Symptom >> Surgical >> Proctology

Difficulty defecation

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Constipation is not a disease, but a symptom that can be seen in many diseases. It has different meanings in different patients, including: 1. The amount of stool is too small, too hard, and difficulty in defecation. 2, difficulty in defecation and some special syndromes, such as long-term forced defecation, rectal sensation, incomplete bowel movements or need to help defecation. 3. The number of bowel movements is less than 2-3 times a week.

Cause

Cause

Dietary factors

Some people eat too little, the food is too fine, the cellulose and water in the food are insufficient, and the intestinal tract can not form a certain amount of stimulation, the intestinal peristalsis is slow, the food residue can not be pushed to the rectum in time, and the residence time in the intestine is prolonged. Excessive moisture absorption causes the stool to dry. Because of the small amount of fecal residue after entering the rectum, sufficient pressure cannot be formed to stimulate the neurosensory cells to produce defecation reflexes and cause constipation.

2. Insufficient defecation

During defecation, not only the relaxation of the anal sphincter, but also the levator ani muscles are pulled upwards and outwards, and the diaphragmatic muscles are lowered, the abdominal muscles are contracted, and the breath is forced to push the feces out. Old and frail, long-term illness in bed, postpartum, etc., due to the contraction of the diaphragm, abdominal muscles, anal sphincter, weakened abdominal pressure, the defecation power is insufficient, so that the feces are not clean, feces are residual, and defecation is difficult.

3. Delaying stool time

Some people regard the stool as irrelevant, can be early or late, neglect the habit of regular bowel movements; or because of busy work, emotional stress, travel life, etc., delay the stool time, so that the rectum that has reached the rectum returns to the colon; Or prolonged stool interval due to anal diseases such as anal fissure and hemorrhoids, fear of pain, fear of bleeding, and lack of bowel movements. This may cause the nerve cells on the rectal wall to react to the pressure-sensing reaction after the feces enter the rectum, so that the residence time of the feces in the rectum is prolonged without causing a feeling of defecation, and it is difficult to form habitual defecation.

4. Excessive water loss

A large amount of sweating, vomiting, diarrhea, blood loss and fever can cause water loss and compensatory cause of dry stool.

5. Organic resistance is blocked

In the case of stenosis in the intestine or compression outside the intestine, such as benign and malignant tumors of the intestine, intestinal stenosis caused by chronic inflammation, rectal fistula caused by megacolon, intestinal adhesion after surgery, partial intestinal obstruction, etc. , or large tumors in the abdominal cavity, such as ovarian cysts, uterine fibroids, as well as pregnancy, ascites compression of the large intestine, etc., controllable feces through the obstacles, staying in the intestines for too long, forming a difficult bowel movement.

6. Large intestine lesions

Such as allergic colitis, large intestine diverticulitis, congenital megacolon and other diseases can cause large bowel fistula, movement disorders, so that the stool is difficult to pass and the difficulty of defecation.

7. Difficulties in defecation caused by drug effects

Taking calcium carbonate, aluminum hydroxide, atropine, probufen, morphine, phenipiridine, barium carbonate, etc., and metal poisoning such as lead, arsenic, mercury, phosphorus, etc. can cause difficulty in defecation. Long-term abuse of laxatives reduces the stress of the neuromuscular cells in the intestinal wall. Even if there is sufficient feces in the intestines, normal peristalsis and defecation reflexes cannot be produced, which leads to intractable defecation.

8. Difficulties in defecation caused by mental factors

Mental stimulation, horror, emotional stress, anxiety, anxiety, or high concentration of a certain job can make the intention disappear, making it difficult to defecate.

In addition, nervous system disorders, endocrine disorders, vitamin deficiency, etc. can also cause difficulty in defecation.

Examine

an examination

Related inspection

Fiberoptic colonoscopy balloon ejection test sigmoidoscopy

Common causes of defecation are habitual constipation, neurological diseases, colon tumors and so on. Acute defecation difficulties are mostly caused by acute infection or by intestinal obstruction.

(1) habitual defecation difficulties

In the medical history, there is generally a habit of eating a partial eclipse, not eating vegetables or eating too fine, or having not developed a habit of defecation on time. Inconvenient toilets or work environment are inconvenient for defecation, and emotional stress also affects habitual constipation.

(2) irritable bowel syndrome

There are three clinical manifestations of irritable bowel syndrome: colonic fistula, chronic intermittent painless watery diarrhea, alternating constipation and diarrhea.

(3) Laxative enteropathy

The patient began to use laxatives for the smooth discharge of bowel movements, and the long-term application of the dependence of defecation on laxatives was called laxative enteropathy.

(4) Colorectal cancer

Colorectal cancer includes colon and rectal cancer. Early symptoms of colorectal cancer are not obvious, changes in bowel habits such as constipation or diarrhea, or an alternation of the two may be early manifestations of colorectal cancer; postprandial bleeding is a common symptom of colorectal cancer.

(5) megacolon

Megacolon refers to a significant expansion of the colon with severe defecation difficulties. It can occur at any age and can be acquired congenitally or acquired.

(6) Difficulties in defecation caused by other causes

Acute constipation is more common in intestinal obstruction, intestinal adhesion after abdominal surgery, toxic megacolon, acute peritonitis, intussusception and so on.

Diagnosis

Differential diagnosis

1. Colon obstructive constipation:

(1) In addition to constipation, patients often have symptoms such as bloating, abdominal pain, nausea and vomiting.

(2) Colonic tumors, intestinal adhesions and other chronic intestinal obstruction, the onset is slower, constipation is gradually worsening, a small number of left colon cancer patients with stool can be fine; if acute intestinal obstruction, the onset is more rapid, The condition is heavier, abdominal pain, nausea, vomiting and other symptoms are more serious than constipation; patients with ischemic bowel disease such as acute mesenteric vascular infarction or thrombosis, also with severe abdominal pain as the first symptom, may be accompanied by nausea and vomiting and constipation However, patients often have bloody stools.

(3) If the abdominal plain film is found to be stepped, it is important for the diagnosis of intestinal obstruction.

(4) X-ray barium enema or colonoscopy can detect polyps, cancer and other diseases.

2. Irritable bowel syndrome (constipation type):

(1) Constipation is often affected by factors such as emotional stress or anxiety. Patients often have a history of stage diarrhea, and only a few patients are only responsible for the main performance.

(2) Barium enema examination can sometimes find some intestinal segments showing a sputum change, but the intestinal wall is smooth.

(3) Colonoscopy sometimes finds that it is difficult to pass the bowel tube through the bowel tube, and the patient has pain and other discomfort, but no obvious organic lesions.

3. Tension-reducing constipation:

(1) More common in the elderly, with visceral drooping, or chronic malnutrition. Constipation is caused by weakened bowel movements, and many of them have a history of long-term use of laxatives.

(2) When the oral tincture is examined, the time for the tincture to pass through the small intestine and colon is significantly prolonged.

(3) Determination of colon transit time. The Bouchoucha method is usually used to determine the transit time (DTT) of the radiopaque marker in the colon. When the marker is not excreted after 72 hours, it can be considered as slow transit constipation.

(4) Colonoscopy often has no organic lesions.

4. Rectal constipation:

(1) Due to anal fissures such as anal fissure, fistula, and nucleus, the patient has pain in the stool, so he is afraid of bowel movements. The long-term lack of convenience, the bowel movements are slow and constipation occurs, so that the stool accumulates in the rectum. It is thick and firm, and sometimes there is blood outside the stool.

(2) A small number of patients have dry stools like chestnuts, and there is pain in the left lower abdomen, which is caused by sigmoid colon.

(3) Anal periorbital nucleus, anal fissure and anal fistula can be found during anal examination.

(4) When the barium enema was found, the colon of the sputum was narrow, but the intestinal wall was smooth and free of defects.

(5) Determination of pressure in the rectum and anus and determination of electromyography in the rectum. When the pressure or EMG is abnormal, it is conducive to the diagnosis of outlet obstructive constipation.

(6) Colonoscopy In addition to perianal lesions, there were no organic lesions in the rectum and upper colon.