- Definition of constipation
- Main symptoms
- Classification of constipation depending on the causes of
- Complications of constipation
Constipation is a multifactorial problem. Most gastroenterologists are inclined to believe that this is not an independent disease (although the ICD-10 code is K59.0), but a symptom of a malfunction of the body. Laxatives do not always solve the problem, and often aggravate the situation.
Definition of constipation
For normal functioning, the intestine needs a good blood supply, harmonious peristalsis (waves excited by alternate contractions and relaxation of the walls), healthy microflora, and no anatomical pathologies. These are the basic conditions for proper formation of fecal masses and timely removal of them from the body. Directly, the act of defecation is provided by the rectum and anal sphincters (internal and external), where nervous conductivity and reflexes also play an important role.
Constipation (constipation) is an irregular, incomplete, painful, or too rare bowel movement. Ideally, the body of adults is released from the feces once or twice a day, and their discharge should be natural and soft. On the failure of the intestines can be said in the event that the chair is no more than 48 hours. For some, the option of the norm is defecation every 3 days, but subject to good health and a normal consistency of feces.
If feces depart daily, but in scant amounts, have a firm consistency, then this condition is also constipated.
Irregular and difficult bowel movement is accompanied by the following symptoms:
- feeling of heaviness in the abdomen, often bloating;
- dull pains usually occurring in the right iliac region;
- if the stool was not more than 5 days, then the organism begins to poison: toxins from the stool begin to be absorbed through the intestinal walls. The result is a feeling of weakness, headaches, lack of appetite, the skin turns pale;
- worried about the feeling of distention in the rectal area, especially when sitting.
The prostate gland in men is located very close to the rectum, so when the latter overflows with solid masses, in some cases (with inflammation of the prostate ), pain may occur in the lower abdomen, extending into the rectum. In chronic constipation, constant pressure, impaired blood flow have a detrimental effect on a healthy gland.
Classification of constipation depending on the causes of
There is no formal classification of constipation. There is a conditional division on the basis of provoking factors, which in one way or another have a negative effect on intestinal motility and its innervation (the system of nerve endings that ensure the connection of the organ with the central nervous system).
If we are talking about congenital or acquired pathology of the structure or innervation of the excretory intestine (for example: achalasia, Hirschsprung disease), then primary constipation is diagnosed. Secondary forms develop under the influence of various factors: trauma, illness, intoxication, unhealthy diet.
All causes of various types of constipation, depending on the origin, are divided into functional (impaired intestinal motility due to external factors) and organic (pathologies of the intestinal itself).
In foreign medical literature, functional constipation is often called idiopathic. That is, the mechanism of the colon is broken, but the cause during the examination of the intestine can not be established. At the same time, pathological changes in the neuromuscular apparatus of the colon are noted, the reaction of nerve endings to food intake is reduced.
Functional constipation is divided into two types:
- rectal , caused by weakening of the defecation reflex. Normally, as the feces travel along the rectum, its receptors are irritated and pressure is increased, as a result of which the feces are expelled;
- cologenic , in which the movement of fecal masses through the colon is disturbed (dyskinesia).
The cause of rectal constipation is often a type of activity, a profession, a feature of which does not allow the intestines to be emptied in a timely manner (for example, the driver). Due to the constant suppression of the reflex in the rectum, the threshold of sensitivity changes. Conscious delaying defecation is also due to hemorrhoids, chronic anal fissures and other diseases in which the stool is accompanied by pain.
Since the process of involuntary emptying of the rectum is controlled by the nervous system (centers located in the sacral segments of the spinal column), and random bowel movement is controlled by the brain, head injuries to the spine, as well as mental and neurological diseases can cause a disturbance of reflex responses.
The reflex defecation and psychogenic (hypochondriacal) constipation is weakened. In men, this form is rare. The cause of the problem is an excessive concentration on the regularity and quality of the stool: various manipulations are constantly being undertaken (enemas, laxatives) in order to completely release the intestines, which in the end really refuses to work independently on their own.
Frequent bowel cleansing procedures and taking laxatives without a doctor’s prescription can lead to expansion of the right colon, disruption of fluid absorption, dehydration, loss of potassium, and development of lazy bowel syndrome. Eczema or urticaria may appear on the skin.
Defecation with cologenic constipation is difficult because of a violation of motility, malfunction of the mechanisms responsible for activity, as a result of which the degree of elasticity of the intestinal walls changes in different areas:
- hypertonus causes spastic constipation : the masses are periodically stuck in certain places. At the same time, “sheep” feces are observed (in hard pieces). Spastic constipation is most common in young people;
- hypotonia provokes atopic constipation due to too sluggish bowel movement. As a result, the feces come out in the form of large-diameter cylinders, the process is accompanied by ruptures and cracks of the anus. This form of constipation is characteristic of men of retirement age, as there is an age-related loss of wall tone. In young people, the intestinal wall may be stretched due to frequent accumulations of fecal masses due to chronic constipation. Atonic constipation can occur on the background of diseases such as cholecystitis, pancreatitis, appendicitis, ulcers.
The reasons for such an imbalance of motility can be both external and internal (diseases, anatomical pathologies). There are several types of constipation associated with difficulty moving feces through the intestine:
- Muscle . This form arises because of a lack of coordination of the muscles of the pelvic floor: dysfunction of the pubic-rectal muscles, sphincter ring. When you have a bowel movement, there is always a feeling of insufficient emptying.
- Alimentary . This is a type of chronic constipation caused by a systematic eating disorder: the abuse of foods that provoke fecal stagnation (flour, cottage cheese, eggs, pomegranate, strong tea, white rice).
- Hypodynamic . The lack of movement negatively affects not only the tone of skeletal muscles, but also the state of the muscles of the intestine. This type of chronic constipation is characteristic of bedridden patients, as well as for those who spend almost all their time in a static position due to the nature of the profession.
In a separate group can be identified disorder of metabolic processes arising from various pathologies:
- heart failure, portal hypertension. The lack of blood supply and oxygen disrupts the functioning of the intestine, while water-electrolyte metabolism is unbalanced. This type of constipation mainly accompanies men after 50 years;
- hypothyroidism (a disease associated with thyroid hormone deficiency), diabetes mellitus;
- potassium deficiency (hypokalemia), an excess of calcium and / or magnesium (hypercalcemia, hypermagnemia);
- long-term medications, for example: antacids (Almagel), antiallergic drugs (Suprastin), diuretic, pressure reducing, calcium preparations, enzymatic agents, antispasmodics, painkillers, and Bifidumbacterin, Smekta, Imodium. Constipation caused by the reception of these funds, called iatrogenic.
Functional constipation is cured completely with the timely elimination of the causes of their development.
The organic form of constipation occurs due to lesions of the colon or rectum: a violation of the structure and function of the walls. Changes in the structure are caused by surgical pathologies:
- twists, lengthenings or expansions, additional loops;
- cicatricial deformities of the intestinal walls;
- hemorrhoids, cracks;
- tumor formations;
- prolapse of the intestine;
- hernias, hernia-like protrusions on the walls (diverticula);
- contractions (strictures).
The functioning of the muscular layer of the intestinal wall is disturbed in the following diseases:
- irritable bowel syndrome;
- colitis (inflammatory processes of the walls);
With the mechanical overlap or compression of the intestinal lumen on the background of constipation, obstruction gradually develops, which is eliminated only by urgent surgical intervention. And wall inflammations require long-term therapy and a strict diet.
Acute and Chronic Constipation
By the nature of the course, constipation can be acute or chronic . In the first case, there is a clear growing discomfort against the background of an unusually long absence of defecation (over 3-5 days or more). It feels heaviness, pain, cramps in the stomach, belching, heartburn. If acute constipation is caused by diverticula, then a rise in temperature is likely. With the development of intestinal obstruction due to a tumor, acute stool retention is sometimes the only symptom, and vomiting may be added later.
Acute constipation can also be episodic, caused by abrupt changes in nutrition, overeating, stress, trauma. In such cases, the situation is usually quickly resolved with the elimination of provoking factors.
Chronic constipation develops gradually and requires long and complex therapy. This form is diagnosed on several grounds:
- for a long time (at least 3 months) every fourth act of defecation occurs with difficulty (strong attempts, damage to the anus);
- delays are 48 hours or more;
- feces dry, compressed, stand out in small quantities (about 35 g).
Chronic constipation is often a companion of various diseases, the result of prolonged use of a number of medicines, as well as the result of malnutrition and physical activity.
Complications of constipation
The most common complications of constipation are rectal fissures (often becoming chronic), the development of hemorrhoids, intoxication of the body. Men rarely associate constant fatigue and headaches with irregular bowel movements without taking measures to normalize stool.
Prolonged accumulation of feces in the lumen of the rectum and colon leads to inflammation of the mucous membranes of their walls. From the cecum feces can be thrown back into the thin, which will lead to the development of enteritis.
The rectum under the influence of the pressure of the feces may expand or lengthen, which will lead to more prolonged and severe constipation. As a result, rupture (perforation) of the wall iperitonite is likely.
A terrible consequence of tight constipation can be a malignant tumor, the prerequisites for the development of which arise due to the effect on the intestinal walls of carcinogens, which are formed when frequent intake of certain types of food (smoked meat, deep-fried food, lard, sausages). Men over 50 years old are at particular risk.
If you have problems with defecation, you should contact a proctologist or a gastroenterologist. After interviewing the patient, a series of studies is scheduled.
For diagnosis, a general and biochemical blood test is taken, a sample is taken for the presence of impurities and to determine the composition of microflora.
In order to identify the causes of constipation, several groups of instrumental tests have been developed:
- for the analysis of the dynamics of the promotion of feces in the colon. For this purpose, an X-ray study involving radiopharmacological or X-ray-positive markers, electromyographic monitoring is used. To measure the pressure in the rectum is manometry;
- colonoscopy is used to check for the presence of colon abnormalities (inspection of the walls from the inside with a special device);
- For the detection of problems in the anorectal region, a finger examination, electronic probing, X-ray defectography are performed.