Chronic constipation

Chronic constipation is a complex of several different symptoms that indicate that there are difficulties with bowel movement. Usually, the diagnosis of constipation implies either a rare (less than 3 times in 7 days) bowel emptying, or problems during defecation, in which less than 35 g of its contents per day are released from the intestine.

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Epidemiological studies have shown that approximately 5-21% of all people suffer from constipation (an average of 14%). But at the same time, only 3-5% of patients are treated with this problem. Women suffer from constipation more often than men (3 times), and in pregnancy this problem occurs in about 44% of expectant mothers. The highest risk of constipation in the elderly (about 50% of them suffer from this disease).

[8], [9], [10], [11], [12], [13], [14], [15]

Causes of the chronic constipation

Among the causes of chronic constipation, the following are most often identified:

1. Incorrect diet and habits. Ignoring the urge to defecate because of unsuitable conditions or time - this contributes to the deterioration of the defecation reflex. Concomitant circumstances are: finding in an unfamiliar environment, bed rest, workload during the day. Intentional challenge of the act of defecation (taking laxatives) because of the expectation of more frequent or regular emptying than is normal for a person. A diet in which there are few products rich in plant fibers. A reduced amount of stool due to the use of drugs that contribute to the development of constipation, or because of the depletion of the body.
2. IBS is a disorder of the motor function of the colon, as a result of which the patient has a stiff rare stool accompanied by mucus (this condition alternates with diarrhea), abrupt, cramping pain in the abdomen. Disruption of the intestine can aggravate due to stress.
3. Mechanical blockage. Benign or malignant neoplasm of sigmoid or rectum. Thus the lumen in the intestines narrows, because of what the frequency and rhythm of emptying changes, there is a pain in the abdomen, diarrhea and bleeding begin. In the case of rectal cancer, there is a change in the appearance of the stool column (it becomes like a pencil), as well as false painful urges to emptying with an almost empty intestine. Coprostasis, in which hardened feces accumulate in a straight (sometimes thick) gut. As a result, the patient feels bowel overflow and feels a pain in the abdomen. Also there is diarrhea - the mass of liquid feces flows around the cork in the intestine from the solidified feces.
4. Other diseases in which there is a blockage of the intestine - intussusception, inversion of the intestines, inflammation of the diverticulum. As a result of these pathologies, the narrowing of the intestinal lumen (or its complete closure) may begin, at which colic in the abdomen is observed, a stool similar to "raspberry jelly" (in case of invagination), as mucus and blood are present in the stool, as well as swelling .
5. Pathologies of the anal canal, which are accompanied by painful sensations. Because of pain, a spasm in the external sphincter can occur, as a result of which the defecation reflex will be suppressed. Such symptoms are observed with anal fissure, acute hemorrhoids, and in addition to rectal fistula.
6. The use of drugs that provoke constipation.
7. The state of depression.
8. Neurological disorders, as a result of which autonomic innervation of the intestine can be disturbed. Among such diseases - multiple sclerosis, various injuries of the spinal cord, aganglion.

[16], [17]

Pathogenesis

Chronic constipation can develop due to various factors, a common link in the pathogenesis of each of which is dyskinesia of the large intestine. Because of the disruption of the work of this body, the balance between anti-peristaltic and propulsive motility is destabilized. There is an increase in antiperistaltic activity, and the area of action of retrograde waves expands along the entire length of the intestine. As a result, segmenting contractions become more active, because of what the fecal masses are re-consolidated.

[18], [19], [20], [21], [22], [23],

Symptoms of the chronic constipation

The frequency of intestinal emptying is different, but it is normal 1 time in 2-3 days. If the defecation occurs once a week or less, this indicates that there are problems with the intestine. The symptom of constipation is also that the stool becomes dense, dry, like a sheep - dark lumps or small balls. Also feces can have a ribbon-like, bean-shaped, or cord-like appearance.

Occasionally, blocking diarrhea may occur - in this case, due to a prolonged delay in emptying, the mucus that occurs as a result of irritation of the intestinal walls begins to dilute the stool.

Symptoms of constipation can also be raspiruyuschie and pain in the abdomen. The patient feels relief after the withdrawal of gases or act of defecation.

An unpleasant manifestation of constipation is also flatulence, which arises from the slow movement of fecal matter along the colon, and also the fact that the activity of intestinal bacteria leads to increased gas production. In addition to these symptoms, swelling can also occur involuntary reactions of other organs - increased heart rate, pain in the heart, etc.

With constipation, the patient's appetite worsens, an unpleasant taste in the mouth, an eructation of air. Muscular and headache, decreased ability to work, bad mood, nervousness, sleep disorder can also be observed.

With persistent constipation, the appearance of the skin can change - it becomes pale, has a yellow tint. The skin loses elasticity, becomes flabby.

Syndrome of chronic constipation

Syndrome of chronic constipation - a very common pathology, which significantly impairs the quality of life. Chronic constipation is a heterogeneous disease that is observed in every population group. The frequency of their occurrence increases with age.

[24], [25], [26]

Chronic idiopathic constipation

Chronic idiopathic constipation or an inert large intestine is a disorder of the motor activity of the large intestine, which arises from the slowing of the rate of movement of stool in the intestine (with no anatomical anomalies present). The etiological factors of this disease are mechanical, structural, metabolic, and also cortico-visceral effects on the large intestine.

[27], [28], [29], [30], [31]

Chronic atonic constipation

If the atonic constipation is not cured, it can go on to a chronic stage, with rather life-threatening consequences:

1. The fissure of the anus, which causes severe pain, since with each act of defecation diverges again and begins to bleed. In this case, we should not allow the emergence of a new constipation, because because of it the crack will inflame more and increase.
2. Hemorrhoids - appearing in the anal passage painful cones, sometimes bleeding when straining. Bleeding usually accompanies internal hemorrhoids. When the illness turns into a severe form, the patient experiences pain constantly - while walking, sitting, lying.
3. Intoxication. Fecal masses must leave the body in time, since they contain many toxins. If the stool remains in the intestine for a long time, these toxins are absorbed into the blood, thereby poisoning the body.
4. Reduced immune status, which occurs due to intoxication. With reduced immunity, the body becomes more difficult to fight with various viruses and infections.
5. The lazy intestine syndrome, which occurs as a result of the abuse of laxatives to relieve chronic constipation. Under the influence of drugs, the musculature of the intestine ceases to function, as the habituation takes place. It will be much more difficult to get rid of this problem than from obstruction.
6. Oncological diseases of the colon - this is one of the worst consequences of chronic constipation. Symptoms of the development of this disease is anemia, the presence of blood in the feces, a change in stool. The person starts to lose weight quickly, and also feels incompleteness of defecation. But at first the disease develops without any manifestations, therefore it is necessary to go on a regular basis for examination to a gastroenterologist, especially if there are reasons for concern.
7. Diverticular disease of large intestine. Diverticula - a protrusion of the intestinal wall, which occurs due to constipation, when the delay in emptying sharply increases the pressure in the intestine. Diverticulum can also be congenital. Symptoms of the disease are blood in the stool and pain in the abdomen. Feces accumulating in the diverticulum can cause inflammation, which later can lead to the development of a cancerous tumor.

[32], [33], [34]

Chronic constipation of a nervous nature

Chronic constipation, arising on nervous soil, appears either as a result of imbalance between the para- and sympathetic nervous systems, or because of the depressive state of the patient.

Neurogenic is also considered constipation, which arose due to a disorder of motor motility of the intestine, which developed due to problems in the neuropsychic region. In addition, the causes of the disorder may be problems with the conditioned reflex act of defecation, the involuntary effect of altered pathology of the organs, as well as organic destruction of the spinal cord and brain. Thus, neurogenic constipation can be divided into several subgroups: psychogenic, conditioned reflex, dyskinetic (in which spasms or ations predominate), as well as organic ones.

[35], [36], [37], [38], [39]

Chronic constipation in the elderly

Chronic constipation in elderly people usually occur much more often than acute ones. Nowadays chronic constipation is already considered an independent pathology, although it is often a symptom of some other gastrointestinal diseases. Signs of chronic constipation in the elderly are such circumstances:

• Within a week there were less than 3 bowel movements;
• The chair is scrappy and hard with 25% emptying;
• At least 25% of emptying occurs only with straining;
• More than 25% of emptying cause a feeling of unfinished defecation;
• At least 25% of emptying cause a sense of anorectal blockade;
• For emptying in 25% of cases, the help of hands is required;
• There are no signs that can confirm the patient's IBS. 

If at least 2 of the above manifestations occur at least 3 months per year, this indicates the development of chronic constipation.

[40], [41], [42], [43], [44], [45]

Complications and consequences

A consequence of prolonged chronic constipation can be a variety of complications, such as proctosigmoiditis (inflammatory process in the rectum and sigmoid colon) and secondary colitis.

Prolonged fecal congestion in the caecum can lead to a back-throwing of the contents into the small intestine, resulting in enteritis. Among the complications that accompany constipation, also hepatitis and pathologies of the bile ducts.

Chronic constipation can cause a variety of diseases of the rectum. Basically it is hemorrhoids, but also anal fissures with paraproctitis often appear.

In some cases, constipation leads to lengthening and expansion of the large intestine, which makes the disease even more stubborn.

The worst consequence of chronic constipation is the appearance of a cancerous tumor.

[46], [47], [48], [49], [50], [51]

Diagnostics of the chronic constipation

Chronic constipation is diagnosed in such cases:

• Emptying of the intestine occurs less than 3 times a week;
• When defecating the patient has to strain;
• The chair has a tuberculate or dense consistence;
• The appearance of a feeling of incompleteness of the act of defecation.

[52], [53], [54], [55]

Analyzes

To confirm the diagnosis, tests can be taken:

• sowing feces on the intestinal microflora;
• research (histochemical and histological) biopsies of the intestinal mucosa.

[56], [57], [58], [59], [60], [61], [62], [63],

Instrumental diagnostics

To identify the symptoms of chronic constipation, instrumental diagnostics methods can also be used:

• Irrigoscopy (X-ray of the large intestine);
• colonoscopy;
• studying the motor activity of the large intestine;
• functional study of the musculoskeletal system of the rectum.

Differential diagnosis

In the case of chronic constipation, especially in people over the age of 45, with recently appeared and having increasing symptoms (anemia, a sharp decrease in weight), it is necessary to exclude the possibility of a cancer first.

Also it is necessary to exclude the following diseases:

• Having a different nature of narrowing of the intestine (inflammation of the large intestine, narrowing of radiation or ischemic origin, diverticulosis);
• Infection with parasites or chronic infectious diseases of the intestine;
• Neurological diseases (tremor paralysis, vegetative disorder, multiple sclerosis);
• Diabetes mellitus, agangliosis, hypothyroidism;
• Scleroderma;
• Cholestatic pathologies;
• Chronic constipation resulting from medication;
• Endometriosis;
• Ulcer.  

Treatment of the chronic constipation

Treatment of chronic constipation includes not only the use of laxatives. In addition to the symptomatic, there should also be a therapy directed at the stimulus that caused the constipation.

Self-medication in this case is not recommended, since prolonged regular constipation may be a sign of severe pathology, or contribute to the occurrence of life-threatening complications.

It should also be understood that the independent use of laxative drugs, which does not take into account the characteristics of the drugs, their effects on the body, and side effects, often leads to even more serious problems with the act of defecation, as the motor activity of the intestine is reduced. In addition, in this case the dose of the medicine becomes more and more each time, as a result of which, in the course of time, it generally loses its effectiveness and does not affect the body.

Having ascertained the cause of the development of chronic constipation, the doctor determines what treatment to assign to the patient. This takes into account all the pathogenetic factors, so that drugs affect the body more effectively, while not causing side effects that can exacerbate the disorder of the intestine.

Enema for chronic constipation

With chronic constipation, enemas should be single. Patients should alternate the application (1 p./ed.) Of water-oil (every day in the morning, a maximum of 200 ml) and cleansing enemas. This procedure is performed in order to restore the reflex lost by the intestine.

[64], [65], [66]

Laxatives for chronic constipation

Chronic constipation most effectively eliminates laxatives from the group of prebiotics: they help stabilize the intestinal microflora, and also stimulate intestinal motility. Due to this the effect of the drug will be long and stable.

Prelax is used in a daily dosage of 2-6 tablespoons. During the meal. The duration of the treatment course can be at least 2 weeks, and a maximum of 3 months. Contraindicated with high individual sensitivity to the elements of the drug.

The daily dosage of syrup Lactusan for adults is 20 ml (divided into 2 receptions); children are prescribed 10 ml with the same conditions. Take the drug when you need food. In tablets, the dosage for adults is 8-10 pcs / day, and for children older than 5 years - 3 pcs / day. Therapeutic course lasts 1-2 weeks. If the form of the disease is started, the treatment can be extended up to 1 month. Side effects: at the beginning of the treatment course, bloating may be observed, which disappears after a few days. Because of lactulose, laxative effect may be too strong and provoke the development of diarrhea. Lactusan is contraindicated with high sensitivity to additive elements and other components of the drug, with lactase deficiency, as well as galactosemia.

Dufalac is consumed in the morning while eating. Dosages are set for each patient individually. For constipation or for softening of stool, such dosages are used:

• Adult - 15-45 ml initial dose and 10-25 ml maintenance;
• At the age of 7-14 years - 15 ml initial, 10 ml supporting;
• At the age of 3-6 years - 5-10 ml and the initial, and supporting;
• Children under 3 years old - 5 ml initial and supportive.

Usually the dose is reduced after 2 days of use according to the needs of the patient. The effect of the drug manifests itself 2 days after the first reception, since this is the property of lactulose. Dosage or frequency of use may be increased if after 2 days of taking the medication the patient's condition did not improve.

Side effects of Dufalac: disorders of the digestive tract (nausea, bloating, vomiting); with an overdose, diarrhea may start. Contraindicated with intestinal obstruction, high sensitivity to galactose, fructose lactose, or active substance of the drug, as well as galactosemia. With caution is prescribed for diabetes.

Physiotherapeutic treatment

Physiotherapeutic treatment will be more effective in combination with diet. If the constipation is of an alimentary nature, irrigation of the intestine, for which mineral waters having a laxative effect, is suitable as a method of treatment. Mineral sulfate water should be drunk on an empty stomach in the morning and in the evenings for about 2 weeks. If constipation also causes abdominal cramps, you should drink warm water.

If constipation occurs as a result of atony of the colon, you need to do a stomach massage, perform the procedures of mechanotherapy and therapeutic gymnastics, take a circular shower and sub-aqua baths. Thanks to massage, the intestinal motility improves. If the patient feels spasms, you should use thermal procedures - apply appliqués from the paraffin on the stomach, take coniferous baths.

Alternative treatment

There are also methods of alternative treatment for chronic constipation.

Pour 1 stack. Boiling water 2 boxes. Bran and leave to cool, then drain the liquid, and the resulting mixture of bran to eat on an empty stomach. With the correct application of this alternative laxative, an improvement in the digestive system occurs after only 5 days of admission, and stool stabilization occurs on day 10. Even more effective this tool will be combined with enemas.

Equally effective for constipation is also tea, obtained from the bark of the buckthorn.

Another recipe: take the lemon peel, rhubarb (0.5 kg), and sugar (200 g). Dissolve sugar in water (0.25 ml), peel and cut the rhubarb. Ingredients pour into a saucepan and cook until the mixture is cooked. You need to take the medicine every day until there are improvements.

Tea from the leaves of oregano - pour 30 g of ingredient 1 liter of boiling water, insist and use 0.5 cups each. 3 rubles / day.

[67], [68], [69]

Herbal Treatment

Chronic constipation is very effective in fighting celiac disease. To prepare a laxative from this herb, you need to cut it and mix it with sugar (take 250 g for both ingredients). Put the mixture on gauze, wrap it in a tourniquet, and then put it in a jar full of serum. Close it with a lid and roll in a dense fabric. Put the container in the place closed from the light and leave to infuse for 2 weeks. The resulting tincture strain and consume 0.5 stack. Before meals (for 20 minutes). In treatment, adhere to the following regime - take the medicine 2 weeks daily, then take a break for 2 days, and then resume the reception.

A quality laxative effect on the body has senna. To make a medicine from it, you need to mix 2 tsp. Leaves of this herb with prunes (100 g) and pour a mixture of 3 stacks. Boiling water. Infuse the medicine for 3 hours, then drain. Ready tincture to drink every hour for 5 tablespoons. Before the full restoration of the intestine.

Homeopathy

Among the homeopathic preparations that help with constipation, the following are distinguished: Sulfuris eliminates disturbances, stabilizing portal blood circulation in cases when, together with constipation, the patient has an itch in the anus and hemorrhoids. With similar symptoms, but with more severe hemorrhoids, Aesculus hippocastanum should be taken.

Nux vomica is used if the bowel function is reversed - when urged to defecate the sphincter does not relax, but rather contracts, preventing the feces from exiting.

Diet for chronic constipation

Features of the diet for chronic constipation: the basis of a nutritious diet should be foods and dishes from them that improve intestinal peristalsis. At the same time, food should be completely excluded from it, which can cause rotting or fermentation in the intestine, as well as stomach.

To normalize the functional activity of the intestine from the diet, it is necessary to remove products from puff and yeast dough, fast food, soups, infused on the first broth, kvass, sweet carbonated water, legumes, and also pasta products. In addition, you can not eat mushrooms. It is forbidden to drink cocoa, too strong tea, jelly, and coffee. From sweet it is impossible to use the cakes containing a custard, and also chocolate; from berry and fruit - blueberries, bananas and dogwood.

[70], [71]

Menu with chronic constipation

An approximate day menu for chronic constipation.

The diet should be divided - there is a need for small portions of 5-6 rubles / day. The menu can have approximately this sequence:

• For breakfast lettuce (tuna and fresh vegetables), cottage cheese with the addition of jam or honey, as well as weak tea;
• The 2 nd breakfast includes fruit salad (it is recommended to make it from pears, apples, cherries, as well as oranges, pineapples, plums, etc.);
• At lunch, eat seafood soup, an omelette with vegetables, and a compote made from dried fruits;
• Afternoon snacks should consist of a weak tea with a dessert (this may be, for example, marshmallow or pastille);
• For dinner, cook a side dish, which includes friable buckwheat with butter and fish bits (baked);
• 3 hours before going to bed, drink defatted kefir (1 stack).

Exercises for chronic constipation

When chronic constipation exercises are best done in the morning, and later again after lunch. Please note that the procedures can be performed no earlier than 1.5-2 hours after a meal.

Lie on your back, while dilating your arms around the sides, inhale with inhalation and at the same time draw in the anus, then exhale back to the previous position. Perform this procedure 2-3 r.

Having assumed the position of lying, bending / unbending, and also to reduce / raise legs, in addition to rotating stops (all movements of 4-5 rivers).

In the lying position, place the arms along the body. Expand your palms upward, stretch out your arms and bend them in your elbows, then return them to the previous position and turn your palms to the bottom. The procedure should be repeated 5-6 r.

In a lying position with hands along the body. On an exhalation turn to the right, reach with the left hand to the edge of the bed, take the former position on the inspiration. Repeat the motion with your right hand. Do this exercise 3-5 r.

Taking the position lying down, grasp the back of the bed with your hands and carry out cycling movements with your legs - make 8-20 turns with each foot.

In the lying position, bend the legs in the knees, then reduce / dilute them - repeat 4-5 r.

Lie on your back with your hands on your head. Perform lifting of the trunk, using as support points of the hand, the occipital part of the head and the heel. When climbing, draw in the anal input. The procedure should be repeated 4-5 r. After completing the above exercise, place your hands on your chest, as well as your stomach, then twice deep breathe in your chest, and then your belly.

Take the position of "elbows-knees" and in turn pull your legs back (repeat 4-5 rubles).

In the knee-elbow position, lift the pelvis by straightening the knees. The procedure should be repeated 3-4 r. If possible, after this procedure, try to stand in the arms of 3-4 short-lived racks, while kicking at the wall. Doing struts, perform kicking moves.

Take the standing position, and the legs are brought together. Do the stretching while drawing in the anus. The procedure is 2-3 r.

Adopt standing with crossed legs. Stretch, pulling the anal passage - repeat the procedure 2-3 r.

To keep legs together, being in a standing position, and arms to dissolve on the sides and on an inspiration to be stretched, having pulled in an anal input. Perform the procedure 3-4 r.

Stand up straight and close your legs. Make flies legs to the side, as well as back and forth. Repeat the exercise 3-4 r.

Walking at first is the usual step, then - lifting your knees high, then back to normal again. The procedure lasts 1-2 minutes.

Take a standing position and reduce your legs, put your hands on your waist, then take your elbows back to inhale, thereby pushing your chest forward. Together with this movement, draw in the anus. On exhalation take the initial pose. Perform the procedure 2-3 r.

Stand up, reduce your legs, place your arms along the body. Quietly and deeply inhale / exhale 2-3 r.

[72], [73], [74], [75]

Prevention

Prevention of constipation is the timely detection and treatment of diseases of the digestive system, as well as other pathologies that result in constipation. In addition, it is necessary to eat properly and include foods rich in organic fiber in your diet. Drink a sufficient amount of fluid, move a lot, observe the food regime of the day, and also in time to empty the intestines.

[76], [77], [78], [79], [80],

Forecast

Chronic constipation often has a favorable prognosis. But it should be borne in mind that this pathology can have complications - the formation of a fecal obstruction, the development of fecal peritonitis or intestinal obstruction. These problems are particularly relevant to paralyzed people, as well as to older people.

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