Constipation In Adults - Causes And Symptoms Of Atonic Constipation In Adults Treatment Of Chronic Constipation. Why Is Constipation Dangerous?

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Causes, symptoms and treatment of constipation in adults

Content:

• What is constipation?
• Description of the disease
• Why is constipation dangerous?
• Causes of constipation
• Constipation symptoms
• Differential diagnosis
• Treatment of constipation in adults

What is constipation?

Constipation is a situation in which a person has no bowel movements for more than 24 hours, or a bowel movement occurs, but the bowel movement remains incomplete.

In a healthy person, the frequency of bowel movements depends on diet, habits and lifestyle. People who suffer from constipation often complain of chronic fatigue, an unpleasant taste in the mouth, a feeling of nausea, and decreased appetite. In patients with constipation, the abdomen is swollen, an unhealthy yellowish-brown skin tone, slight anemia and vitamin deficiencies may be observed due to the lack of absorption of nutrients due to the frequent use of laxatives.

Constipation (constipation) affects up to 20% of the world's population, mainly residents of developed countries. The problem of intestinal dysrhythmias is relevant for all age groups. Most often, constipation develops in people 25-40 years old, and then the problem only gets worse. In fertile age, constipation is more common in women. During the period of male and female menopause, statistical differences are minimal. Constipation in older people is about 5 times more common than in young people. These observations are recognized by the majority of researchers dealing with the problems of age-related gastroenterology.

In clinical medicine, organic and functional constipation is distinguished:

1. Organic constipation. They are caused either by morphological and anatomical changes in the intestine (most often diagnosed in childhood), or by pathological and iatrogenic causes (the likelihood of development is the same at a young and mature age).

Organic constipation results from:

• Congenital anomalies (dolichocolon, dolichosigma, colonoptosis);
• Complications after surgery on the intestines;
• Inflammatory (adhesive) processes in the intestines or omentum;
• Intussusception (entry of the intestine into the intestine), infringement of the omentum, volvulus, intestinal obstruction;
• Neoplasms in the intestines or adjacent organs pressing on the intestines.

2. Functional constipation. Associated with a disorder of the psychoemotional sphere of a person, motor, secretory, excretory and absorption functions of the mucous membrane of the large intestine. The morphological changes in the intestine are not expressed. Functional constipation belongs to a group of pathologies combined into irritable bowel syndrome (IBS). A syndrome is a combination of symptoms with a single pathogenesis and a different etiology (cause). The disease, as a nosological unit, is always united by a common etiology and pathogenesis.

Organic constipation, especially associated with surgical pathologies, usually manifests itself in an acute form and is caused by congenital structural features of the intestine. In some cases, it is necessary to resort to prompt elimination of defects. If organic constipation develops as a result of intussusception, scarring, volvulus, blockage of the intestinal lumen or compression by a foreign body, the clinical picture develops rapidly, and immediate medical intervention is required to save the patient. The clinical manifestations of acute constipation are quite striking and relatively easily determined by instrumental methods.

Functional disorders have a more diverse etiology and pathogenesis, while constipation often takes a chronic form and is not always easy to eliminate. Most people suffering from functional intestinal dysrhythmias do not recognize themselves as sick.

Clinicians distinguish two categories of individuals with IBS:

• "Not patients", have symptoms of constipation, but do not go to the doctor for various reasons. Pathology has no significant effect on their lifestyle;
• Patients experiencing discomfort go to the doctor. Pathology affects their quality of life to varying degrees.

Functional disorders of the gastrointestinal tract are identified on the basis of characteristic symptoms (exclusion method) using the entire spectrum of diagnostic techniques. In some cases, it is difficult to eliminate the symptoms of chronic constipation.

To diagnose functional constipation, the following set of symptoms is used:

• Diagnostic Roman criteria of the third version. The first and second versions existed earlier. This name is due to the fact that the first version was adopted in Rome on the initiative of the International Working Group for the Study of Functional Pathology of the Gastrointestinal Tract;
• Bristol Stool Scale Type 1 and 2. Developed by researchers at the University of Bristol. The feces of the first type are in the form of hard nuts. The feces of the second type are in the form of welded lumps. The feces of the third and fourth types are the norm, the feces of the fifth and sixth types are diarrhea. Feces of the seventh type are watery, a possible sign of secretory or invasive or osmotic diarrhea.

In clinical practice, diagnostic criteria, as a rule, are supplemented by methods of laboratory, instrumental and functional diagnostics.

Description of the disease

Normal defecation is an indicator of human health. Various sources indicate the approximate physiological norms of the frequency of bowel movements, the volume of feces formed per day, the shape and consistency of feces.

The correct functioning of the gastrointestinal tract is characterized by the following features:

• Emptying of the intestines in a healthy person occurs with a frequency of three times a day to three times a week;
• The weight of feces is from 100 to 200 grams per day, the minimum rate is 40 grams;
• The feces are in the form of a cylinder (sausage-like);
• The consistency of the stool is soft.

Defecation disorders in some cases are a variant of the norm and are random in nature. Meanwhile, constipation is almost always a sign of gastrointestinal pathologies, manifested by constipation and other signs.

In the clinical diagnosis of IBS, the following types of bowel movements correspond to constipation:

• Less than three times a week;
• Stool volume less than 40 grams;
• The act is accompanied by strong straining and ends with the release of small, dense pieces of round feces;
• In some cases, defecation is possible only by the method of forced emptying of the rectum.

Subjective criteria for constipation in patients with functional constipation syndrome:

• A feeling of incomplete bowel movement after a bowel movement;
• Feeling of blockage (plugging) in the rectum.

Constipation is not always true; it can be temporary and short-lived.

The accidental origin of intestinal dysrhythmias is excluded:

• Identification of two or more of the above clinical signs of constipation and subjective sensations in patients;
• The duration of the symptoms of constipation. It is generally accepted that constipation is true if it continues for twelve weeks in the six months preceding the date of the visit to the doctor (at the indicated time, short periods of remission are possible).

Why is constipation dangerous?

Based on the degree of influence of constipation on the quality of life and human health, they are divided into three types:

• Compensated. Constipation has no significant effect on the homeostasis of the body. Many researchers consider this stage to be the upper limit of the physiological norm;
• Subcompensated. The borderline state between norm and pathology. The borderline with the compensated stage of constipation is conditional. Low or medium hazard to the body;
• Decompensated. Pathological constipation, often associated with disease. It has a pathophysiological effect on the body, in some cases it causes morphological changes in the internal organs. Medium or high hazard to the body.

I. Stage of compensated constipation

Most people with this stage of constipation do not see a doctor. They are treated with traditional medicine or over-the-counter drugs, prevention is carried out by experimenting with diets. The stage is most typical for persons from 25 to 45 years old, suffering from functional constipation. In children, compensated constipation is more often of organic origin, namely, it is the result of an unusual lengthening of some parts of the intestine. Pathological changes in the body associated with constipation are not expressed. First of all, the quality of life suffers.

The stage of compensated constipation is characterized by the following diagnostic signs:

• When interviewing patients, neuroses, stress, mental and emotional disorders, as well as peculiar living conditions, when a person is forced to restrain the urge to defecate for a long time, are revealed;
• With in-depth functional and laboratory studies of the gastrointestinal tract, it is possible to identify signs of impaired absorption of the intestinal function, in some cases, the initial stages of dysfunction of internal organs associated with the gastrointestinal tract are recorded.

Clinically, the stage of compensated constipation is manifested by the following symptoms:

• Lack of bowel movements for two to three days, rarely longer;
• Pain and bloating, the intensity directly depends on the duration of constipation;
• The urge to defecate is prolonged, the act usually always ends in success;
• The form of feces according to the Bristol scale corresponds to the second, less often the first type.

For the treatment of compensated constipation, it is advisable to consult a clinical nutritionist or gastroenterologist in order to correct eating behavior and select the optimal laxative. During this period, it is important to normalize the psycho-emotional sphere of life. According to the indications, it is recommended to consult a neurologist or psychologist.

II. Subcompensated constipation stage

This is often a continuation of the negative scenario of compensated constipation. Sometimes it develops as an independent pathology or a symptom of another disease. Functional subcompensated constipation is diagnosed in the older age group (50-60 years), age-related fluctuations are possible (at an early age with organic constipation). Clinically subcompensated constipation is diagnosed by exclusion. Differential diagnostics is carried out using instrumental and laboratory studies and functional tests. An in-depth examination is certainly indicated if constipation was not previously observed in the patient's history.

Pathological changes are moderately expressed:

• When interviewing patients against the background of neuroses, stresses and the like, pathologies of internal organs and systems are revealed (damage to the liver, gallbladder, hemorrhoids, cracks in the anus);
• In-depth studies of the gastrointestinal tract reveal signs of impaired motor, secretory and excretory functions, sometimes - symptoms of damage to internal organs and systems.

Clinically, the stage of subcompensated constipation is manifested by the following symptoms:

• Lack of bowel movements for three to seven days in a row or more;
• Abdominal pain (it is necessary to differentiate pains in the stomach, intestines, rectum and anus);
• The urge to defecate is long, the act is very difficult, sometimes help is needed to empty the intestines;
• The shape of feces according to the Bristol scale corresponds to the first or second type.

To correct subcompensated constipation, regular in-depth examination is necessary, including colonoscopy (endoscopic examination of the distal intestine).

III. Stage of decompensated constipation

It is accompanied by pathological changes in the body. It is usually diagnosed at the age of 50-60 years (age deviations are possible). It can be a continuation of a subcompensated stage or act as a symptom complex of the underlying disease. The most alarming sign is the rapid development of constipation against the background of previous intestinal normotonia and the absence of IBS in the anamnesis. Hospitalization (according to indications) and in-depth examination are advisable. After eliminating the causes of constipation, you need to continue examinations on a regular basis at the frequency recommended by the doctor.

Pathological changes are moderately or brightly expressed:

• During the survey, a previous gastrointestinal disease or a chronic disease of internal organs is revealed. Special attention is paid to the swiftness of pathogenesis;
• With in-depth studies of the gastrointestinal tract, signs of damage to internal organs and systems are recorded.

Clinically, the stage of decompensated constipation is manifested by the following symptoms:

• No stool for a week or more;
• Pain and bloating are accompanied by loss of intestinal peristalsis;
• There is no urge to defecate, help is needed to empty the bowels;
• The form of feces according to the Bristol scale corresponds to the first or second type (during enema treatment it may be of a different form).

Treatment of decompensated constipation is preceded by in-depth examinations of the gastrointestinal tract and other body systems.

Based on the effect of constipation on homeostasis, there are close and distant consequences that reduce the patient's quality of life:

• Close consequences of constipation - intoxication of the body with feces, dysfunction of the gastrointestinal tract, dysbiosis;
• Long-term consequences of constipation - hemorrhoids, intestinal inflammation, bleeding during bowel movements, intestinal obstruction, intestinal intussusception, polyps and neoplasms in the rectum.
• Decreased quality of life - kalomaziya, constant discomfort, fecal incontinence.

Causes of constipation in adults

The reasons:

• I. Organic changes in the intestine
• II. Intestinal functional disorders
• Constipation after antibiotics
• Sitting is a common cause of constipation
• Constipation after removal of the gallbladder
• Constipation after bowel surgery

I. Organic changes in the intestine

Organic bowel changes are not the most common causes of constipation in adults. Previously, it was generally believed that organic changes can only be congenital and, accordingly, they should cause constipation in children. However, medical research in the second half of the last century to some extent refutes this statement.

The causes of organic constipation in adults are congenital and acquired bowel anomalies:

• Dolichocolon - the colon is longer than normal size, there is a change in the ganglia of the muscular walls of the intestine. As a result, the passage of feces is lengthened and slowed down. Constipation in the case of congenital dolichocolon without treatment continues into adulthood. In adults, dolichocolon is a consequence of the abuse of enemas and laxatives, as well as metabolic disorders in the walls of the large intestine;
• Megacolon is an enlargement of the colon. In adults, the reasons are the same. An acquired megacolon is considered if there are no congenital changes in the intestinal walls (structure, atresia). A sign of acquired pathology is constipation with the etiology of megacolon, manifested in adulthood;
• Dolichosigma - lengthening of the sigmoid colon. Elongation and expansion - megadolihosigma. In this section, there is an accumulation of feces that have moved from the small intestine. Acquired dolichosigma is a consequence of the processes of fermentation and putrefaction in the intestine with a sedentary lifestyle. Changes in the size and morphology of this section are a common cause of congenital constipation. As a consequence of the vicious circle of pathogenesis, dolichosigma is the cause of acquired constipation;
• Additional loops of the sigmoid colon. They are observed with an abnormal increase in the length of the sigmoid colon, usually by two to three loops. The reasons are the same as for dolichosigma. The presence of additional loops is accompanied by persistent constipation;
• Colonoptosis is a congenital or acquired anomaly, a consequence of the prolapse of the colon (weakness of the mesenteric ligamentous apparatus), in women it develops after childbirth. It is characterized by a slowdown in intestinal motility and, as a result, constipation. It is diagnosed by irrigography - an X-ray method of studying the intestine by filling it with a contrast agent;
• Transversoptosis is a descent into the pelvic region of the transverse colon. The normal position is in the projection above the navel. Transversoptosis is accompanied by pain, adhesions, impaired innervation and, as a result, constipation. Lordosis, scoliosis and other types of curvature of the spinal column contribute to the development of this disease;
• Insufficiency of the ileocecal valve (Bauhinia valve). Ileocecal valve is a morphological formation at the border of the small and large intestine, which prevents the reflux of the contents of the large intestine into the small intestine. Distinguish between congenital and acquired anomaly. Clinically, it manifests itself in a variety of symptoms, in particular, alternating constipation and diarrhea;
• Diverticulosis of the sigmoid colon. A diverticulum is a hernia-like protrusion of the intestinal wall, the result of degenerative processes in the walls of the large intestine against a background of high pressure in the intestine. It usually develops over the age of 50. Clinically manifested by a tendency to constipation, anal bleeding, flatulence (frequent discharge of intestinal gases), a feeling of pulling pain and heaviness in the left side, which disappears after a bowel movement.

The causes of organic constipation in adults can also be adhesive inflammatory processes, acute intestinal obstruction (intussusception, entrapment of the intestines, volvulus, as well as dynamic and compressive obstruction, as a result of the effect of neoplasms on the intestinal wall).

II. Intestinal functional disorders

Bowel dysfunction is a common cause of constipation in adults. Constipation of functional genesis is a type of dyskinesia of the large intestine. Dyskinesias may be accompanied by diarrhea and / or constipation.

Dyskinesias with a predominance of constipation in the pathogenesis are divided into:

• Atonic - the result of pathological relaxation of intestinal smooth muscles;
• Spastic - the result of a reflex spasm of the anal sphincter or other part of the colon.

In clinical practice, difficulties arise in differentiating atonic and spastic constipation due to the mutual influence of factors that cause their manifestation.

Meanwhile, constipation in people is considered to be atonic:

• Leading a sedentary lifestyle;
• Depressed with mental disorders and various psychosomatic diseases;
• Eating mainly high-calorie foods containing animal protein;
• Regularly suppressing the natural urge to defecate.

Spastic constipation usually develops in people who have:

• Problems in the area of the anal sphincter (fissures, hemorrhoids) and organ dysfunction that cause reflex spasm of the intestines;
• Signs of chronic intoxication with heavy metal salts;
• Endocrine diseases (autoimmune thyroid lesions, diabetes mellitus);
• History of chronic diseases and periods of prolonged treatment with drugs that disrupt bowel function, including antibiotics.

Constipation after antibiotics

The use of antibiotics certainly leads to intestinal dysfunction. In some cases, constipation is a consequence of antibiotic therapy. The pathogenesis is not fully understood, probably, there is a violation of the basic functions of the large intestine.

The main physiological functions of the large intestine:

• The formation of feces before fecal eruption, participation in the act of defecation;
• Reabsorption of electrolytes (water) - this function of the intestine is unique, water absorption occurs only in the thick section;
• Formation of endoecological biocenosis of saprophytic intestinal microflora, which serves to enhance the physiological activity of the intestine, synthesis of hormones, disinfection of metabolites and activation of the immune system.

Therefore, prolonged use of antibiotics (from 30 days) accompanied by dyskinesia in the form of constipation is probably due to:

• Dysbacteriosis, due to which the physiological activity of the intestine is weakened (contraction in the form of rhythmic segmentation, pendulum, peristaltic and antiperistaltic movements);
• Strengthening the reabsorption of water, resulting in the formation of a dehydrated chyme;
• Delayed motility of the large intestine, and, as a result, delayed contents of the large intestine.

Sitting is a common cause of constipation

How does the normal bowel cleansing process take place? Defecation is necessary to complete the digestion process and rid the body of processed foods.

• When the rectum is filled with stool, it naturally stretches. The brain receives signals from sensitive intestinal cells. The older the person, the lower the sensitivity of these receptors. Therefore, to start the process of defecation, older people need more stretching of the intestines. The lower part of the rectum has the greatest sensitivity, which explains the increased urge in the upright position. It is for the same reason that almost all bedridden patients suffer from constipation.
• The next stage of the act of defecation is the onset of involuntary contractions of the muscles of the rectum and sigmoid colon, due to which the feces move to the anus. A person cannot influence the strength of contraction of the intestinal muscles if he does not take any medications for this.
• But a person can, by an effort of will, control the relaxation and tension of the circular muscles of the anus. Thanks to this, it is possible to restrain the act of defecation until the time is right. However, infinite or very long-term control is still impossible.
• When a person decided that it was time to free the intestines from feces, the pubic-rectal muscle relaxes, the pelvic floor descends and the anorectal angle expands. If the muscles of the anus are not tense at a given time, then a bowel movement occurs.

The best position for a complete bowel movement is a squatting position. People call this position of the body "the pose of the eagle". Although the toilet is a kind of comfort element, it contributes to the fact that people have chronic constipation. After all, on the toilet it is impossible to sit in the "correct" position, in which the optimal activity of all pelvic muscles will be achieved. Meanwhile, very often it is enough just to change the position and the constipation will go away on its own.

Attitude towards the act of defecation in some countries of the world. Most of the peoples of the world do not regard the process of bowel movement as something unaesthetic or indecent. For example, in Africa, not only every child, but every adult can have a bowel movement where need begs him. In India, they continue to sell such toilets on which you can take the so-called "eagle pose" and empty the intestines as efficiently as possible.

The role of the autonomic nervous system in bowel emptying. The autonomic nervous system is directly involved in the act of defecation. So, the sympathetic section contributes to the fact that a person has an appetite, and also has an effect on stool retention. As for the parasympathetic division of the autonomic nervous system, it, on the contrary, stimulates the processes of bowel emptying and suppresses appetite.

These two divisions of the autonomic nervous system are in constant confrontation. However, such opposition does not harm the human body, but, on the contrary, has a positive effect on the act of defecation. The sympathetic system protects and mobilizes the body, reacting quickly to any changes. The parasympathetic system works more slowly, it is responsible for moisturizing all mucous membranes in the body, including intestinal hydration. Thanks to its work, mechanisms such as vomiting and diarrhea, as well as defecation, are triggered.

The main neurotransmitter that regulates the work of the parasympathetic system is acetylcholine. This is possible due to its effects on muscarinic and nicotinic cholinergic receptors. A neurotransmitter peptide such as cholecystokinin is responsible for the work of the sympathetic nervous system.

If these complex systems fail, the normal bowel movement suffers. This is especially acutely noticed by smokers who, without a cigarette, are not able to perform an act of defecation. This is due to the fact that nicotine has a strong stimulating effect on the parasympathetic nervous system and is a kind of "laxative".

Natural activation of the parasympathetic system occurs in the morning (between 5 and 7 hours). If you do not interfere with this process, then bowel emptying should occur at this time. If the act of defecation is absent in the morning, this indicates a failure of biological rhythms.

The biorhythms of a person are very well studied and illuminated by Chinese medicine. The maximum time for the activity of Yin energy falls precisely in the morning hours. It is very bad if a person restrains the natural urge to empty the bowels. This is especially dangerous for women. At the same time, forcibly performing an act of defecation is no less harmful.

Constipation after removal of the gallbladder

The gallbladder is anatomically and physiologically similar to the liver. Surgical removal of the gallbladder is accompanied by the development of postcholecystectomy syndrome (PCES). With an uncomplicated course of the postoperative process, the function of the gallbladder is compensated by the bile ducts of the liver, and after a while the patient's condition returns to normal.

PCES clinically looks like a temporary or permanent (with a complicated course of postoperative healing) violation:

• Bile secretion, changes in its physical, chemical and biological composition;
• Tone of the sphincter of the common bile duct (sphincter of Oddi);
• Ejection of bile into the duodenum, accompanied by stasis or cessation of bile movement, inflammation, reflux or reverse impulsive flow of bile, dysfunction of the duodenum with symptoms of IBS (constipation or diarrhea).

The causes of constipation in gallbladder dysfunction are concentrated in the small intestine and duodenum. Pathology is manifested by a decrease in intestinal tone, impaired peristaltic activity and, as a result, intestinal obstruction.

The leading clinical signs of duodenal obstruction are vomiting of undigested food some time after ingestion and the absence of defecation. PCES is diagnosed by instrumental methods.

Constipation after bowel surgery

Operations on the intestine are diverse, but the principle of the operative technique is the same - the operative separation of the intestinal tissues and various connection options.

The main types of bowel surgery:

• Suturing an accidental (traumatic) bowel wound;
• Separation of the tissues of the intestinal wall, performing operative manipulations, suturing the walls;
• Anastomosis - the imposition of an artificial fistula to connect different parts of the intestine;
• Resection (partial removal) of a section of the intestine and subsequent connection of the ends to maintain the continuity of the intestine.

Almost always, manipulations on the open intestine are referred to operations with a high risk of infection of the surgical wound with pathogenic and opportunistic microflora. The result of infection is exudative inflammatory reactions, the formation of adhesions, the development of peritonitis and other formidable complications.

Postoperative constipation may be accompanied by:

• Increased body temperature;
• Nausea and / or vomiting
• Abdominal pain;
• Intestinal bleeding (occult blood during operations on the small intestine and blood in the stool, visible to the naked eye with bleeding, most often in the rectum or anus).

Constipation symptoms

The symptoms of constipation, formulated by the International Working Group for the Study of Functional Pathology of the Gastrointestinal Tract in Rome and the Bristol Group of Researchers, are universally accepted and recognized as a standard set. Meanwhile, physiological and pathophysiological processes occurring in the body are not always built into a single set of features. A similar pathogenesis can be caused by different reasons, and vice versa, different causes of the disease can be accompanied by the same symptoms.

Let us consider in more detail the symptoms that in some cases accompany constipation.

Constipation with blood

With constipation, bleeding from the anus is diagnosed as:

• Feces streaked with scarlet or scarlet blood pouring from the anus;
• Rectal discharge or tarry feces;
• Sometimes hidden blood in the stool is not visible, and is determined only by laboratory tests.

When bleeding in the lower colon, the blood is usually scarlet. This is especially true for heavy bleeding, when the blood does not have time to be exposed to the intestinal environment. This picture is observed with lower intestinal bleeding caused by various reasons (rectal fissure, hemorrhoids, trauma to the anus, diverticulosis (protrusion) of the colon wall, damage to the capillaries of the anus wall with a hard dry fecal lump).

With bleeding in the upper and middle gastrointestinal tract, the blood is either dark brown (from the small intestine) or tarry (from the stomach).

Heavy anal bleeding can be:

• An independent cause of constipation;
• Sign of a serious gastrointestinal disease.

Diseases and pathologies that may be accompanied by constipation with blood:

• Ulcerative colitis and gastritis;
• Neoplasms on the intestinal walls;
• Cracked anus and hemorrhoids;
• Inflammation of the rectum (paraproctitis);
• Intestinal infections (constipation and diarrhea);
• Dysbacteriosis (sometimes);
• Colon diverticulosis;
• Bowel wounds.

A health hazard is represented by profuse anal bleeding with a progressive deterioration in the patient's well-being, accompanied by pain.

Constipation pain

Pain is a common symptom accompanied by constipation of various origins. There are several options for the manifestation of a pain reaction with constipation.

1. Pain accompanying the act of defecation with:
• straining,
• passing a fecal coma through the anal sphincter,
• immediately after bowel movement.
2. Pain in the abdominal area between the urge to defecate, can be diffuse (extends to the projection of all areas of the abdominal wall) and local:
• at the angle of the right scapula - pain in the sigmoid colon;
• right hypochondrium and lumbar region - pain in the duodenum;
• navel area - pain in the transverse colon in normal projection;
• the right side of the abdominal wall - pain in the ascending part of the colon;
• left side of the abdominal wall - pain in the descending part of the colon.

Orientation to topographic projections is very arbitrary, in some cases the source of pain may be in the indicated projection, but the reason is in a completely different organ.

• Pain with constipation, not associated with difficulty in evacuating feces from the intestines, accompanies the following diseases:

• cholecystitis - inflammation of the gallbladder;
• pancreatitis - inflammation of the pancreas;
• overgrown neoplasms;
• appendicitis.

Nausea with constipation

Nausea is an unpleasant sensation that precedes vomiting. Nausea often accompanies constipation and other gastrointestinal diseases, at the same time, it can be a sign of a pathology that has nothing to do with digestion. Nausea is one of the symptoms of intoxication, diseases of the excretory system, neuroses, etc.

There are five factors that provoke nausea and vomiting with constipation:

• Mechanical obstruction to the passage of feces;
• Accumulation of feces in the intestines and intoxication;
• Paralysis of intestinal peristalsis with volvulus or omentum;
• Delayed intestinal motility against the background of dysbiosis;
• Violation of the act of defecation, as a result of a combination of straining with fecal intoxication.

Constipation temperature

Violations of the temperature regime (hyperthermia - increased, and hypothermia - low body temperature) are not typical for constipation. Accompanying constipation with a change in temperature is a formidable signal about the inclusion of additional factors in the pathogenesis.

Possible causes of deviations from normal body temperature with constipation:

• An increase in temperature with constipation is a sign of involvement in the pathogenesis of inflammatory reactions (stage of alterative and exudative inflammation);
• A drop in temperature with constipation is a harbinger of collapse (shock).

See the article - what you can and cannot eat for constipation

Chronic constipation (differential diagnosis)

Long-term constipation (chronic constipation) belongs to the group of functional disorders. For the differential diagnosis of chronic from acute constipation, traditional examination methods are used.

Physical Methods - Initially, the compliance of actual symptoms with Rome III criteria is examined. The information obtained by interviewing the patient is supplemented by an external examination using percussion and palpation of the abdomen.

Percussion (tapping) is a method of determining the nature of the sound emitted by the abdominal wall in response to a blow with a percussion hammer or finger:

• Tympanic (drum) sound indicates the accumulation of gases (liquids) in the intestine;
• A dull sound indicates an overflow of dense contents in the abdominal cavity.

Palpation (feeling) is a method that is used to determine the pain of the abdominal wall and the degree of enlargement of internal organs. Rectal palpation determines the state and filling of the ampulla-shaped expansion of the rectum. An overflowing expansion is evidence of a chronic course of constipation.

Laboratory methods for the study of blood, urine and feces are used for a fine differential diagnosis of chronic constipation, they include:

• Complete blood count (CBC);
• General urine analysis (OAM);
• Determination of total bilirubin (OB);
• Analysis of alkaline phosphatase (ALP);
• Analysis of aspartate aminotransferase (AST);
• Alanine aminotransferase (ALT) assay;
• Analysis of gamma-glutamyl transpeptidase (GGTP);
• Coprogram;
• Analysis of feces for dysbiosis;
• Analysis of feces for occult blood.

Correct interpretation of laboratory tests provides valuable information for excluding serious gastrointestinal pathologies.

Instrumental methods for the differential diagnosis of chronic constipation include:

• Colonoscopy. An endoscopic probe (colonoscope) is used to examine the colon. The method provides valuable information about the condition of the rectal mucosa and the presence of neoplasms on its surface;
• Anorectal manometry. Used to determine the tone and contractility of the rectum and anus;
• Electrogastroenterography. Used to assess intestinal motor function;
• X-ray examinations (irrigoscopy). In the differential diagnosis of constipation, barium sulfate is used - a radiopaque substance.

Treatment of constipation in adults

The main directions of treatment and prophylactic measures for constipation:

• Elimination of negative factors, change in lifestyle, restoration of the natural reflex of defecation;
• Organization of regular moderate physical activity;
• Correction of eating behavior (inclusion of fiber in the diet);
• Drug therapy with laxatives;
• Physiotherapy (bowel massage, electrical stimulation).

The first three points of treatment strategy depend on the patient. When organizing comfortable living conditions, a large role can be played by the patient's immediate environment, devoted to the problem. When organizing physical activity, it is recommended to pay attention to the individual characteristics of the organism. Shows regular walks in the fresh air. With a sufficient level of physical fitness, you can go jogging and swimming. Cycling is contraindicated.

As for the diet for constipation, the products allowed for consumption during the period of exacerbation of the disease are prunes, dried apricots, fruit nectars (preferably made from fruits common in the patient's area of residence), fermented milk products, mineral waters, vegetable and butter, steamed wheat and rye bran. The hospital usually uses a special diet number 3 according to Pevzner.

Important factors in stool regulation are:

• Compliance with the diet (meals at the set time);
• Drinking enough liquids (up to 2 liters per day);
• Self-massage of the abdomen (circular movements with palms in a clockwise direction);
• Formation of the correct defecation reflex (going to the toilet at the same time after breakfast, defecating in a comfortable environment without haste in a comfortable position).

There are also many special foods that can help normalize stool - what helps with constipation?

Drug therapy

Despite the wide selection of over-the-counter laxatives, one should remember the need for their correct selection and use strictly according to indications, and only at the first stage of therapy.

Laxatives are divided into four groups according to the mechanism of pharmacological action:

• Drugs that have a laxative effect by irritating the receptors of the large intestine. The therapeutic effect begins after 6 hours, the intake causes a single bowel movement;
• Drugs that have the ability to retain water in the intestines and soften the contents of the colon;
• Drugs that increase the contents of the intestines help to induce bowel movements with an insufficient volume of fecal coma;
• Oils (such as pumpkin seed oil) have a lubricating effect and facilitate the passage of feces.
• Probiotics. These include: Enterol, Exportal, Acipol, Linex, Bifidumbacterin.

Physiotherapeutic agents for constipation in adults are used as directed by a doctor:

• Intestinal electrical stimulation is an effective method, the principle is to replace the natural nerve impulse that causes peristalsis with an electrical signal with a certain repetition rhythm. The procedure allows to increase blood supply and improve intestinal motor function;
• Massage for constipation. Has limitations in the same way as electrical stimulation. Persons who have undergone special training are allowed to carry out the massage;
• IOC - monitoring bowel cleansing. A procedure for the controlled removal of fecal stones from the lumen of the colon. Does not affect the beneficial intestinal flora. Sometimes combined with a course intake of bifidobacteria. It is indicated for some forms of constipation.

To prevent constipation, eat regularly and variedly, eat as many fiber-rich foods as possible, and empty your bowels regularly as desired. Try not to take the laxative too often, as addiction occurs, the intestines lose the ability to naturally defecate, and in the most severe cases this turns into the fact that a person can no longer empty the bowels on his own, without a laxative.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.