride, a prokinetic drug, selectively promotes the release of acetylcholine, thus accelerating gastrointestinal peristalsis and making feces easy to discharge. Literature reports that the effective rate of treating constipation is 50% ~ 95%, but a few patients can induce heart problems after taking medicine. Mosapride and Cabily are new prokinetic drugs, which can not only promote gastrointestinal movement, but also increase the positive prokinetic effect of anal sphincter and promote the spontaneous relaxation of anal canal. In addition, tegaserod can also promote intestinal peristalsis, reduce intestinal visceral sensitivity and promote intestinal secretion.

(3) Microecological preparation Microecological preparation promotes intestinal peristalsis through intestinal reproduction, and produces a lot of lactic acid and acetic acid. It can relieve constipation symptoms and effectively reduce the long-term recurrence rate, but its curative effect needs further clinical observation and verification.

(4) External medication: Anal local medication needs further observation and study. Local injection of botulinum toxin and suppository anal plug in the treatment of outlet obstructive constipation have been mentioned in domestic and foreign reports, which have certain curative effect on the treatment of this disease. Enema and hydrotherapy can also relieve symptoms, but the therapeutic effect on severe intractable outlet obstructive constipation is limited.

5. Biofeedback therapy

Include manometric feedback therapy and electromyography feedback therapy. Biofeedback is mainly used to treat functional outlet obstructive constipation caused by disharmony of anal sphincter and contradictory contraction of pelvic floor muscle and external anal sphincter during defecation. After regular biofeedback treatment, the effective rate can reach more than 70%.

6. Behavior therapy

This method exercises defecation at a specified time, develops good defecation habits, strengthens the strength and coordination of defecation muscles, and promotes the passage of colon contents and the smooth discharge of feces. This exercise is usually carried out after breakfast, simulating the defecation process for defecation training and rebuilding the defecation mechanism. The method is to try to rebuild the stimulating and reactive defecation related to eating, that is, let the patient have defecation training 5 minutes after breakfast, simulate the defecation process, and cough with both hands on the abdomen to increase abdominal pressure and promote defecation. If you can't start defecation, do it after lunch and dinner, and extend the time appropriately until defecation, thus rebuilding the defecation mechanism. This method is mainly effective for outlet obstructive constipation and also helpful for patients with slow transit constipation.

7. Psychotherapy

Visceral nerve belongs to autonomic nerve, so the changes of internal and external environment and emotional psychology will affect intestinal movement through autonomic nerve, and psychological factors can not be ignored in the treatment of slow transit constipation. To have a high sense of responsibility and sympathy and gain the trust of patients, we should carefully look for possible psychological stimulating factors from the social, psychological and behavioral perspectives, patiently explain the important significance of these factors in the occurrence and development of diseases, and make patients realize that adjusting psychological state and stabilizing psychological mood can eliminate bad symptoms. You can get the help of psychological counselors and psychologists.

8. Surgical therapy

Sometimes it is not limited to the choice of single operation, but should be treated comprehensively according to the actual situation of patients.

(1) Total colectomy with ileocecal anastomosis is suitable for patients with total colonic dyskinesia. If the rectum is normal, the integrity of the rectum should be ensured as much as possible, that is, the rectum below the junction of straight and B should be preserved. Doing so can preserve normal defecation reflex, reduce postoperative diarrhea and prevent anal incontinence.

(2) Total colectomy and ileal pouch anus anastomosis have high technical requirements and good long-term effect. The effective rate is 70% ~ 100% for patients with slow transit constipation complicated with rectal emptying dysfunction and rectal mucosal allergy.

(3) Subtotal colectomy plus ascending colon anastomosis is suitable for patients with dyskinesia of the right colon. Due to the retention of ileocecal valve, the emptying speed of small intestine is effectively slowed down, which is not only beneficial to the absorption of nutrients, but also reduces the number of defecation after operation.

(4) Patients with slow transit constipation after partial colectomy are limited to the local colon, and the left colon is the most common, followed by the right colon and sigmoid colon, and they receive different partial colectomy accordingly. The resection range should exceed the affected intestinal segment during operation, so as to ensure the resection of all the intestinal segments with ganglion lesions. The premise of operation is to detect the colon with slow transmission accurately and reliably.

(5) The traditional operation of rectocele is mainly transanal or transvaginal repair. Although many surgical methods have been created to treat rectocele, there is still a lack of ideal treatment methods. Transrectal repair is not suitable for moderate and severe rectocele, and it is easy to recur after operation. Transvaginal repair is traumatic and slow to recover, and it is easy to fail due to complications such as infection and bleeding after operation, and it can not solve the problems of rectal mucosal relaxation and prolapse at the same time.

(6) The commonly used surgical methods for the treatment of rectal mucosal prolapse are: suture and hardening of distal rectal mucosa, rubber band ligation, transabdominal rectal fixation and rectal prolapse surgery.

In addition, PPH is also used to treat rectocele and rectal mucosal prolapse.

(Author: Department of Anorectal Surgery, China-Japan Friendship Hospital: Li Jianan, Wang Yanmei)