Defecation disorder

Introduction Defecation disorder mainly refers to the disorder of discharge of feces due to pelvic floor muscle coordination disorder or difficulty in stool. This type of disorder can also be called outlet obstruction constipation, often due to the inability of the pelvic floor muscles and anal sphincters to coordinate during defecation, or Feeling abnormal. Defecation is a complex physiological process involving multiple systems and affected by multiple factors. Among them, the structure and function of the colon, the nerve plexus of the intestinal wall (intestine brain), and the volume of the intestinal lumen can directly affect the colonic peristalsis. Any cause of slowing colonic motility can lead to bowel movements.

Cause

Due to abnormal sensation or motility of the anorectal, mainly the external anal sphincter and the puborectal muscle can not relax, and sometimes their activity is reversed during defecation, the so-called anal fistula. The weakness of the abdominal muscles causes the pressure in the rectum to not rise during defecation, and the gradient of rectal pressure and anal pressure is lowered, which also causes difficulty in defecation. Patients with abnormal sensation often show an increase in the threshold of defecation, so there is little sense of convenience. The other type is that the threshold is lowered, which is characterized by frequent intentions, falling feelings, and unpleasant bowel movements. Long-term forceful drainage can damage the perineal nerve, causing an increase in the stimulation threshold of defecation, resulting in difficulty in defecation.

an examination

Related inspection

Fecal smell fecal occult blood test balloon ejection test fecal food residue fecal bacteria culture

Anal digital examination is a basic and simple examination that can exclude organic diseases such as hemorrhoids, anal stenosis, and blood in the stool. An assessment of the strength and coordination of the anorectal muscles was examined by examining the patient's simulated bowel movements and tightening of the anus. Anorectal manometry is one of the most commonly used tests to determine the function of the internal and external sphincters of the anus, as well as the sensory function and compliance of the rectal wall. These include: (1) resting pressure of the anal sphincter, maximum systolic pressure, systolic time limit, (2) length of the anal sphincter, (3) anorectal reflex inhibition, (4) pressure change during simulated bowel movement, and (5) rectal sensory function, (6) Rectal compliance and the like.

Differential diagnosis

Abnormal frequency of bowel movements: manifested as diarrhea. Normal people usually have bowel movements once a day. Individuals have 2 or 3 bowel movements per day or once every 2 to 3 days. The characteristics of feces are normal. The average weight of feces per day is 150-200g, and the water content is 60%-75%. . Diarrhea is a common symptom. It means that the frequency of bowel movements is significantly higher than the frequency of usual habits. The faeces are thin and the water is increased. The daily defecation is more than 200g, or contains undigested food or pus and mucus. Diarrhea is often accompanied by symptoms such as urgency of bowel movements, anal discomfort, and incontinence. Diarrhea is divided into acute and chronic. The incidence of acute diarrhea is acute, and the course of disease is within 2 to 3 weeks. Chronic diarrhea refers to recurrent diarrhea with a course of disease of more than two months or intermittent within 2 to 4 weeks.

Constipation: It is not a disease, but a symptom that can be seen in many diseases. It has different meanings in different patients, including: 1. Too little stool, 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.

Defecation is not enough: Many people have the feeling that the bowel movements are not clean, and the stool is not formed, and the bowel movements are not comfortable and uncomfortable. In fact, most of the feelings of defecation are caused by chronic enteritis. Chronic enteritis can be caused by prolonged or recurrent episodes of acute enteritis, and the course of disease is more than 2 months. Long-term fatigue, emotional excitement, excessive mental stress, and malnutrition can all be the cause of chronic enteritis. It can also be secondary to diseases such as chewing disorders, gastric acid deficiency, subtotal gastrectomy, and intestinal parasitic diseases. According to the increase in the number and frequency of clinical diarrhea, feces are thin, even watery stools, accompanied by bowel, but no urgency, nutritional disorders, combined with recurrent episodes or the cause of chronic enteritis, the diagnosis is generally not difficult.

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