Proctology

Chronic Constipation

Chronic-Constipation

It is necessary to distinguish the concept of “chronic constipation” and so-called “incidental” or “situational” constipation. Occasional constipation mostly occur within a certain, short period of time and are caused by a variety of causing their causes and situations (if a person’s initial inclinations and predisposition to constipation).

To the constipation include: constipation among tourists; constipation during pregnancy; constipation caused by eating certain foods (tea, cocoa, foods with a low content of ballast substances, reduced intake of fluid, etc.); constipation, caused by various emotional factors (mental overload, depression); constipation as a side effect caused by medication. Such constipation, as a rule, the disease is not considered. Later in this section mainly talking about chronic constipation.

Chronic constipation

For most people, chronic delay bowel movement for more than 48 hours should be considered as constipation. Characterized by small amounts of feces, its high hardness and dryness, lack of feeling of complete bowel movement after bowel movement. In patients suffering from constipation, there are all these signs, but some of them may be absent. The presence of even one of these symptoms indicates constipation. The change for a given person the frequency and rhythm of bowel movements is also an important symptom of constipation.

In recent years, and not without reason, constipation elevated to the rank independent of the disease; and yet they are often the symptom of another pathology, for example, gastritis, cholecystitis, spastic or atonic colitis, etc.

Very interesting capacity and the correct definition of constipation, which gave this syndrome the physicians of past centuries: “the detention of what should be cast away”, “the weakness of the exorcist and the power of holding force”, “the narrowness of the passages and clogging them, the density and the viscosity of matter”, “loss of feeling the need to expel, for emptying contributes to and will power”. Indeed, the delay of advancement of the colon content in certain segments, weakness of the muscles of the walls of the intestine and powerful resistance spazmirovannah anal sphincter, organic or functional narrowing of the lumen of the colon, compacted fecal lumps, loss of volitional defecation – all of these elements of the pathogenesis of constipation and now appear to be the most important.

The condition of “shortness of advancement of feces in the rectum and inability to expel them, despite natureline” is well known – patients have to press your fingers on the crotch, on the side walls of the anus, on the vagina. It is a systematic condition of incomplete emptying of the rectum causes in some cases subsequently, the disease syndrome of the descending perineum.

In medical literature contains many definitions of chronic constipation, but basically they all boil down to the following:

Diagnosis of chronic constipation can be made if:

  • frequency of stool is less than 3 times a week;
  • defecation requires voltage;
  • stool thick or lumpy;
  • a feeling of incomplete defecation.

Due to the high prevalence of constipation today relate to socially relevant issues. Chronic constipation is among the more common health disorders and, according to medical statistics, often occur especially in young children and the elderly over the age of 60 years. Constipation so frequent and so aggravate the condition of millions of people around the world that this complex syndrome is now often considered separately and, for example, as pain becomes the subject of an independent study of proctologists, gastroenterologists, psychoneurologists and doctors of other specialties.

Causes

Causes of constipation are numerous. They are difficult to consider separately from the forms of this syndrome. You can still introduce some of the major factors leading to slowing of the fecal mass through the colon.

Constipation is caused by violation of processes of formation and promotion of stool through the intestines. The main reasons are disorders of motor activity (motility) of the muscles of the intestine, weakening of the urge to defecate, the changes in the structure of the intestines or surrounding organs, impeding the normal progress of content, the discrepancy between the capacity of the colon and the volume of intestinal contents.

As you know, the intestine consists of two segments, small and large intestine. The colon depending on the functions are divided into 3 sections: proximal (initial) division; distal, located closer to the anus; rectum.

Normal daily in proximal colon receives on average about 1-2 liters of liquid content, in this Department is its mixing, which creates conditions for optimal contact with the surface content of the intestinal mucosa and promotes the absorption of water and various salts. Distal part serves as a reservoir to ensure the accumulation, formation and removal of feces. The rectum plays a significant role in the process of defecation.

In the intestine arise periodically electrical impulses, leading to contractions of smooth muscles of the gut. Peristaltic contractions help to move content in the gut, stirring and thickening. The urge to defecate occurs when feces entering the rectum, stretch it and irritate the receptors (nerve endings) in the mucosa. With age, the sensitivity of receptors of the rectum is reduced and requires more pressure to trigger defecation.

Defecation is a partly arbitrary and partly involuntary act. Usually, when people in the morning, takes a vertical position, accumulated during the night the feces begins to push on the bottom, the most sensitive part of the ampoule (expanded part) of the rectum, causing defecation. This is the most physiological rhythm of bowel movement.

Violations of motor function of the intestine contributing to constipation, can be caused by many reasons. First of all, this is a variety of neurogenic factors. These include the so-called autonomic dysfunction, which is a disorder of the activities of the vegetative nervous system regulating the functions of internal organs. This occurs under the influence of mental overstrain, conflict, depression, fears, long-term violations of a mode of day, activity etc. The factors that cause constipation with the participation of nervous mechanisms are also reflex effects on the intestine of the various organs, primarily the stomach and biliary tract.

In diseases of the endocrine glands (thyroid, adrenal, etc.) in connection with the strengthening or weakening of the hormonal effects on bowel movements can cause constipation.

Circulatory disorders in the vessels of the intestine in atherosclerosis and other vascular diseases affect the intestinal peristalsis and cause constipation.

Physical inactivity (lack of exercise) contributes to inhibition of motor function of the intestine and the appearance of constipation, mostly in elderly and old people.

Separately should stay on meds that can cause constipation, especially with prolonged use. To the greatest extent it is inherent in the atropine, various drugs, some anticonvulsant drugs (Phenytoin), calcium bicarbonate (baking soda). Can cause constipation psychotropic drugs (tranquilizers, antidepressants), some diuretics, iron preparations, aluminum hydroxide (Almagel).

The rhythm disorders of defecation contribute to a late rising, the morning rush, work in various shifts, changes in usual living conditions and work.

Suppress the urge to unhygienic conditions in the toilets, sometimes a false sense of shame.

Cause constipation are often inflammatory bowel disease.

A further obstacle to the promotion of stool through the colon tumors, narrowing of the intestine in connection with the formation in it of scarring and other pathologies.

Apparent reason constipation:

  • depletion of food in crude fiber along with reducing fluid intake and reducing physical activity. This is true in developed countries where food is usually refined, and its consumers are not enough physically active. Some researchers refer here such a phenomenon as frequent containment of bowel movements;
  • neurological disorders – stroke, Parkinson’s disease, Hirschsprung’s disease, injuries and tumors of the spinal cord, multiple sclerosis and asthenoneurotic condition;
  • lesions of Endocrine – hypothyroidism, premenstrual syndrome, pregnancy, diabetes, gipocalziemia;
  • diseases of the gastrointestinal tract – peptic ulcer, chronic pancreatitis, dysbiosis, irritable bowel syndrome, and of course, tumors of the colon.

Dysfunction of the pelvic floor muscles – rectocele, rectal prolapse, impaired physiological act of defecation.

There are two main mechanisms of development of chronic constipation dyskinesia of the large intestine and the violation of the act of defecation (dyschezia). In the first case the disorder of coordination of intestinal contractions or in violation of the tone of the intestinal wall due to disorders of the nervous regulation of the colon and the effect of hormones. The second mechanism psychogenic suppression of the act of defecation, the anal sphincter hypertonicity, decreased sensitivity of receptors of the rectum and pelvic floor muscles.

To identify the main cause of constipation is possible, it would seem, by the carefully collected history (way of life, usual diet, previous diseases, etc.), but this is only the tip of the iceberg, a starting point for focused inquiry.

The most common causes of chronic constipation

1. Lifestyle and habits

The wrong time or conditions for defecation. Ignoring the feeling of fullness rectal inhibitory reflex defecation (Associated symptoms and contributing circumstances: bed rest, overloaded working day, as new environment)

Unreasonable expectation of the stool. The expectation of more regular or more frequent stools than the one that was for a normal patient (frequent use of the advertised laxatives)

A diet poor in fiber. The decrease in the number of stool (exhaustion, drugs contributing to constipation)

2. The irritable bowel syndrome

Frequent violation of the motor function of the intestine (scanty, hard stool, often with mucus, alternating with diarrhea; cramping abdominal pain; stress can deepen the dysfunction of the intestines)

3. Mechanical obstruction

Cancer direct or sigmoid colon. Progressive narrowing of the lumen of the intestine (change in rhythm and regularity of the stool, diarrhea, abdominal pain, bleeding; cancer of the rectum tenesmus, change in stool karahasano column)

Koprostaz. Stationary accumulation of hardened feces in the straight, less frequently in the colon (the feeling of fullness in the rectum, abdominal pain, diarrhea – fecal liquid mass flow “fecal plug”)

Other occlusive disease, diverticulitis, volvulus, intussusception, hernia incarceration. Narrowing or complete closure of the lumen of the bowel (colicky abdominal pain, bloating, stool in the form of “raspberry jelly” with intussusception due to the presence of blood and mucus)

4. Diseases of the anal canal, accompanied by pain

Pain may cause spasm of the external sphincter and to suppress the reflex of defecation (anal fissures, thrombosis hemorrhoids, abscess)

5. Supplementation

6. Depression

A typical bout of depression, characterized by at least five of the nine following symptoms for at least 2 weeks: depressed mood nearly every day (in children may manifest irritability); a significant decline in interest and indifference to the surrounding; unexplained increase or decrease in body weight with increased or poor appetite; insomnia or sleepiness, nearly every day; psychomotor agitation or retardation nearly every day; fatigue and lack of energy nearly every day; feelings of worthlessness existence and sinfulness; slowing of thought processes, indecision, inability to concentrate; the repeated appearance of suicidal thoughts (depression, fatigue and other symptoms)

7. Neurological disorders

Violation of the Autonomous innervation of the intestine (damage to the spinal cord, multiple sclerosis, Hirschsprung’s disease).

Main etiological factors of constipation:

  • alimentary constipation associated with inadequate consumption of foods or liquids with qualitatively malnutrition (deficiency of calcium, vitamins, fiber, and improper meal timing);
  • anorexia – a manifestation of pathological viscero-visceral reflexes in peptic ulcer disease, duodenitis, chronic cholecystitis, renal stone disease, and constipation in neurological diseases – multiple sclerosis, cerebrovascular disorders, tumors and injuries of the brain and spinal cord;
  • psychogenic constipation, especially the so-called usual, due to violations of the habits of daily bowel movements with a change of residence, long trips, prolonged forced bedrest. It is classified as constipation at mental diseases;
  • constipation due to anorectal lesions – hemorrhoids, anal fissure, anal abscess, accompanied by severe spasm of the anal sphincter, etc.;
  • toxic constipation: lead, mercury chronic intoxication, the effects of some medicines – anesthetics, antipsychotics, etc.;
  • protogenia constipation – caused by a violation of the act of defecation, associated with dysfunction of the pelvic floor muscles;
  • constipation due to mechanical obstacles – of the tumor, large polyps and strictures of the colon, as well as anomalies of its development.

Symptoms and classification of chronic constipation

The symptoms of constipation are very diverse and largely depend on the nature of the disease, which became their cause. In some cases, constipation only complaint, in others – patients pay attention to other ailments.

The frequency of bowel movements varies from once every 2-3 days to once a week and less. Feces are usually sealed, dry, has the form of a dry dark balls or lumps, reminiscent of sheep; sometimes the stool can be bean-shaped, ribbon-like, choreoraphy.

Some patients have a so-called stop diarrhea, when the long delay bowel movement occurs liquefaction of the feces in mucus, produced by irritation of the bowel wall.

Sometimes patients concerned about pain and bloating in the abdomen, relief comes after a bowel movement or flatus.

Quite painful symptom may be abdominal distension (bloating), which is due to the slow movement of stool through the colon and increased formation of gas as a result of activity of bacteria in the gut. Bloating, besides the intestinal symptoms may be accompanied by reflex reactions of other organs: heart pain, palpitation, etc.

Patients with constipation may decrease appetite, appears belching air, a bad taste in the mouth. Often reduced ability to work, get headaches, pain in the muscles of the body, General nervousness, depressed mood, upset sleep.

Persistent constipation can be accompanied by skin changes. She becomes pale, often yellowish, flabby, loses its elasticity.

When enteritis (inflammation of the small intestine) constipation have been reported in each of the fifth, and in chronic colitis (inflammation of the colon) – every second patient.

Classification of chronic constipation

Constipation without anomalies; the anus, the rectum and colon and without mental disorders. These include patients with incorrect diet and lifestyle, constipation in pregnant women, in elderly and senile age, idiopathic constipation from slow intestinal transit, and also irritable bowel syndrome.

Constipation with disorders of structures of the anus and colon (rectum and colon) intestine. This group includes patients with anal neuralgia (mainly after unsuccessful operations on the anus or after trauma), stenosis of the anus of different etiology, stricture of the colon, pseudoobstruction colon, etc.

Secondary constipation caused by extraintestinal anomalies and diseases. This group includes lesions of the endocrine (hypothyroidism), neurologic disorders (spinal cord injury, sacrum, pain when the tension due to compression of branches of the sciatic nerve), systemic sclerosis and other connective tissue diseases.

Psychological causes of constipation. Is it depression, neurogenic anorexia.

Constipation related to side effects of drugs.

Complications of chronic constipation

Long-existing constipation can cause a variety of complications: secondary colitis, proctosigmoiditis (inflammation of the sigmoid colon and rectum).

Prolonged stagnation contents in the cecum may reverse its abandonment in the small intestine with the development of enteritis (reflux-enteritis). Constipation can be complicated by biliary tract diseases, hepatitis.

Prolonged constipation contribute to the emergence of various diseases of the rectum. Often occurs hemorrhoids as well as fissures of the rectum, inflammation coloramerican tissue (abscess).

They sometimes cause expansion and elongation of the colon (acquired megacolon), which makes the constipation more stubborn.

The most severe complication of prolonged constipation is cancer of the rectum and colon. There is a perception that the stagnation of the contents in the intestine caused by eating foods poor in dietary fibre, leads to a high concentration formed in the intestine carcinogenic (contributing to cancer) substances and long-term effect on the bowel wall. Anxiety symptoms that suggest the possibility of occurrence of tumours of the colon are General malaise, weight loss, recent onset of constipation in people older than 50 years, a stool which before was normal, blood in the stool.

Fecal obstruction

Finally, on this very unpleasant phenomenon as fecal blockage. This condition quite often occurs in the elderly and mental patients. This complication of constipation occurs when the elderly, particularly bad well-groomed to forget the time of the last bowel movement and no longer follow it regularly. The matter is complicated by the fact that around formed and gradually thickening in the rectum of fecal stone long remain a gap between it and the walls of the intestine, in which liquid stool passes; the patient seems that he had diarrhea, and he begins to treat it with home remedies, which, of course, only exacerbates the process. There comes a partial obstruction of the rectum, pain in the abdomen, lost appetite, appears belching, nausea, vomiting. At inspection of such patients the finger is usually achieved lower pole of the fecal lump of stony density. Typically in an older patient has underlying cardiac or pulmonary insufficiency or other serious illness, so the treatment of fecal blockage, difficult to achieve. First of all, no laxatives; they should use before, and in this state they can only lead to buildup of intestinal obstruction. Enemas also does not help: the enema tip is usually unable to penetrate freely above the stone, not to blindly use with the aim of crushing stone from the danger of injury of the bowel wall. Need a hand and a thick rubber glove and well lubricated index finger with the ointment to start a cautious and gradual fragmentation of the distal part of the stone, removing it vacated the wreckage. The position of the patient on the side (better on the left if there is no pronounced cardiac disorders) with bent knees and pressed against his stomach with his feet. Usually this manipulation is possible without much difficulty because, as a rule, in these patients the tone of the anal sphincter will snagem and nearly gaping anus. However, this procedure is long and, to put it mildly, uncomfortable for the patient, so in such cases, previously assigned sedative or analgesic drugs. When most dense the distal parts of the stone is fractured, the rest of the upper part are removed much easier and in the end either starts a separate, very copious dejection, or you should perform an enema siphon. Allowing fecal blockage, the patient or his relatives explain the prevention of delayed stool (preferably weekly cleansing enema), because if you limit your extraction of the fecal stone (stones), it all starts over again.

Diagnosis of chronic constipation

Diagnosis plays a very important role in the treatment of chronic constipation. Simply assigning laxatives patient with complaints of constipation may be not only ineffective but in some case, to play a very negative role.

If complaints of constipation it is very important to appoint the necessary diagnostic tests, and the result is to obtain a complete picture of the causes of the disease. Only in this case the doctor can prescribe the correct and effective course of treatment.

A variety of options and causes constipation sometimes spawns at the doctor’s desire to simplify the approach to the diagnosis of this condition. However, the reluctance to clarify the mechanism of development of constipation often leads to loss of time, the consolidation of reflex connections, the development of secondary changes in the bowel and “fixing the situation”, i.e. its transition from functional to organic. So at the first sign of constipation it is necessary to conduct diagnostic search, the steps of which are presented below:

I stage.

Evaluation of clinical data and radiological examination of the bowel, which allows to evaluate the anatomic condition of the colon, irritation or normal structure in functional disorders, tumors, anomalies, or megacolon, is characteristic of obstruction of gipoganglioza, idiopathic expansion.

Stage II.

Colonoscopy, histological and histochemical study of biopsy specimens of the intestinal mucosa.

Stage III.

Special research methods, allowing to assess the motor-evacuation function of the colon, microbial spectrum, or content of volatile fatty acids (integral indicator of microbial cenosis), as the obturator apparatus of the rectum, the function of other organs and gastrointestinal tract, endocrine apparatus, the autonomic nervous system (for women mandatory gynecological examination to determine the position of the uterus).

Completed the survey and to answer the main question – whether the constipation is a disease or functional disorder. The most common remain functional constipation diagnosis of which requires the exclusion of organic diseases. The outpatient phase of the study includes a thorough collection and analysis of anamnestic data, physical examination, palpation of the abdomen, examination of the anus and digital rectal exam, barium enema and colonoscopy. A study of motor-evacuation function is performed in a hospital. And only after the diagnosis is made, determine the forms that are subject to the surgical treatment involved in the treatment of endocrinologists, psychiatrists, gynecologists, is a long (sometimes months and years) treatment of constipation.

Methods of diagnosis of chronic constipation can include:

  • barium enema x – ray study;
  • colonoscopy;
  • the sowing of a feces on a microflora (dysbacteriosis);
  • study of motor function of the colon;
  • functional studies of the obturator apparatus of the rectum;
  • histological and histochemical study of biopsy specimens of the mucous membrane;
  • etc.

The decision on the appointment of any method of examination, the doctor takes on the basis of complaints of the patient, characteristics of the disease and other factors.

The chronic constipation

The view that the treatment of chronic constipation an easy task, and its solution is enough to buy at the pharmacy “good” laxative – a profound error.

The problem of treating chronic constipation requires mandatory consultation with a specialist.

The long, independent use of purgatives without knowledge of their mechanism of action, indications and contraindications, in most cases gives opposite result:

  • constipation become more persistent and severe;
  • significantly reduced bowel motility, its motional activity;
  • the first dose of laxative is constantly growing, then its effect becomes ineffective;
  • there are problems associated with violation of metabolism in the body.

Thus, the problem of treatment of chronic constipation requires a very serious approach from both the patient and the attending physician.

The key to successful treatment of chronic constipation – is to identify the true causes of existing of a number of causes and factors and its elimination.

Treatment of chronic constipation requires an individual approach in each particular case, but the General principles in the diagnosis and treatment do exist and are consistent in identifying or excluding possible causes of the disease, and the appointment of a survey of appropriate treatment:

1. Initial consultation of the doctor – explanatory conversation with the patient about the problem of constipation, to collect detailed anamnesis, General recommendations:

  • dietary recommendations;
  • cancellation or neutralization of the “fixing” of drugs;
  • recommendations for physical activity.

When collecting namaza particular attention is drawn to the duration of constipation, frequency of bowel movements and character of bowel movements – without natureline, velocity (time) evacuation, pain in the anus, feeling of incomplete emptying (heaviness in the abdomen), abnormal discharge with a stool (especially blood). Turns out comorbidities, prescription medications, etc.

2. Diagnosis identify possible causes of constipation.

The exclusion or confirmation of the “mechanical” and organic causes of chronic constipation, as well as anomalies of the structure of the large intestine (survey methods – colonoscopy, barium enema, etc.).

  • the presence of rectal cancer, sigmoid or colon;
  • the presence of large polyps of the colon,
  • the presence of stenosis of the lumen of the colon;
  • the presence of fecal stones, blockages;
  • the presence of diverticulosis;
  • the presence of rectocele, megacolon;
  • the presence of adhesions in the abdominal cavity;
  • the presence of volvulus, intussusception, hernia strangulation.

The exclusion or confirmation of diseases of the gastrointestinal tract and anorectal region: irritable bowel syndrome, dysbiosis, colitis, ulcers, anal fissure, acute hemorrhoids, abscess, etc. (survey methods – colonoscopy, stool test, rectal finger examination, anoscopy, sigmoidoscopy, etc.).

The exclusion or confirmation of causes of neurological, psychogenic (consult a neurologist, psychotherapist).

The exclusion or confirmation of the reasons for of the endocrine nature (consultation of the endocrinologist, laboratory studies)

3. The purpose of the treatment (surgical or therapeutic).

Surgical treatment of constipation can be carried out only after a thorough comprehensive examination of patients in specialized proctologic hospitals. Indications for surgery and its volume should be individualized, and it should be remembered that surgery constipation it’s a desperate, last resort to which resort only in the most extreme cases.

Guidelines for treatment of functional constipation

Here we are talking about the so-called functional constipation, the causes of which different (but not mechanical), but not about the tumor or other organic strictures of the colon. In the latter case, only the timely diagnosis and etiological, often surgical treatment can give success.

Independently, without medical examination, combating constipation, in many cases, delay diagnosis of the real cause of constipation.

Diet regime

Treatment of constipation should begin primarily with the regulation of the diet. You must enter a diet constantly and daily foods rich in fiber: fruits, vegetables, coarse black bread (sometimes specifically dietary bran) and at least 2 liters of fluid a day. If eating vegetables and fruit is accompanied by bloating and flatulence, it is recommended to take the drug, Mukofalk. It’s necessary to eat regularly, at the same time.

Compliance with certain requirements for compiling the diet the patient with constipation plays a huge role in its treatment. Every person suffering from constipation must know which nutrients contribute to bowel and any delay emptying.

Promote bowel black bread, raw vegetables and fruits, dried fruits, bread containing a significant amount of bran; cereal: buckwheat, barley, oat; meat with lots of connective tissue, pickles, marinades, a herring; smoked products, snackbars canned food; soft drinks (mineral waters, lemonade, juices), beer, kvass, sour cream, Slivki; sweet dishes, kissels; sour-milk products: yogurt, kefir is a one-day, white grape wines.

Delay bowel products containing tannin: dried blueberries, strong black tea, cocoa, natural red wine (Cahors, etc.); food in a shabby, substance viscous consistency (mucous soups, pureed porridge, especially semolina and rice).

When composing a diet for patients with constipation, should consider the content of dietary fiber in foods. With a large number of eating coarse fibers in people with flatulence is allocated on average 2 times more gas than a diet with moderate their content, and almost 5 times more than the use of chemically homogeneous liquid diet without fiber. Patients with constipation and complaints of bloating limit or even eliminate from the diet foods rich in dietary fiber. Exclude causing flatulence dishes of beans, cabbage, sorrel, spinach and other fruit juices are not recommended, apples, grapes.

If constipation is accompanied by severe intestinal motility, especially in the presence of spastic abdominal pain, a diet rich in dietary fiber, can cause increased pain. In such cases, at first apply a diet low in dietary fiber content. To reduce and ultimately eliminate, the spasms of intestinal appoint antispastic medication, and then gradually add foods that contain fiber soft and subsequently coarser consistency. Since plums contain organic acids that promote bowel movement, despite the relatively low content of fiber (0.5 g per 100 g), patients with constipation recommend prunes in any form, including infusion, puree of dried fruit.

If there are no special contraindications (heart disease, edema), the patient suffering from constipation should drink a day about 1.5-2 liters of fluid. The acceptance of a sufficient amount of liquid is very useful, since due to delayed evacuation of feces from the intestine is their drying, which in turn, hinders their promotion through the colon.

It is important to follow a proper diet. Food should be taken at least 5 times a day. Invalid big breaks between meals.

Very significant treatment effect for constipation give bran. Bran is resistant to digestive juices, they are not a significant source of energy and at the same time greatly stimulate the evacuative function of the intestine.

The rhythm of emptying

No less important is the rhythm of bowel movement. It is individual and you should not practice artificial “norms” and to insist, for example that the stool was daily, if you usually have a bowel movement once in 2 or 3 days. The task is not so much the frequency of defecation as in the prevention of straining, i.e., stool softener. In any case, do not artificially suppress the urge to defecate, this only exacerbates the problem.

Medicinal and cleansing enemas

Medicinal enemas are mainly intended to facilitate evacuation (oil enema fish oil, sunflower oil, etc.).

Cleansing enemas are also used as a treatment for constipation. Colon cleanse water enema (1,5-2 liters of boiled water at room temperature, without any impurities) at night, once a week (preferably on Saturday) is very useful. We are talking about one enema, not about the whole system of high and siphon cleansing enemas.

Cancel the “fixing” of drugs

It should be possible to cancel (or to replace with other) drugs that can cause or exacerbate constipation. These include opiates, antacids, ganglioplegic, diuretics, iron preparations, psychotherapeutic tools, as well as oral contraceptives. If you regularly take any medications, read the attached annotation if there are among the side effects of constipation.

Increased physical activity

Important role in the prevention and treatment of constipation compliance plays an active motor mode. Unacceptable later getting out of bed in the morning, long lying. Very useful Hiking or cross-country skiing, swimming, Cycling and other physical activities. Physical exercises stimulate the motility of the intestines, strengthen muscles, abdominal wall, increases the tone of the whole organism beneficial effect on neuro-mental sphere.

While reducing motor activity of the intestine, as evidenced by the large amount of feces, recommend more saline water – Essentuki number 17. Constipation with increased contractile activity of the intestine, with pain in the stomach is preferable to reception of warm mineral water.

Increased physical activity leads to increased intestinal motility and strengthening of the abdominal muscles and pelvic floor, which is beneficial to the process of emptying and accordingly the treatment of chronic constipation.

Use of laxatives

To laxative should be resorted to only in cases where the above measures are not effective enough. As for laxatives, they can be divided into several groups: increases stool bulk (bran, seeds, synthetic agents), irritants (anthraquinones and derivatives difenilmetana), which increases osmotic pressure in the intestine that enhance motor function of the intestine (prokinetics), softening of feces (liquid paraffin).

To the selection and intake of laxatives should be approached with extreme caution. In chronic constipation is not recommended prolonged use of laxatives irritant and enhancing intestinal motility. Long-term use of these funds, as a rule, leads to dependence – the syndrome of “lazy bowel”. If the normal evacuation you need an increasing dose of a laxative, and without applying a sustainable constipation – beat anxiety. You need to change the drug, but it is better to consult about this with your doctor. During normal use of laxatives as treatment for chronic constipation, its dose should be gradually reduced, until the complete abandonment of its use.

In relatively mild cases it is more expedient to resort to more “natural” laxative, it is best apply a mixture of figs, prunes and dried apricots with honey and Alexandrian list (But drug). Separately, there is the problem of herbal medicine constipation. Years of experience clearly shows in the use of different laxative herb gathering (hemorrhoidal tea, etc.), but on one condition: all herbs can be purchased only in pharmacies. Phytotherapeutic laxatives can lead to dependency, so prolonged use is not desirable.

Proper diet for constipation

Constipation is one of the symptoms characteristic of various diseases of the digestive system. They can occur when ulcers stomach and duodenal ulcers, hemorrhoids, polyps of the intestine. In order to choose the right treatment, in particular diet, need to know the cause of the disease. That’s why with long-term constipation you should consult a doctor and pass the designated examination. Advice on therapeutic nutrition thus have many individual characteristics. Therefore, the appearance of a tendency to constipation in any case it is not necessary to self-medicate. The doctor will prescribe treatment based on the core and accompanying diseases.

The prevalence of constipation in the last decade is associated with physical inactivity, a systematic failure to comply with a diet, using foods that contain little dietary fiber (fiber) that promote bowel movements. The fascination with food containing animal proteins (meat, fish, eggs, cheese) can also predispose to constipation. Similarly, long adherence to a rigorous diet excessively can lead to the violation of the evacuation function of the intestine.

To resort to laxative remedies and cleansing enemas for constipation is allowed only on the recommendation of the attending physician. Dietary adjustment diet given above is often the most effective means of treatment of constipation and its prevention.

Dietary fiber

Dietary fiber (dietary fiber, coarse fiber) is a part of plants, mostly cereal consumed in the us food and component, along with fats, proteins, carbohydrates, vitamins nutritional balance. Dietary fibers are not digested in the digestive tract, and utilized by intestinal microflora. The main function of cellulose — water adsorption, but in parallel, she plays an important role in other processes – reduces the level of blood cholesterol by binding intestinal bile acids, which, as you know, some carcinogenic activity. The adsorption of water in the intestine increases stool bulk and decreases the risk of constipation. Chemical composition dietary fiber is non-digestible cellulose. The content of its products in the first place food bran (53-55% of the fibers), then vegetables (20-24%) and rye bread. Refined products – white flour, sugar, etc. – dietary fiber contain. In regions where the intake of dietary fiber reduced the risk of lesions of the large intestine and primarily constipation, above. Some groups of Africans-natives, almost do not eat meat and milk, the stool is usually semi-liquid; they have less frequency of polyps and colon cancer than people in developed countries who consume refined products.

There is an opinion about the possibility of a connection of chronic constipation and development of colorectal cancer. In particular, it is known that in some countries and regions the frequency of colon cancer varies dramatically, and the difference can be 20-fold, and this difference is directly correlated with the peculiarities of the diet in these regions. In any case, without denying the role of pre-cancerous lesions of the colon (adenomas) and a possible content in food recognized carcinogens such as nitrites and nitrates, note that the “Western” type of food with the prevalent use of refined products characteristic of the population of the more developed countries in which colon cancer and – especially – constipation significantly more frequent. At high incomes the consumption of large quantities of animal protein, fats and a relatively small quantity of carbohydrates will lead to increase the time of intestinal transit and to reduce the concentration of bacterial metabolites in the colon. With this type of food main metabolic processes are not in the large and small intestine and, therefore, the colon gets content much more rich bacterial, possibly carcinogenic, flora that is clearly traced when analyzing the feces of people from different kind of population groups. All this gives theoretical grounds for the nomination, or at least discussion of possible communication disorders, i.e., slowing down transit through the colon and precancerous lesions or colon cancer.

Increasing the mass of feces, dietary fiber reduces the risk of constipation. It is a must – increased intake of water (1.5-2 liters per day), without which food cellulose (pectin, other synthesized drugs) stops performing its adsorbing function. So bran is an important dietary component of complex treatment of constipation.

Ballast substances accelerate the movement of content through the intestines by increasing the mass of feces.

Numerous studies have shown that these relationships can be traced both healthy individuals and in patients suffering from constipation. The increase in the mass of stool is achieved here mainly due to 2 different mechanisms. One of them involves the binding of water, which is caused by physico-chemical properties of these substances. Different ability to bind water here depends on the kind of fibres (hemicellulose, cellulose and lignin). They absorb water as a result of filling the empty spaces of the fibrous structure of substances in the unstructured ballast substances (pectin, psyllium husk) the binding of water takes place with the help of hydrocolloids in the gels and viscous solutions. In addition, ballast substances increase bacterial mass of the stool and thereby increase their own enzymatic activity of the bacteria. Products of bacterial digestion, especially short-chain fatty acids (butyric acid, propionic acid, etc.), contribute to normal functioning of the mucosal cells of the colon and regulate bowel motility. The liberated gases increase the stretching of the colon, which, on the one hand, stimulates propulsive motility of the intestine, and ,on the other hand, can cause flatulence.

The need for ballast substances.

At the end of the last century, people daily ate about 100 grams of ballast substances a day. Currently, this consumption dropped to an average of 15-20 grams per day, and more young people use significantly more fibres than older. The German society for nutrition recommends a daily intake of at least 30 g fibres in day. This shows that the average deficiency of these food components is 10-15 grams per day.

Taken from food ballast substances have, depending on their ability to bind water, different effects on the quality of the stool. Thus, the binding capacity of potato and peas is relatively small and is 40-100 g of water per 100 g of food product, while the binding capacity of apples and carrots is respectively 180 and 220 g water per 100 g of product. Bran, and special preparations as well as pectins have a binding capacity of 300-400 g of water per 100 g of substance. Along with the growth mechanism of the bacterial mass, this leads to different quantities of these foods required for doubling the mass of feces.

The specified number is: for bread flour, sauerkraut and apples 400-1400 g of product per day, for special products such as bran, Plantago ovata (Mucofalk) or hoerova resin – 30-40 grams a day.

To ensure a sufficient amount of ballast substances would diet comprising 200 grams of bread from wheat flour (16 g of ballast substances), 200 g potatoes (7 g), 250 g of vegetables (7 g) and 250 g of fruit (5 g) per day, which would give a total content of ballast substances 35 grams per day.

The portability of food with a high content of ballast substances.

The possibility of increasing the content of ballast substances in food is often restricted to their individual different patients. Primarily due to increased gas and increased flatulence are poorly tolerated cabbage and beans. However products from wheat flour, oats, some varieties of vegetables can also cause these complaints. According to research foods rich in dietary fiber, can be transferred to patients with chronic constipation bad. So, oatmeal or cereal with milk and vegetables caused 12-45% of patients the strengthening of dyspeptic complaints, particularly abdominal pain and bloating. In turn, the corn flakes was not accompanied by the appearance of these disorders. Bran, is usually recommended in such cases, caused 55% of the surveyed patients the increased dyspeptic disorders. On the contrary, special preparations such as Plantago ovata (Mucofalk), relatively well tolerated and contributed to 40% of patients to reduce abdominal pain and dyspeptic disorders. This coincides with the results of studies that have shown that the use of drugs Plantago ovata (Mucofalk) reduced the severity of dyspeptic disorders and has improved the consistency of the feces to a greater extent than the use of bran, which in many cases was accompanied by increased flatulence and abdominal pain.

General information

In patients with infrequent constipation for the normalization of stool is often sufficient enrichment diet dietary fiber. Patients with chronic constipation sometimes necessary to recommend such amount of ballast substances, which often leads to increased diarrhoeal disorders (flatulence and abdominal pain). Thus, in the appointment of patients with chronic constipation diet enriched in dietary fiber, it is necessary to take into account the individual tolerability. In this regard, in many cases it is expedient the additional use of special preparations containing ballast substances, and preparations of bran often cause severe flatulence and are transported worse than modern drugs “Plantago ovata” (Mucofalk). When treating patients, especially the elderly, often having a deficiency of fluid, it is necessary to pay attention to its intake. Given the possibility of binding of ballast substances with calcium, iron and zinc with the subsequent appearance of mineral exchange violations, avoid their overuse.

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