How to get rid of constipation

Author: Luan Weihua China Rehabilitation Research Center

Reviewer: Huang Yebin, deputy chief physician of China Rehabilitation Research Center

Many people may have experienced constipation for a few days, weeks or even a long time. Constipation is a common problem among the population. In my country, the prevalence of adult constipation is as high as 4.0% to 10.0%. Constipation has become a problem for many people and even seriously affects our work and life. What should we do when we encounter constipation? Let's take a deeper look at constipation.

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1. Does constipation simply mean dry stools?

The answer is no. When we talk about constipation, we usually mean chronic constipation. It is a symptom (group of symptoms) characterized by difficulty in defecation and/or reduced frequency of defecation, and hard and dry stools. Difficult defecation includes straining during defecation, difficulty in defecation, feeling of incomplete defecation, feeling of anorectal obstruction, time-consuming defecation, and the need for assisted defecation. Reduced frequency of defecation means less than 3 bowel movements per week.

2. What are the dangers of constipation?

Constipation can be a serious or minor problem, and a small constipation can cause great harm.

(1) Local hazards : Long-term constipation can cause rectal and anal diseases, such as hemorrhoids, anal fissures, and rectal prolapse.

(2) Systemic hazards : Strained defecation can easily lead to cardiovascular and cerebrovascular accidents, especially in the elderly. Constipation can induce high blood pressure and cause stroke. Straining to defecate can also induce myocardial infarction or even cardiac arrest. For patients with cirrhosis or liver failure, constipation can prolong the contact time between certain toxic substances and the colon mucosa, leading to increased absorption of toxic substances and inducing hepatic encephalopathy.

3. Why does constipation occur?

(1) Lack of exercise can easily lead to constipation. Especially for the elderly, their food intake decreases, which leads to less feces production. At the same time, their intestinal motility weakens, and if they lack activity, they are prone to constipation. In addition, female constipation is also often related to lack of exercise. It should be noted that impaired pelvic floor muscle function after childbirth is also one of the main causes of constipation.

(2) Long-term consumption of low-fiber foods, reduced fluid intake, and less physical activity may all lead to constipation.

(3) Psychological factors such as anxiety, depression, and adverse life events are also risk factors for constipation.

(4) The use of certain drugs is also a risk factor for constipation, such as certain antidepressants, anti-epileptic drugs, antipsychotic drugs, calcium supplements, iron supplements, analgesics, etc.

If you have the above risk factors, you need to pay attention to the prevention of constipation.

4. What are the types of constipation?

1. Organic constipation

Organic constipation refers to constipation caused by certain diseases, and constipation is just one of the symptoms of these diseases. Diseases that can cause constipation: ① Intestinal and perianal diseases, such as colon cancer, colon inflammation and benign tumors that cause intestinal stenosis, rectal prolapse, rectocele, etc. ② Endocrine and metabolic diseases, such as diabetes, hypothyroidism, etc. ③ Nervous system diseases, such as Parkinson's disease, cerebrovascular disease, spinal cord injury, etc. ④ Myopathy, such as amyloidosis, scleroderma, dermatomyositis, etc.

2. Drug-induced constipation

Refers to constipation caused by certain drugs. Common drugs that can cause constipation include: antipsychotic drugs, such as chlorpromazine; antidepressants, such as amitriptyline; anti-Parkinson's drugs, such as benztropine; analgesics, such as morphine and ibuprofen; anti-epileptic drugs, such as carbamazepine; antihypertensive drugs, such as nifedipine and amlodipine; in addition, there are calcium and iron preparations.

3. Constipation caused by functional diseases

Refers to constipation caused by excluding organic diseases and drug factors. It is mainly caused by dysfunction of nerve smooth muscles in the colon, rectum and anus.

5. How to prevent and treat constipation?

1. Improve your lifestyle

(1) Adjust the dietary structure, increase dietary fiber and water intake: Dietary fiber has an anti-hydrolysis effect on certain enzymes in the small intestine and will not be absorbed by the colon, so it can retain intestinal water and increase stool volume, thereby improving constipation. The recommended intake of dietary fiber is 20-35g per day. It is recommended to consume more foods rich in dietary fiber, such as beans, mung beans, and green beans, grains such as barley, wheat germ flour, and millet, fruits such as apples, pears, fresh dates, bananas, leeks, green peppers or hot peppers, lotus roots, beans, and soybean sprouts; eat less pizza, ice cream, cream, meat, French fries, processed foods, and other low-fiber foods.

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Drinking 2L of water a day will increase the laxative effect of dietary fiber, and the recommended water intake is 1.5 to 2.0L a day. It is worth noting that simply increasing the amount of water you drink will not affect colorectal function or relieve constipation. Increasing the amount of water you drink on the basis of increasing dietary fiber intake will help improve constipation.

(2) Increase exercise: Regular physical exercise can increase intestinal motility, shorten intestinal transit time, and facilitate defecation. Aerobic exercise such as walking and cycling is effective in improving constipation. Except for exercise restrictions, there are no strict restrictions on the frequency and intensity of other sports for patients with constipation. The generally recommended amount of exercise is 30 to 60 minutes per day, at least twice a week. Appropriately increasing the amount of exercise may be more effective for patients with less daily exercise and elderly constipation.

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2. Establish good bowel habits

Defecation can be cultivated and trained. Establish a habit of regular bowel movements every day, and persist even if you fail. After a period of persistence, a defecation reflex can be established. The standing reflex in the morning can promote colon movement and help produce the urge to defecate. After a meal, the stomach expands and food enters the duodenum, which can induce gastrocolic reflex and duodenocolic reflex, promote collective peristalsis of the colon, produce a defecation reflex, and facilitate successful defecation. Therefore, it is recommended that patients with constipation try to defecate every morning or 2 hours after a meal.

When using the toilet, you need to concentrate and avoid being distracted by factors unrelated to defecation, such as avoiding looking at mobile phones, newspapers and books, etc. Each defecation time should not be too long, generally recommended to be no longer than 10 minutes. Studies have confirmed that squatting is more conducive to the discharge of feces than sitting, so it is recommended that patients with constipation adopt a squatting defecation posture.

3. Treatment of the cause

Constipation caused by organic diseases and drugs requires timely medical treatment and treatment of the primary disease. Depending on the condition, the drugs that cause constipation should be discontinued or replaced with other drugs.

4. Medication

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If constipation is ineffective after 4 to 8 weeks of basic treatment, laxative drugs can be used for treatment. Laxatives include bulk laxatives, osmotic laxatives, stimulant laxatives, lubricant laxatives, secretory laxatives and prokinetic drugs. For mild and moderate constipation, bulk laxatives (such as psyllium, calcium polycarbophil) or osmotic laxatives (such as polyethylene glycol, lactulose) can be used, and combined when necessary. When severe constipation is ineffective after bulk and osmotic laxatives, prokinetic drugs (such as mosapride, prucalopride) or secretory laxatives (such as linaclotide, lubiprostone) can be used in combination. Children, the elderly and the weak who are unable to defecate can use enema to assist defecation.

It should be noted that drugs for constipation should be used according to the doctor's instructions and should not be used for a long time. Long-term use of irritant laxatives (such as phenolphthalein and bisacodyl) can easily lead to drug dependence, malabsorption and electrolyte disorders. It can also damage the patient's enteric nervous system and lead to weakened colon motility, and even cause the colon mucosa to turn black, that is, colon melanosis. Please use under the guidance of a professional physician.

5. Psychological treatment

Patients with obvious depression, anxiety disorders and sleep disorders need to see a psychiatric specialist to improve constipation through mental and psychological adjustments.

6. Other treatments

Constipation caused by pelvic floor muscle dysfunction can be treated with biofeedback. Sacral nerve stimulation can be used for refractory constipation that is not responsive to conventional medical treatment. When conservative treatment is ineffective or there is a clear organic disease, surgical treatment can be performed after strict evaluation and in accordance with surgical treatment indications.

When it comes to constipation, we should neither ignore it nor be too worried or anxious. We should treat constipation scientifically and go to the hospital for treatment in time. I believe constipation will stay away from us.