Abnormal fecal excretion

Introduction Abnormal fecal discharge process (urgency, defecation, and effort) is one of the clinical diagnoses of irritable bowel syndrome. Irritable bowel syndrome (IBS) is a type of gastrointestinal function that is associated with chronic or recurrent abdominal pain, diarrhea, bowel habits, and abnormal bowel traits, and lacks gastrointestinal structural or biochemical abnormalities. The syndrome is often associated with other functional diseases of the gastrointestinal tract such as gastroesophageal reflux disease (GERD) and functional dyspepsia (FD).

Cause

(1) Causes of the disease

The cause of IBS is not clear. It is currently considered to be related to the following factors.

1. Mental and neurological factors

The incidence of mental disorders in patients with IBS is significantly higher than that of ordinary people.

2. Intestinal stimuli

Certain factors in the intestine may alter bowel function and aggravate the original irritable bowel syndrome. These stimuli include external foods, drugs, microorganisms, etc., and may also include certain internal substances produced during digestion.

(two) pathogenesis

Abnormal bowel movement

The main pathogenesis of IBS is abnormal intestinal motility. Studies have found that patients with IBS have increased creed clustered constrictions (DCCs) and prolonged proliferative constrictions (PPCs), and are consistent with spastic pain. In the diarrhea-type IBS patients, the number of migrating motor complexes (MMc) increased during the day, and the cycle shortened; there were more jejunum contractions in stage II and after meals; the colon showed a large number of rapid contractions and propelled contractions; The segmental colon quickly passed and was positively correlated with the weight of the stool; cholinergic stimulation increased the multi-dynamic index of the descending-sigmoid colon. Conversely, in patients with constipation-type IBS, the passage of the proximal colon is prolonged, the emptying is significantly slowed down; the high-grade propelled contraction is reduced; the descending and systolic time of the sigmoid colon is reduced in the basal state, and the reactivity to cholinergic stimulation is reduced. At the same time, the percentage of proximal colonic contraction time increased significantly, showing inconsistency. The pressure in the anal canal is elevated, and the anal sphincter is slow to respond to rectal dilation. Abnormal contraction of the external sphincter during defecation is associated with difficulty in defecation in patients with IBS.

IBS dysfunction is not limited to the intestinal tract, and there are dysmotility in the esophagus, stomach, and biliary tract, which is called "asthma of gut". At present, the results of research on IBS dynamics are not completely consistent, and some even lead to the opposite results. It shows that the dynamic disorder of IBS is very complicated. It is not only an abnormality of the power of a certain intestine, but there is a problem of coordination between them.

2. Feeling abnormal

IBS patients have lower abdominal pain thresholds than normal, and therefore have an excessive sensation of standard colonic expansion. This synergistic effect of paresthesia and cluster motor abnormalities is a major factor in the occurrence of spastic pain in patients with IBS. Mental stress and anxiety aggravate the painful feeling of the patient when the colon is dilated. Conversely, the perception of intestinal dilatation is reduced in the relaxed state. The extraordinary rectal anal sensation causes a feeling of defecation and even a feeling of abdominal pain before defecation. The excessive sensation of the rectum and anus is accompanied by excessive rectal movement of the rectum. That is to say, the defecation is not irritating, and the exercise response is enhanced, resulting in an increase in the frequency of defecation, but not accompanied by an increase in the weight of the defecation.

3. Abnormal secretion

The secretion of stimulating substances in the small intestinal mucosa of patients with IBS is enhanced. Colonic mucosa secretes increased mucus.

an examination

Related inspection

Conventional fecal microscopy, stool volume, urine routine blood routine

1, general examination: IBS patients with intestinal symptoms, abdominal distension is severe abdominal distension; abdominal pain for the umbilical and left lower abdomen may have tender tenderness; diarrhea in the bowel sounds can be hyperthyroidism; constipation can be weakened; Some patients may have tender rectal posterior wall rectal examination, and some patients may have no obvious positive signs.

2, laboratory examination: a large number of mucus or normal stool examination, hematuria, fecal occult blood culture (at least 3 times), thyroid function test, hepatobiliary pancreas and kidney function, erythrocyte sedimentation rate, electrolytes, serum enzymes examination, etc. are normal.

3, X-ray examination: X-ray barium enema can be seen rapid colon filling and irritability, but no obvious intestinal structure changes; full digestive tract barium meal can sometimes be seen through the small intestine tachycardia, taro in 0.5 ~ 1.5 hours can reach ileocecal unit. In the barium enema examination, it is advisable to use a warm saline enema, because soapy water or cold liquefaction enema can cause colonic spasm and cause irritation.

4, colonoscopy: visual observation of the mucosa no abnormalities or only more congestive edema and excessive mucus secretion, colonic mucosal biopsy is normal. Some patients with IBS undergo a microscopic examination because of hyperalgesia, often unable to tolerate due to abdominal pain, and need to stop the test or not check. Some patients have abdominal pain and bloating for a long time after examination, and it is difficult to recover, which may be related to the stimulation during colonoscopy.

5, colonic motor function test: sigmoid colon pressure, decreased in patients with painless diarrhea, increased constipation; rectal pressure, increased constipation, decreased diarrhea, and anal relaxation; regardless of constipation or diarrhea, can lead to The sigmoid colon and rectum have an increased motor index.

Differential diagnosis

Differential diagnosis:

Chronic bacterial infection

Many fecal routine and culture positive findings, as well as adequate and effective antibiotic systemic treatment, the symptoms improved significantly, can be clearly diagnosed.

2. Chronic amoebic dysentery

Multiple stools to find amoeba and metronidazole test treatment can confirm the diagnosis.

3. Schistosomiasis infection

Patients in schistosomiasis areas can be examined by sigmoidoscopy, and the rectal mucosa can be taken to find schistosomiasis eggs, or by fecal hatching and other methods.

4. Absorption syndrome

There is diarrhea, but there are often fat and undigested foods in the stool.

5. Intestinal tumor

Benign small tumors in the small intestine can cause diarrhea and partial intestinal obstruction with intermittent attacks. Colon tumors can also have symptoms similar to intestinal functional diseases. Especially for the elderly should pay attention. X-ray barium angiography or colonoscopy can be performed to confirm the diagnosis.

6. Ulcerative colitis

There are abnormalities such as fever, pus and bloody stools. It can be identified by X-ray barium angiography or colonoscopy.

7. Crohn's disease

Often have fever, anemia, weakness and other systemic symptoms. X-ray barium angiography or colonoscopy can be identified.

8. Lactase deficiency

The lactose tolerance test can be identified. Lactase deficiency is inherited and acquired. The clinical manifestation is severe diarrhea after eating dairy products. The stool contains a lot of foam and lactose, lactic acid. If the milk or dairy product is removed from the food, the symptoms can be improved. The yogurt is decomposed by lactic acid bacteria and can be consumed by such patients.

9. Gastrointestinal endocrine tumors

Gastrinoma can cause severe diarrhea and stubborn ulcer disease. Serum gastrin levels are extremely high, and general treatment is ineffective. Vasoactive intestinal peptide tumor (Vipoma) also causes severe diarrhea; serum VIP levels are elevated.

10. Thyroid disease

Diarrhea can occur with hyperthyroidism. Constipation can occur with hyperparathyroidism. It can be used for thyroid and parathyroid function tests for identification.

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