Constipation - bowel emptying delay (more than 48 hours), as well as the difficulty or lack of systematic (compared with the usual) emptying. The most frequent constipation occur in elderly persons.
Constipation arise as a result of violations of the processes of formation and promotion of stool through the intestines, primarily the colon. Constipation can occur in a healthy person, for example, during a long trip, when you change the familiar environment, changing rhythm of life; in this case they do not last long and are, as a rule, without treatment. In some people, constipation is caused by the systematic suppression of the urge to defecate, which may be due to the peculiarities of the labor process (vehicle driving, working on the assembly line), fear of pain (hemorrhoids, anal fissures, etc..), The need to defecate in an awkward position or other patients on bedrest. Often constipation caused by irregular eating and a small amount of it, a predominance in the diet of protein foods, lack of food is high in fiber (vegetables, fruits), abuse of refined foods that contain little fiber, reduced water consumption and a sedentary lifestyle. Constipation may be a symptom of various diseases. They often occur in the intestines dyskinesia. More than half of the patients with constipation marked increase in motor function of the intestine (hyperkinetic, or spastic constipation). Delay of the chair in these cases due to the strengthening of ineffective peristaltic contractions, increase in the number of retrograde colonic contractions, spasm of the distal parts of it. Hypokinetic, or atonic constipation, which are observed in about 1/4 of cases are caused by the weakening of the contractile function of the colon, until the proximal atony its departments. They observed with congenital elongation of any portion of the colon (e.g. dolichosigma), chronic colitis, anorectal disease, abdominal adhesions, stenosis of the colon (e.g., in tumors). Extraintestinal defeat - a disease of the stomach, bile ducts, female reproductive organs, endocrine disorders, neurosis are accompanied by secondary constipation. May cause constipation effects of toxic substances, and drugs.
Individuals elderly predisposing factors are the atrophy of the mucous and muscular intestinal membranes, increase the threshold of excitability of the receptors of the mucous membrane of the colon and the weakening or disappearance of the reflex bowel movements, excessive intestinal population of microflora, weakness of muscles abdominals and pelvic floor disorders of blood circulation in the vessels of the bowel mesentery . The most common causes of constipation in this age - unhealthy diet, physical inactivity, CNS pathological processes in the anal area.
The frequency of bowel movements for constipation varies from 2 - 3 times to 1 times a week and less. In some patients, the daily stool, but the act of defecation is difficult or incomplete bowel movements. Feces are usually dense, fragmented, often resembles a sheep (in the form of a dry dark balls). In less severe constipation stool sealed only at the beginning, in the future, they have the usual pasty consistency. Often cal is enmeshed in a whitish slime. When persistent constipation may be a so-called stop-diarrhea - the allocation of liquid feces due to the dilution of its mucus, resulting in the rectum because of its long-term irritation. Constipation is usually accompanied by a transfusion, rumbling, bloating, abdominal pain migrating, as well as weakness, headaches, irritability, insomnia, decreased appetite, palpitations, sweating. Individuals elderly sometimes have fecal incontinence , urinary retention . Due to the increased formation and absorption from the colon of toxic products (cresol, indole) may be low-grade fever, nausea .
Diagnostic activities are aimed to recognize the causes of constipation. Primarily exclude tumor colon and megacolon . In the future, determine the nature of motor disorders, which is important for the rational treatment. The main role is played by the results of X-ray examination, sigmoidoscopy and colonoscopy.
The leading role in the treatment of constipation plays diet, regular food intake and its composition. If there are no contraindications, prescribed diet, stimulating bowel movements. The diet includes foods that contain large amounts of fiber (black bread, vegetables, raw or cooked, fruit - plums, figs, dried apricots, buckwheat, millet cereal, etc..), Organic acids (sour milk, fruit juice, sour fruits, etc. .), fats (vegetable oil), as well as sun-dried foods, smoked, boiled meat. bowel movement promotes food and liquid taken cold. Recommended infusion of prunes, mashed cooked dried fruits. High efficiency have wheat bran, which pour over boiling water and drink alone or added to a liquid food (in the first two weeks to 1 teaspoon 3 times a day, then 1-2 tablespoons 3 times a day with subsequent dose reduction to 1 5 - 2 teaspoons 3 times a day). When hyperkinetic constipation food, stimulating motor activity of the intestine, can be irritating and strengthen abdominal pain. In such cases, prescribe a relatively gentle diet with high fat diet. When constipation from the diet excludes foods that cause flatulence (beans, apple and grape juice, turnip, radish, onion, garlic, radishes), bread made from white flour, pastry, fatty meats, spicy dishes, chocolate, strong coffee and tea; restrict cereal semolina, rice dishes, potatoes.
With the ineffectiveness of diet to restore the reflex to defecation is recommended in the morning on an empty stomach to drink a glass of cold water or fruit juice, to which, if necessary, add 1 / 2- 1 teaspoon salt Carlsbad. After 30 minutes after a meal with the help of certain techniques (appropriate posture, massage the abdomen, legs movement, simulating cycling, rhythmic retraction of the anus, pressing on the area between the coccyx and the anus) try to make a bowel movement; the ineffectiveness of these measures, it is advisable to enter into the anus candle with a laxative. An important role in the treatment of constipation play an active lifestyle, physical training and sports.
When violations motility of the colon, especially neurogenic nature, resorting to drug therapy. Reduction peristalsis promote holinoliticheskie (atropine, platifillin) and Adrenomimeticalkie means (ephedrine) and phenobarbital, sibazon (seduksen), diphenhydramine, and others. Increased intestinal activity cause cholinomimetic agents (eg, aceclidine) and anticholinesterase drugs (Neostigmine, galantamine) adrenoceptor blocking agents, metoclopramide (Reglan). Assign physiotherapy: faradization abdomen, galvanic currents, ultraviolet irradiation. When hyperkinetic constipation, in addition, used electrophoresis antispasmodics, diathermy, paraffin bath on his stomach, warm water therapy at hypokinetic - electrophoresis of calcium supplements, cool water treatments. Showing mineral waters (Essentuki № 17, Slavyanovskaya, Jermuk, etc.). When dysbacteriosis prescribe drugs that normalize the intestinal microflora. These include extracts of chamomile, mint, yarrow, corn stigmas, Helichrysum, nitrofuran derivatives (furazolidone, furagin), bacterial preparations (bifidumbakterin, kolibakterin et al.).
In chronic constipation should avoid using laxatives and enemas. If no laxatives do not possible (mainly in the elderly), recommended herbal laxatives (senna, buckthorn bark, fruit zhostera, rhubarb root, seaweed, grass and fennel, etc..). When persistent constipation also effective oil (e.g., liquid paraffin, olive oil), and other laxatives, which, however, should be used with great caution.