My aunt is constipated.

Many female friends experience constipation during their period. At this time, they will feel that their body becomes very uncomfortable and they always want to defecate, which may even cause some anal problems. This requires special attention. In this case, you can eat some foods that moisturize the intestines and promote bowel movements, but more importantly, you cannot consume some cold foods.

(I) Differential diagnosis of outlet obstructive constipation

1. Functional outlet obstruction constipation (rectal constipation)

It is a difficulty in defecation caused by abnormal anorectal dynamics due to physiological changes in the tissues and organs near the anorectum. It includes striated muscle dysfunction, rectal sensory impairment, internal anal sphincter dysfunction, and temporary anatomical obstruction caused by mucosal and rectal prolapse. Its transport function is mostly normal, but feces accumulate in the rectum and are difficult to expel. Symptoms include frequent urge to defecate and incomplete emptying. The diagnosis can be confirmed through dynamic defecation radiography, but it is difficult to detect when there is no bowel movement. According to the mechanism of action, it can be divided into three types:

(1) Atonic (rectal atony) constipation: refers to outlet obstructive constipation caused by degenerative changes in the physiological functions of the rectum and pelvic floor, including rectal prolapse, internal rectal prolapse (intussusception), and perineal descent syndrome.

① Rectal intussusception: also known as internal rectal prolapse, occult rectal prolapse. Most people have a history of long-term constipation, and defecation is laborious and takes several hours every day. They feel that it is difficult to empty the stool and need to use fingers to dig it out or apply pressure on the perineum to help defecation. Due to pudendal nerve damage, fecal incontinence may occur in the late stage. Due to the presence of rectal inflammatory edema and ulcers, mucus and blood in the stool may occur. It is more common in women over 50 years old, because the intussusception is often reduced after defecation, and the intussusception is mostly on the anal edge and rarely prolapses outside the anus. The diagnosis is difficult and routine examinations often fail to reveal it, but defecography can confirm the diagnosis.

② Protrusion of the anterior rectal wall: The normal anterior rectal wall is separated from the vagina by the rectovaginal septum. When straining to defecate, the anterior rectal wall tends to protrude forward, and protrusion is more likely to occur when the rectovaginal septum is relaxed. When the patient defecates, the pressure in the rectum is directed toward the vagina instead of the anus, and fecal matter accumulates in the protruding depression, resulting in difficulty in defecation. In addition to constipation, there may also be local pain and blood in the stool. In typical cases, the patient may feel a pressure drop in the anus, or may need to apply pressure to the pubic bone or insert a finger into the vagina or rectum to defecate.

③ Perineum descent syndrome: Under normal circumstances, the upper end of the anal canal (i.e., the anorectal junction) is at the line connecting the pubic symphysis and the tip of the coccyx. When the breath is held, the anal canal descends, but not below 2 cm below the line. A descent of more than 2 cm is considered perineum descent. It is more common in multiparous women over 30 years old, and the clinical manifestations are difficulty in defecation, long defecation time and a feeling of incomplete defecation. If accompanied by rectal prolapse, there may be mucus and blood in the stool. Due to pudendal nerve damage, perineum pain and fecal incontinence may occur, and it may also be accompanied by vaginal prolapse.