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No urge to defecate. No urge to defecate causes. What to do if there is no urge to defecate. Diagnosis of defecation disorders

It is difficult to figure out what exactly caused the violation of the defecation process, the appearance of false urges. After all, the causes of such problems are manifold.

With failures in the process of nervous regulation of the smooth muscles of the intestine, the anal sphincter, anismus can be diagnosed. This is the act of defecation, in which the sphincter is involuntarily compressed. In this case, the person is disturbed by urges, and emptying does not occur.
With a strong tone of the sphincter and weak muscles of the rectum, a diagnosis of dyschesia can be made. This condition is characterized by the fact that, for the most part, a person cannot normally go to the toilet. Urges are present, but emptying does not always come out. Patients must strain significantly, help with pressure on the perineum, while often there is a feeling of incomplete emptying.
Persistent problems can be caused by proctitis. This is the name of the inflammation that has developed in the rectum. It is characterized by involuntary emptying or frequent ineffective urges. Inflammation is caused by damage to the integrity of the inner lining.
With bacillary dysentery, there is severe diarrhea, accompanied by pain. After emptying, the urge remains. In case of illness, the stool can be mixed with blood, mucus, pus.
Without diarrhea, false urges may appear with benign tumors in the colon. If the neoplasms are malignant, then the patient may find blood in the feces. He may complain of alternating constipation and diarrhea.
Often, tenesmus of the rectum (painful urge in which very little or no stool is excreted) indicates irritable bowel syndrome. In this condition, there are malfunctions in the work of the nervous system, the intestinal microflora is disturbed.
Food poisoning, exacerbation of chronic diseases of the digestive system (ulcerative lesions, gastritis, pancreatitis), microflora disorders, and sigmoiditis can lead to the appearance of tenesmus.
To provoke imperative urges can be excessive passion for laxatives. Sometimes problems begin even with a single dose of potent drugs.

This condition can lead to hemorrhoids, rectal fissures (in women they are found more often), periproctitis, Crohn's disease, colitis, stenosis, polyps or intestinal fistulas.

Treatment

False bowel movements, medically known as tenesmus, are often accompanied by many other symptoms that can help identify the underlying disease. Pain is the most important symptom of a problem. It always accompanies intestinal spasms, and the symptom itself can drag on for a long time.

Most often, with false urges, feces do not come out of the rectum. However, even if a small amount of feces does appear, most likely they will be accompanied by blood. This is due to the strong tension in the anus, on which cracks appear.

In addition, with a false urge to defecate, such troubles as feeling sick, vomiting, and even fever can occur. Similar symptoms are characteristic of poisoning and intoxication, so effective measures must be taken urgently.

Frequent additional symptoms that accompany tenesmus are constipation and diarrhea. This is not only unpleasant, but also dangerous, so you need to see a doctor and undergo a diagnosis in order to get the most correct and high-quality treatment.

Indications for use Applied for chronic hepatitis, cholangitis, cholecystitis and habitual constipation associated with intestinal atony. How to use Inside 2 tablets 3 times a day after meals. The course of treatment is 3-4 weeks.

It is somewhat similar to mucofalk, which I used to drink with simple constipation (then it helped me, but now neither it nor phytomucil helps).

The treatment of chronic constipation requires considerable effort, primarily from the patient himself. Only with the strict implementation of all recommendations is it possible to achieve a real regular chair.

The start of treatment for chronic constipation is a change in diet. It is necessary to increase the content of ballast substances in the diet - indigestible fiber - and introduce products that stimulate the motor activity of the large intestine:

Products with a laxative effect: x
wholemeal bread, carrots, cucumbers, beets, zucchini, dried fruits, oats, nuts, s
ahara (lactulose).

Products that stimulate intestinal motility due to the formation of fermentation acids: m
units, cane sugar, prunes, dried apricots, plums. Sweet apples, apricots, melon, pumpkin.

Organic acids that enhance peristalsis: to
you, dairy products, pickled vegetables, citrus fruits.

Fatty polyunsaturated acids, facilitating the promotion of a content intestine, stimulating peristalsis: o
olive oil, sunflower oil, fish oil, soybean oil, palm oil.

A prerequisite is the use of more liquid, which is necessary to improve the effect of dietary fiber. With a long course of constipation or in case of ineffective diet therapy, preparations with dietary fiber, wheat bran or flax seeds are prescribed.

Bread made from premium flour, baking, fatty meats, smoked meats, canned food, spicy dishes, chocolate, strong coffee, strong tea are excluded from the diet. The consumption of semolina porridge, rice, vermicelli, potatoes is limited. Foods that cause increased gas formation (beans, cabbage, sorrel, spinach, apple and grape juices) are not recommended.

A sufficient level of physical activity should be maintained: gymnastics in the morning, walking for at least 30 minutes a day, swimming, cycling and other acceptable activities. Physical exercises stimulate the motor activity of the intestines, strengthen the muscles of the abdominal wall, increase the tone of the whole organism.

In cases where lifestyle and dietary changes fail to restore regular bowel movements, laxatives are usually the next treatment option. Traditional laxatives work for many but not all patients and may be unacceptable for some patients due to side effects, unpleasant taste or usage patterns.

The treatment of tenesmus depends on its severity and the underlying cause. According to a 2017 study of people with colorectal cancer, a combination of different treatments may be needed to manage symptoms.

Having figured out what tenesmus is, you need to understand in what situations you should not hesitate with the examination and you need to see a doctor. Dangerous conditions will be in which:

there are spastic pains in the lower abdomen;
urges are strong, but ineffectual;
mucus, blood, or pus may be seen when stool is excreted.

In addition, with tenesmus, prolapse of the mucous part of the rectum, the appearance of itching in the anus can be observed. Some have an erosive lesion of the rectal region.

There are many provoking factors for the absence of this process. If there is no urge to defecate, the reasons are often the following:

Problems with emptying require immediate diagnosis and appropriate treatment. To determine the cause, laboratory research methods are used (general analysis of feces, for the presence of spotting), blood tests and biochemistry, digital examination techniques, ultrasound of the gastrointestinal tract, colonoscopy, CT, X-ray, MRI and more.

Characteristics of the problem

A similar phenomenon is due to the fact that the intestinal muscles begin to contract convulsively, while the reasons may be different. All this is accompanied by very unpleasant sensations in the abdomen and it may seem that the intestines should be emptied. However, nothing happens while visiting the toilet. The absence of feces with the urge to defecate is a suspicious symptom that requires careful study and determination of the cause.

Often, such a nuisance leads to malnutrition or food poisoning. For example, if the food is poorly processed, it causes a certain discomfort in the intestines, which leads to the urge to go to the toilet. The same happens with the use of expired and toxic products. They provoke indigestion, which leads to various troubles. False urges will be only the most harmless of them.

Most often, the problem disappears after taking absorbents and completely cleansing the intestines of toxins. If the urge occurs too often and this phenomenon does not stop for a long period, one can suspect the pathology of the gastrointestinal tract. A similar symptom is characterized by gastritis, ulcers, pancreatitis and many other diseases that can occur in a chronic form.

A false urge to defecate during antibiotic treatment is considered a common occurrence. If you take medications incorrectly, there may be a side effect such as intestinal dysbacteriosis. This problem often leads to abdominal pain, false toilet urges, and heartburn.

If the symptom does not go away for a long time and the process of defecation itself becomes difficult, you should definitely consult a doctor. It is possible that in this case we are talking about serious pathologies of the gastrointestinal tract, including oncology. Getting rid of trouble is a must. This is necessary not only because of constant discomfort, but also because of possible complications.

For example, false urges are often accompanied by constipation, and this is a sure way to hemorrhoids. In this case, the patient will experience not only discomfort during a visit to the toilet, but also blood discharge along with feces. Treatment of hemorrhoids is a difficult and long business, so you should try to prevent the development of such a pathology.

No need to overload your body. For example, false bowel movements are more common in people who are actively involved in sports, especially cycling. In rare cases, such a nuisance is faced by people who, when emptying their intestines, have a large amount of feces. But in such a situation, the problem goes away quickly.

If there is a desire to empty the intestines, then the rectum contracts, as if pushing the stool to the exit. If it is empty, then nothing is allocated. But to understand on your own why this happens is impossible. With spastic contractions of the muscles of the rectum, which are not accompanied by reflex relaxation of the sphincter, there is a jerky excretion of excrement in small portions.

The patient needs an examination: it is necessary to consult a general practitioner and a proctologist. The study should be aimed at establishing which group of causes provoked the disease:

damage to the large intestine;
diseases of the nervous system;
perineal crises (a condition caused by frequent diarrhea or copious stools);
idiopathic proctospasm (no specific cause).

Diagnosis of tenesmus

Having got an appointment with a proctologist, you should be prepared for a detailed survey and research. The doctor will be interested in the frequency of urges, the amount of feces. It is important to know whether excrement is excreted in small portions or regular. Assign such tests:

general blood examination;
bacteriological culture of feces;
coprogram.

The survey does not end there. The proctologist conducts a digital examination of the anus, determining the condition of the mucous membranes and surrounding tissues.

Many patients are scheduled for a colonoscopy. This is a fairly informative research method: an endoscope is inserted through the anus into the large intestine. It has a microscopic video camera. From the endoscope, the image is transmitted directly to the screen. The doctor can see the expansion of hemorrhoids, ulcers, polyps, fistulas and other pathologies of the large intestine.

This diagnostic method is contraindicated in acute infectious lesions, heart and lung failure, ischemic or ulcerative colitis, peritonitis and disorders of the blood coagulation system. With it, you can determine the cause of frequent bowel movements, constipation and false urges.

If there are contraindications to colonoscopy, sigmoidoscopy may be prescribed. This is a study of the rectum and the distal sigmoid colon. The research distance is up to 35 cm from the anus. The doctor assesses the condition of the mucosa, its elasticity, relief, vascular pattern.

Systematic false urges to the toilet by and large require the attention of narrow specialists. To identify the cause, the patient is prescribed a set of studies:

standard studies of urine, feces, blood;
colonoscopy;
Ultrasound of the peritoneum;
anoscopy.

Therapy is prescribed depending on the cause of the pathology of defecation. If it is associated with infections, it is advisable to use antibacterial drugs. With the urge to defecate without feces, caused by hemorrhoids, fistulas and cracks, a course is prescribed to improve blood circulation in the pelvic area (suppositories, ointments).

To alleviate and eliminate the most annoying symptom - spasm, antispasmodic drugs are prescribed. If the pain is significant, No-Shpu is used as an intramuscular injection.

Colitis, proctitis can be treated with sulfa drugs. For constipation, mild laxatives are prescribed. The complex of treatment includes sedatives to maintain the nervous system. Methods of therapy with herbal preparations have positively proven themselves. The complex of activities includes sitz baths with decoctions of medicinal plants.

If this is a consequence of neoplasms, urgent surgical intervention is required. In addition to drug therapy, life habits and daily routine should be reviewed. It is important to adjust your diet.

False urge to defecate requires elimination of intestinal irritants from the diet:

excessively hot and cold dishes;
bitter, salty;
fried, smoked;
spicy.

The main cooking methods are: steaming and boiling. Nutritionists recommend eating fractionally, in small volumes. Also, in order to exclude the cause of a false urge to defecate, you should refuse:

fatty meats;
rough food of plant origin;
overly sweet desserts;
alcoholic beverages;
canned food.

Nutrition should be healthy, wholesome and balanced. It is preferable that most of the diet consists of vegetables and fruits. For constipation, it is recommended to use:

For the correct diagnosis of tenesmus and their causes, it is necessary to conduct appropriate examinations. Serious pathologies, such as cancer or IBD, must be detected as soon as possible, since early intervention is a key factor for successful treatment of these diseases.

The doctor should take a complete history, including medical data, information about the patient's living conditions. The following questions may be asked:

Duration, frequency and severity of false urge to defecate?
Nutrition and lifestyle?
Having other health problems?

The following procedures may be prescribed:

Blood tests.
Buck seeding stool.
X-ray or computed tomography of the abdominal region.
Colonoscopy.
Screening for sexually transmitted diseases.

Discoordination of the act of defecation

Impaired bowel movements that contribute to constipation can be due to many reasons. In diseases of the endocrine glands (thyroid gland, adrenal glands, etc.), constipation may occur due to an increase or decrease in the hormonal effect on bowel movements.

Separately, one should dwell on drugs that can cause constipation, especially with prolonged use. Constipation is often caused by inflammatory bowel disease.

There are two main mechanisms for the development of chronic constipation - dyskinesia of the colon and violation of the act of defecation (dyschezia).

The treatment of chronic constipation requires considerable effort, primarily from the patient himself. It is used as an initial remedy in the treatment of constipation, daily use is possible, incl. during pregnancy.

These laxatives can be used to treat occasional (not chronic) constipation, as they are more addictive than all other groups of drugs.

Therefore, in old age, a larger volume of filling of the rectum is needed for the urge to empty. Proctitis or inflammation of the rectum can occur due to damage to its mucous membrane, for example, during enemas.

For the last 1.5 months, I have lost the urge to defecate, I go to the toilet every 4-5 days, with the help of laxatives. With age, the sensitivity of the rectal receptors decreases and more pressure is required to cause the urge to defecate.

Constipation - For most patients, this is a bowel dysfunction characterized by longer than normal intervals between bowel movements, difficult bowel movements, inadequate bowel movements, and hardened stools.

However, the presentation of this common problem is very vague and may vary from patient to patient and even among physicians of different specialties.

Therefore, in modern gastroenterology and coloproctology, a special diagnostic scale for functional constipation is used. Chronic constipation can be diagnosed if symptoms have been observed for at least six months and the patient has had at least two of the following situations in the last three months:

More than 25% of bowel movements are accompanied by straining;

Hard stools in more than 25% of bowel movements;

Feeling of incomplete emptying of the bowels in more than 25% of bowel movements;

The need for manual assistance to facilitate bowel movements in more than 25% of bowel movements;

Sensation of blockage / obstruction in the rectum or anus in more than 25% of bowel movements;

Less than three bowel movements per week.

Until recently, chronic constipation was thought to affect, on average, about 12% of the adult population worldwide. According to some reports, today in the UK alone, more than 50% of the population classifies themselves as suffering from constipation; in Germany this number is 30%, and in France it is about 20%. In Russia, according to one study, 34.3% of the population complains of constipation.

Two main forms of constipation can be distinguished: constipation caused by slow movement of contents through the colon (impaired intestinal motility - dyskinesia, both hypomotor and hypermotor, as well as mechanical obstructions in the intestine), and constipation associated with impaired rectal function. or anal sphincter, or obstructive defecation.

Very often, the problem occurs in women who have given birth over the age of 50, when after menopause the hormonal background changes, affecting the structure and elasticity of the connective tissue, resulting in a decrease in the tone of the pelvic floor. Pathological processes in the rectum, accompanied by pain during defecation (hemorrhoids, fissure of the anus, ulcerative lesion of the anal canal in Crohn's disease, with rectal cancer) also cause "forced" constipation.

Only a coloproctologist specializing in pelvic floor problems can determine the presence of constipation in more detail and clarify the diagnosis.

Selection of therapy tactics

If the doctor believes that tenesmus provokes irritable bowel syndrome, then a special sparing diet is prescribed. Also, patients are advised to pay attention to the state of the nervous system, work with a psychologist or consult a psychiatrist. A condition characteristic of irritable bowel syndrome may disturb the patient for a period of 3 months to a year. At the same time, patients complain not only of false tenesmus, but also of flatulence, pain, and general discomfort.

The proctologist may prescribe antispasmodic drugs. But with prolonged use, their effectiveness decreases. Hyoscyamine, Dicyclomin sometimes help to get rid of imperative urges. These funds reduce the tone of smooth muscles, reduce motility.

With anal fissures, fistulas, hemorrhoids, a different treatment is required. The doctor will prescribe local ointments, suppositories, the action of which is aimed at tissue regeneration, pain relief, and an increase in the tone of the veins. A positive effect is observed with the simultaneous appointment of funds intended to improve blood circulation. Sometimes surgery is required.

Regardless of the causes of tenesmus, antispasmodic drugs can get rid of pain. They are prescribed in the form of rectal suppositories or tablets.

Other methods of therapy are also used if the patient complains of frequent urge to defecate without feces. Among them:

sitz baths with potassium permanganate, a decoction of medicinal herbs;
microclysters with heated vegetable oil, a solution of silver nitrate;
special diet.

When neoplasms are detected, a biopsy is performed. With further tactics of treatment are determined depending on its results. In some diseases, antibacterial and anti-inflammatory therapy is necessary. Therefore, finding out how to treat tenesmus should be after an accurate diagnosis.

What are the most common causes of constipation?

More often, men face false urge to defecate due to hemorrhoids. Women suffer less often, but in addition to pathology in the large intestine, tenesmus can be the cause of diseases of the urinary system and reproductive function. Differences in causes are associated with the physiological characteristics of the organism - the further course and outcome of the disease depends on them.

The main causes of false urge to defecate:

There are several reasons for this discomfort. They are divided into those that occurred through the fault of the person himself and are due to factors beyond his control. The most common causes:

Irritable Bowel Syndrome. This disease is characterized by a feeling of nausea, diarrhea with alternating constipation, and a number of other negative factors that are caused by inorganic pathologies (that is, there are no problems at the level of organ function).
Haemorrhoids. If knots are observed inside the rectum, then this leads to an increase in its size, disruption of the veins and blood vessels, as a result, it seems to a person that the intestines are not completely emptied, although in fact this is not.
Polyps. Neoplasms do not allow feces to come out freely, as a result, obstruction develops. Polyps are benign formations, but if they are not removed surgically, they can develop into malignant ones - a cancerous tumor will occur.
Anatomical defects in the structure of the rectum. Occur after operations on the gastrointestinal tract.
Inflammation. Inflammatory processes destroy the rectum, the mucosa is damaged - feces cannot pass freely.
Psychological problems. These diseases (eg, stress, neurology) are not usually considered to be the cause of bowel dysfunction, although they are the cause in 20-25 percent of cases.

Colon

Only a specialist can determine the exact diagnosis. To do this, they resort to various kinds of research, including a study for the presence of tumors. Only after identifying the cause of incomplete emptying of the rectum, it is possible to prescribe an effective treatment plan.

Errors in the diet: a diet high in animal fats (meat, dairy products, eggs), refined sugar, highly digestible carbohydrates (buns, confectionery flour products) and low in dietary fiber, especially insoluble dietary fiber;

Intentional delay in defecation (postponing going to the toilet "on first demand of the intestines", the impossibility of an immediate trip to the toilet due to lack of conditions);

"Constipation of travelers", associated with a change in the nature of food and water;

Hormonally caused bowel dysfunction associated with pregnancy and old age;

Abuse of laxatives. Frequent use of laxatives can lead to dependence on them, requiring an increase in dose, which eventually leads to the development of a "lazy gut", which becomes unable to work independently;

Anal fissure and hemorrhoids, causing pain during bowel movements;

Irritable bowel syndrome (spastic colon syndrome), in which the balance of biologically active substances that regulate intestinal motility is disturbed (the so-called primary colon dyskinesia);

Mechanical obstacles to the passage of intestinal contents (scars, narrowing of the intestinal lumen, tumors, diverticula, foreign bodies of the intestine;

Medications: certain analgesics, antacids containing aluminum, antispasmodics, antidepressants, tranquilizers, iron supplements, anticonvulsants, calcium channel blockers;

Neurological diseases (parkinsonism, multiple sclerosis, ischemic stroke);

Involuntary bed rest in patients with comorbidities.

To establish the actual presence of constipation, to understand the causes of its occurrence in a particular patient, to choose the right treatment tactics can only be a doctor with a thorough analysis of complaints and after a laboratory and instrumental examination.

The doctor may prescribe the following studies to rule out anatomical causes of constipation - diverticula, tumors, or other causes of narrowing of the intestinal lumen:

Rectosigmoscopy

Colonoscopy

Irrigoscopy

Fecal occult blood test (if needed)

If the patency of the colon is not broken, the doctor prescribes special methods of research to identify other causes of constipation - obstructive defecation (for example, rectocele) or lazy colon syndrome, since the treatment of these diseases varies.

When should you see a doctor for constipation?

A person should consult a specialist when it becomes difficult for him to empty his intestines, especially if pain also occurs at the same time. If the symptoms persist for several days, then in the absence of proper treatment, there is a high risk of aggravating the situation.

Colon

False urge to defecate is accompanied by a whole range of functional disorders in the body. Pain in the peritoneum, systematic urge to defecate, inability to empty the rectum, diarrhea. Probably, there is no person who has not felt such symptoms at least once in his life. If the disease does not let go and retains all its symptoms for two weeks, this is a serious cause for concern.

Many, faced with unpleasant symptoms, do not attach importance to them. Lack of therapy and unwillingness to find out the root cause can aggravate and delay the recovery process for many months and even years.

It is quite natural that the disease leads to psycho-emotional disorders. Constant tension, obvious symptoms that are noticeable even to others (seething in the stomach, flatulence, systematic weaning to the bathroom), lead to a depressive state, stress, headaches and disturbing sleep. Sexual desire decreases, pain appears in the axis of the spine.

You can't pretend the problem doesn't exist. It is important to be examined by a gastroenterologist. Do not forget that the first signs of false urge to defecate can reveal oncology in the early stages and a number of other serious pathologies.

A person should seek medical attention if:

the process of emptying is difficult, and the urge to defecate is accompanied by strong painful sensations;
blood appears in the stool;
fever and chills;
nausea, urge to vomit.

If there is no stool for more than 3 days, accompanied by pain in the abdomen;

If difficulties with bowel movements continue for more than 3 weeks;

If, as a result of constipation, proctological diseases appear or worsen (anal fissure, hemorrhoids);

If the shape of the feces changes (the type of balls is “sheep feces”, ribbon-like feces), if mucus and liquid come out instead of feces, if an admixture of mucus and blood appears in the feces and on toilet paper;

If constipation is accompanied by nausea, fever, loss of appetite, abdominal pain;

Immediate health care if constipation is accompanied by severe bloating and the inability to exit gases.

Constipation in the elderly

With age, the amount of food and water taken, physical activity decreases, a bunch of various “age-related” diseases accumulate and the associated need to take a large number of medications. The reflex of the act of defecation weakens and the sensitivity of the rectum decreases: older people often do not feel the filling of the rectum and do not feel the urge to defecate.

Uncontrolled use of laxatives in the elderly to a greater extent, compared with other age groups, leads to the development of "lazy gut".

Only a doctor can choose the most suitable laxative for each patient. You should not ignore the recommendations of the doctor and take laxatives on your own, this is unsafe for health. You also need to remember that the transition to drug therapy for chronic constipation should not mean abandoning non-drug treatments: healthy eating and physical activity should be firmly established in the lifestyle.

Why does constipation begin and what to do?

Any violation of the process of formation of fecal masses and their movement can lead to problems with the stool. The main causes of constipation are:

Disorder of muscle activity.
Lack of urge to empty the bowels.
Pathological changes in the organs of the gastrointestinal tract, which do not allow the normal movement of the contents entering the intestine.
An altered ratio of the volume of intestinal contents and the capacity of the colon, which does not correspond to the normal process.

To determine what causes constipation, it is necessary to understand exactly how the process of formation of fecal masses occurs before they are brought out. Mixing of the incoming liquid contents occurs in the initial section of the large intestine. At the same time, water and nutrients are absorbed into the circulatory system.

The vertical position that a person takes when getting out of bed causes pressure of fecal masses on the lower sensitive parts of the rectum and provokes the urge to defecate. The absence of a normal stool, despite the fact that the patient continues to consume food, leads to the accumulation of feces, which, being absorbed into the bloodstream and circulating throughout the body, cause poisoning.

The most common reason why constipation occurs is nutritional (alimentary) factors. Monotonous, predominantly flour or meat food, a small amount of it, violations of the diet leads to constipation. Violation of intestinal peristalsis contributes to an insufficient amount of liquid, dry food, hard, poor-quality water.

Why constipation begins in a person can be explained by a violation of the coordination of various types of motor skills, when spasms occur in one place, and atony develops in another. With violations of intestinal motility, its motor activity, and primarily in the sigmoid colon, becomes unproductive.

A decrease in motor activity leads to an atonic type of stool retention, and convulsive contraction of the intestinal walls leads to spastic constipation. Depresses gastric motility depression, depletion of nerve receptors caused by the partial consumption of laxatives or enemas, conscious suppression of the urge to defecate when a person is in an unsanitary environment or is embarrassed by publicity.

Why do atonic constipations appear? This may be due to severe infectious diseases, severe malnutrition, lack of physical activity, and they are also characteristic of older people, women who have given birth a lot. Why does a person have spastic constipation? There is a wide variety of answers to this question. The reasons may be:

The beginning of inflammatory processes or the development of ulcers in the gastrointestinal tract.
The reaction of the diseased organ of the abdominal cavity and, first of all, the genitourinary system.
reflex fear pain during bowel movements, in the presence of cracks, hemorrhoids, ulcers or scars in the rectum.

In case of violations of the endocrine glands, menopause, failures occur in their work, which explains why constipation begins. Occupational poisoning with substances while working with them, poisoning with nicotine or narcotic substances, as well as eating food containing a large amount of tannic astringents, which causes constipation, is also noted in a large number of people.

To eliminate the reflex retention of the stool, it is very important to establish the source of this reflection. At the same time, diseases of the nervous system, such as cerebrovascular accidents, infectious diseases caused by viruses or chronic progressive diseases of the nervous system, quite often serve as a source of constipation. Sometimes difficulties with defecation begin in people who lead an active lifestyle and consume enough fiber.

The explanation of why and from what there is constipation in adults, in this case, may lie in the use of certain drugs, primarily diuretics, painkillers, as well as medications for the treatment of diseases of the cardiovascular system. Problems with difficulty emptying the bowels can cause antidepressants, narcotic and psychotropic drugs, drugs that are taken to normalize the acidity in the stomach.

From what constipation in pregnant women is explained by hormonal changes in the body leading to a decrease in intestinal activity. In addition, the growing volume of the uterus puts its weight on the intestines, destabilizing its work and causing delays in stool. Emphysema, obesity, heart failure lead to weakness of the muscles of the diaphragm and abdominal wall, which increases intra-abdominal pressure during bowel movements.

It is important for patients to know what to do if there is no urge to defecate. With constipation, which lasts for 2-3 days, it is enough to adjust the diet. You need to eat in small portions, 5 times a day. The menu should contain fresh vegetables and fruits (beets and pumpkin are especially effective), dried fruits (prunes). Various cereals (except rice), broths, fermented milk products (ryazhenka, kefir) are useful.

It is necessary to refuse apples, pears, cabbage, potatoes, any heavy food for the period of stool recovery. If the patient wants meat products, it is better to eat poultry and fish.

It should be noted that the amount of water you drink should be at least 2 liters per day.

Among the drugs, it is possible to take laxatives based on lactulose. They help soften the feces, facilitate their passage in the intestinal lumen, and have a fairly mild effect.

Rectal suppositories are used to call the act of defecation. One of the most effective and safest is glycerin-based suppositories. They are prescribed even to children and pregnant women. Microlax candles are also used, they are characterized by an effective and mild effect.

It is possible to take the drug Bisacodyl (in suppositories and tablets), but this drug has a large number of contraindications, it cannot be used often. Bisacodyl is not prescribed for pregnant women and children.

Doctors also prescribe choleretic drugs that help normalize the processes of digestion and defecation. Often used - Allochol, Hofitol, herbal preparations.

Medicines are prescribed in cases where the patient has followed diets and during the postpartum period.

If these techniques do not work, you can perform a cleansing enema. It is carried out at home and in medical institutions.

It is better to contact the clinic or hospital, as the procedure will be performed efficiently and in full. Using Esmarch's mug, the health worker fills the intestines with water.

The patient lies on his side until the urge to defecate. This usually takes 3 to 5 minutes.

Question: Lack of urge to defecate during pregnancy?

Hello! I am 30 years old, now 24 obstetric weeks of pregnancy. Prior to this, the chair was regular, every morning, often even unformed, mushy; sometimes, if you quickly eat or worry, you could slander. This was typical for me even before pregnancy. But for two weeks now, the urge to defecate has weakened, they began to appear every other day, and then I had to strain a little to provoke them.

But the chair was normal, decorated, not hard. Now for the second day there is absolutely no urge to defecate, sometimes it seems that you just want to go to the toilet - but only a little gas leaves and that's it. There is no discomfort in the intestines yet, but it strains me psychologically. I eat often, always porridge in the morning, be sure to have soup at lunch, drink a glass of bifidok before going to bed, eat fruit, a few pieces of dried apricots and prunes every day, but I drink little water (I always drank very little).

I work sedentary, but I try to move more: in the morning and in the evening I walk a kilometer and a half on foot, go out for a walk at lunchtime, at home in the evening I do a light warm-up for about 15 minutes. What can be done in my case so that the urge to defecate becomes regular again?

To normalize the work of the intestines, it is very important that a sufficient amount of fluid enters the body; per day (if there is no restriction from the kidneys), it is necessary to drink at least 1.5 liters of fluid (including first courses). Also, to enhance intestinal motility, it is necessary to have coarse plant fiber in the diet, for example, bran.

Be sure to introduce light gymnastic exercises into the daily routine, since a sedentary lifestyle will contribute to the growth of intestinal atony. Of the laxatives allowed during pregnancy, you can pay attention to Duphalac (a drug containing lactulose, you can read more about this drug, indications and contraindications for use, as well as about the rules for use, in our section of the same name: Dufalac).

However, the use of laxatives without correcting the flow of fluid into the body, as well as without an active lifestyle, will only give a temporary effect. You can read more about the changes that occur in the body of a woman and the fetus at various stages of pregnancy, about possible health problems at each of the stages of pregnancy and how to overcome them, you can read in the complex of our articles on pregnancy by week: Pregnancy Calendar.

Normally, the urge to defecate (emptying the intestines) occurs when the ampoule (end part) of the rectum is filled. Each person has their own bowel release biorhythm. The normal frequency of bowel movements is varied - from 3 times a week to 2 times a day. Constipation is usually called difficult or systematically incomplete bowel movement, or the absence of such for 3 days or more.

The signs of constipation are:

an increase in the intervals between acts of defecation compared with the individual physiological "norm";
forced straining;
intermittent or persistent insufficient bowel movements, feeling of "incomplete emptying of the bowel";
discharge of a small amount of feces of increased density (subject to good nutrition).

Constipation affects more than 20% of the population, and during pregnancy and after it, the risk of occurrence increases significantly. This problem has not only physiological, but also psychological aspects. Specialists know that seemingly innocuous difficulties with the evacuation of the contents of the intestine from the body often become the source of many problems.

A bit of physiology

What helps a person to empty the intestines on time? It has been established that the act of defecation depends on the following factors:

Intestinal microflora. It is based on protective microbes, represented by the so-called bifidobacteria and lactobacilli, which form a protective biofilm on the surface of the mucous membrane, as well as E. coli. The normal amount of protective microflora ensures the breakdown of proteins, fats, carbohydrates, nucleic acids, regulates the absorption of water and nutrients, as well as the motor activity of the gastrointestinal tract.
Motor (motor activity of the gastrointestinal tract. It is thanks to this function that the contents of the intestine normally move along the gastrointestinal tract without delay.

According to the mechanism of occurrence, two types of defecation disorders can be distinguished.

First type- atonic in which the tone of the muscular wall of the intestine decreases. Peristalsis becomes sluggish, unproductive. Atonic constipation often occurs due to muscle weakness, after a caesarean section. This is a common bowel reaction to any surgical intervention in the abdominal cavity. It can also occur due to dietary errors.

Atonic constipation may be accompanied by pulling, aching pains in the abdomen, a feeling of fullness in the intestines, increased gas formation, lack of appetite, nausea, lethargy, apathy, depressed mood. When defecation occurs, there is a lot of fecal masses, the initial portion is formed, dense, of a larger diameter than normal, the final portion is liquidish. Defecation is painful, there may be tears of the mucous membrane of the rectum and anus, then streaks of blood and (or) mucus remain on the surface of the feces.

Second type - spastic constipation, when the tone of the intestine is increased and peristalsis becomes unproductive due to the "squeezed" state of the intestine. For this type, psychological reasons are more characteristic.

In the spastic form, the pain is paroxysmal, more often in the left side of the abdomen. There may be flatulence (rumbling in the abdomen), lack of appetite, fatigue, nervousness, irritability, nausea, stool in the form of the so-called "sheep feces" - the stool is very dense in small rounded portions. The urge to defecate may even occur several times a day, but the emptying of the intestines is incomplete, difficult, in small portions.

Constipation in the postpartum period is associated, as a rule, with several reasons:

Changes in hormonal levels. During pregnancy, hormones that soften the ligaments also have a relaxing effect on the muscles of the intestine, as a result of which it becomes more difficult for it to get rid of its contents.
Weakening and stretching of the abdominal and perineal muscles. Stretched abdominal muscles during pregnancy do not adequately support the intestines and viscera.
Change in the position of the intestine in the abdominal cavity, its gradual displacement to its usual place.
Violation of peristalsis - the motor activity of the intestine, due to which food masses move.
Fear of straining due to the presence of sutures (imposed in the case of caesarean section, sutures in the perineum) and hemorrhoids.
Irrational diet for a nursing mother.
Psychological stress associated with caring for a child and a new family status.
Congenital anomalies of the intestine, for example, its elongated sections.

Separately, it should be said about taking various medications. For the prevention and treatment of anemia (hemoglobin deficiency), preparations containing iron are prescribed, which to some extent contribute to constipation. Aggravates constipation and the use of antispasmodic drugs (such as NO-SHPA). Constipation can also be the result of taking pain medications that are prescribed in the postpartum period to relieve postoperative stitches or painful postpartum contractions.

The diagnosis is established by the doctor on the basis of general examination data, the history of the development of the disease and the results of bacteriological examination of feces.

Solution

Treatment of constipation should be carried out strictly individually, after a thorough examination and under the supervision of a physician.

Diet. To solve the problem of constipation, a young mother, in any case, needs to choose the right diet, taking into account breastfeeding and possible allergic reactions.

To eliminate dysbacteriosis, foods containing essential oils rich in cholesterol, as well as fat breakdown products formed during frying, and foods that cause fermentation in the intestines should be completely excluded from the diet. Food is steamed or boiled.

An approximate daily diet should be at least 100 g of protein, 90-100 g of fat, 400 g of carbohydrates. 6-8 g of table salt, 100 mg. ascorbic acid, 0.8 g calcium, 0.5 g magnesium, 30 mg. nicotinic acid.

Rye or wheat bread from wholemeal flour, bran yesterday's baking.
Soups on weak meat, vegetable broth with pearl barley.
Meat, poultry, fish of low-fat varieties boiled and baked in one piece.
Cereals in the form of crumbly cereals and casseroles from buckwheat, wheat, millet, barley groats.
Vegetables - beets, carrots, lettuce, cucumbers, zucchini, pumpkin, possibly a small amount of tomatoes.
Fresh vegetable salads, vinaigrettes.
Dried fruits (dried apricots, prunes) soaked

Useful muesli, buckwheat, millet and pearl barley, oat bran, black bread, vegetable oils, vegetables and fruits, fresh and cooked. For example, carrots, beets, squash, spinach, lettuce, broccoli, cabbage, dried fruit compotes, melon, apples, apricots, cherries and dairy products.

You can take a decoction of gooseberries (pour a tablespoon of berries with a glass of water and boil for 10 minutes, then strain). Take it in a quarter cup 4 times a day, if necessary - you can add sugar. When brewing tea, you can add slices of dried apples or cherries. In the atonic form of constipation, the bowels are stimulated by a glass of cool water, drunk in the morning on an empty stomach.

With constipation, you can not use strong tea, mucous soups, semolina, white bread, wheat bran, polished rice, blueberries, quince, pears, currants, strawberries. Hard cheeses can also slow down peristalsis.

If dysbacteriosis is detected, the doctor may prescribe you drugs containing bifido- and lactobacilli.

Laxatives.

When breastfeeding, taking laxatives - FORLAX AND FORTRANS is not contraindicated.

Of the ready-made laxatives during breastfeeding, you can not take: GUTALAX, REGULAX, CHITOSAN-EVALAR, DULKOLAX (BI-SACODIL), DOCTOR THAISS - SWEDISH BITTER.

Senna-based preparations (SENNALAX, GLAXENNA, TRISASEN) increase the tone of the muscular wall of the intestine, so they should not be taken with spastic forms of constipation. When breastfeeding, they must be taken very carefully, as they can cause colicky pain in the baby.

Attention! With frequent and prolonged (several times a week for 1-2 months) use of almost any laxatives (both medicinal and herbal), addiction may develop, requiring an increase in the dose of the laxative. The effect of its use is weakening, and the problem of constipation itself is aggravated .

Phytotherapy. To solve the problems of constipation, herbal medicine offers salad recipes that will help improve bowel function. For example: fresh carrots, lingonberries, figs, dried apricots, greens. Or: fresh beets, carrots, prunes, raisins, greens. The amount of ingredients depends on your taste; a good dressing for all salads is vegetable (preferably olive) oil.

Fresh (one percent) kefir, curdled milk, fermented baked milk have a laxative effect. You can drink a glass of cold water with a spoonful of sugar in the morning or eat a banana, a couple of apples.

No less effective for the treatment of constipation and infusion of prunes with figs. It is prepared as follows: 10 berries of prunes and figs are washed and poured with a glass of boiling water, covered with a lid and kept until morning. The liquid is drunk on an empty stomach; 5 berries of prunes and figs are eaten at breakfast, the rest - in the evening. Here are some more recipes.

With spastic forms:

Freshly prepared potato juice, diluted in water 1:1, take a quarter cup half an hour before meals 2-3 times a day.
A decoction of figs in milk or water at the rate of 2 tablespoons of raw materials per 1 cup of boiling water; you need to let it cool at room temperature and take 1 tablespoon 2-4 times a day.
Mix in equal parts the fruits of anise, stinging nettle herb, valerian rhizome officinalis, wild strawberry leaves, chamomile flowers, peppermint leaves. Brew a tablespoon of the collection with a glass of boiling water in a thermos and leave for 1.5 hours, then strain. Take half a glass after meals in the morning and evening.

With atonic forms:

Mix in equal parts the fruits of anise, cumin and fennel. Brew 2 teaspoons of the mixture with a glass of boiling water, leave for 15-20 minutes, strain, drink a third of a glass 3 times a day for half an hour before meals. Please note that for this collection, the seeds must be ripe.
In equal proportions, take oregano herb, rowan fruit, gray blackberry leaves, nettle herb and fennel fruit. Brew a tablespoon of the collection with 1 cup of boiling water, insist in a thermos for 1.5 hours, strain, take a third of a cup 3 times a day after meals.

Attention! The use of horse chestnut preparations (dietary supplements, herbal preparations, creams for the treatment of varicose veins and hemorrhoids) can significantly reduce or even stop lactation.

Physical exercise.

This is the safest and most effective way to get rid of postpartum constipation. Stretched abdominal muscles do not provide full support to the abdominal organs, there is a risk of developing a hernia of the white line (midline of the abdomen), the uterus contracts more slowly. Flabby skin and abdominal muscles do not adorn the figure, exacerbating emotional discomfort. The stretched muscles of the perineum cannot become a reliable support for the pelvic organs - there is a threat that the uterus will descend into the vagina, prolapse or prolapse of the uterus will occur.

Regularly performing physical exercises, you can get rid of extra pounds acquired during pregnancy, improve well-being, increase self-esteem, improve emotional background, and gain strength. It is worth giving exercise 5-10 minutes a day (it is advisable to do a set of exercises several times a day).

In the proposed mode, this complex can be performed by women who have not had a caesarean section or deep tears. If you have had surgery or complex perineal, cervical, or other complications, check with your doctor before exercising.

On the 1st -2nd day after birth:

I. p. - lying on your back, arms loosely along the body, legs slightly bent at the knees, take a deep breath and inflate your stomach, hold your breath a little and exhale with force through your mouth, while trying to pull your stomach in as much as possible. Repeat 5 or more times.

On the 3rd day after birth:

I. p. the same, the knees are pressed to each other. Simultaneously with the usual breath, strongly tighten the muscles of the pelvic floor (as to prevent defecation), holding your breath a little, exhale and relax. Repeat several times.
I. p. the same. At the same time, with an inhalation, raise the right leg and left arm up, as you exhale, lower it. Then do the exercise with your left foot and right hand. Repeat at least 5 times.
I. p. - standing, feet shoulder-width apart, arms extended forward. Without lifting your legs, turn your torso to the right, pulling your right arm back as much as possible (inhale). Return to starting position (exhale). Perform the exercise on the other side. Repeat several times.

On the 4th-14th day:

Starting position - as in exercise number 4. Interlace your fingers in a lock in front of you. Turning the torso, try to take your arms as far back as possible. Repeat several times.
I. p. - lying on your back, arms lie freely along the body, legs bent at the knees, while inhaling, raise the pelvis and hold it for several seconds, lower with exhalation. Repeat.
I. p. - standing on all fours. When inhaling, draw in the stomach and perineum, hold your breath for a couple of seconds, and relax with an exhalation. Repeat.

2 weeks after birth:

I. p. - standing. Raise your hands to your shoulders, put your elbows forward. Bending the right leg at the knee and raising it, try to touch the left elbow with the knee. Repeat several times on both sides.
Complicate exercise No. 6 by slightly spreading your legs to the sides and at the moment of lifting the pelvis, strain the muscles of the perineum, as in exercise No. 2. Repeat several times.
Lying on your back, alternately bring the leg bent at the knee and hip joints to the stomach.

Self-massage of the intestine.

In a standing or lying position, with light movements of any palm, you need to “pass” from the right groin up, then hold the palm above the navel and go down to the left groin. From time to time, movements should be accelerated, giving them the appearance of a slight vibration and undulation. The massage lasts 10-15 minutes. It is better to coincide with the time when there is a desire to empty the intestines in order to develop a conditioned reflex to defecate. The introduction of a candle with glycerin into the anus can also help with this. 20 minutes after this procedure, you must definitely go to the toilet, even if there is no urge to defecate.

It is necessary to sit in the toilet until the desired effect appears, or at least 10-15 minutes with careful straining and an attempt to empty the intestines. When the reflex is restored (the urge to defecate will appear regularly, daily at the same time), candles are canceled.

With atonic constipation in the morning, without getting out of bed, you can vigorously rub the skin around the navel and to the left of it towards the inguinal region with the fingers of both hands. The legs are somewhat bent at the knees. Massage should be done for 4-5 minutes.

With spastic constipation, on the contrary, soft, slightly with pressure stroking the entire abdomen in a clockwise direction helps.

For the prevention and treatment of hemorrhoids, after each act of defecation, be sure to irrigate the anus with a cool shower. You can alleviate irritation with microclysters with flaxseed infusion (pour a tablespoon with a glass of boiling water and leave for 3 hours; draw 50 ml of slightly warmed infusion into a syringe; the procedure can be repeated several times a day if necessary).

In conclusion, I would like to note that the problem that has become the subject of our conversation is not pleasant, but completely solvable. And if you follow all the recommendations of the doctor, then soon you will be able to cope with it.

This insidious dysbacteriosis ...

The human intestine consists of thin and thick sections. The microflora of the large intestine consists of 90% of microbes that do not need air (anaerobes) to live, and 10% of aerobes. The small intestine is practically sterile. A change in the quantitative and qualitative composition of normal microflora is called the term dysbacteriosis, or dysbiosis. Intestinal dysbiosis can be both a cause and a consequence of constipation.

The reasons for the development of dysbacteriosis are:

The irrational use of antibiotics, which lead to the death of not only pathogenic (pathogenic), but also beneficial microbes in our body.
Irrational nutrition.
Retention of feces in the large intestine.
Violations of general and local immunity.
Insufficiency of enzymes of the digestive tract.

Dysbacteriosis in the initial phase is asymptomatic. Subsequently, with the development of the disease, bloating, flatulence, stool disorders (constipation or diarrhea) appear, various allergic reactions to food products may develop. This is due to the fact that the process of digestion of food occurs incorrectly and various toxic substances are formed that are absorbed into the bloodstream and have a harmful effect on all human organs and tissues.

For citation: Shulpekova Yu.O., Ivashkin V.T. Pathogenesis and treatment of constipation // BC. 2004. No. 1. S. 49

Constipation is a syndrome that characterizes a violation of the process of bowel movement (defecation): an increase in the intervals between acts of defecation compared to the individual physiological norm or a systematic insufficient bowel movement.

Constipation should also be considered a difficulty in the act of defecation (while maintaining the normal frequency of stools).
The prevalence of constipation among the adult population of highly developed countries is, on average, 10% (up to 50% in England). The widespread occurrence of this disorder gave reason to classify constipation as a disease of civilization.
The normal frequency of stool is an indicator that is individual for each person. It is generally accepted that in practically healthy people the normal frequency of stools ranges from 3 times a day (about 6% of those examined) to 1 time in 3 days (5-7% of those examined). Typically, these features are hereditary.
Constipation can be temporary (episodic) or long-term (chronic, lasting more than 6 months).
There are standard diagnostic criteria for chronic constipation:
. straining, occupying at least 25% of the time of defecation;
. dense (in the form of lumps) consistency of feces;
. feeling of incomplete bowel movement;
. two or less bowel movements per week.
To establish a diagnosis, it is enough to register at least 2 of these signs during the last 3 months.
Stool retention is often accompanied by unpleasant subjective sensations, such as lethargy, headache, insomnia, decreased mood, decreased appetite, nausea, unpleasant taste in the mouth; discomfort, feeling of heaviness or fullness in the abdominal cavity, bloating, spastic abdominal pain. For a significant part of patients suffering from chronic constipation, the characteristic features of the psychological appearance are "care for the disease", suspiciousness.
At the heart of the development of constipation, 3 main pathogenetic mechanisms can be distinguished, occurring in isolation or in combination:
1) increased absorption of water in the colon;
2) delayed transit of feces through the large intestine;
3) the inability of the patient to perform an act of defecation.
Comparison of pathogenetic mechanisms with the "functional units" of the colon in some cases allows you to localize the affected segment of the colon. Thus, the formation of dense fragmented feces is characteristic of a violation of the propulsive peristalsis of the colon, in which the most intensive absorption of water occurs. The absence of the patient's urge to defecate indicates a violation of the sensitivity of the receptor apparatus of the anorectal segment, which performs the function of accumulation and evacuation of feces.
The reason for the development of temporary constipation is usually a change in living conditions and the nature of food, the presence of unusual and uncomfortable conditions for defecation (the so-called "travelers' constipation"). Emotional stress is capable of provoking a temporary violation of the stool. In addition, temporary constipation is often observed in pregnant women, due to natural physiological changes.
In a hospital, the reason for the violation of adequate emptying of the colon can be prolonged bed rest, taking various medications, and the use of barium sulfate in x-ray studies with contrast. In some situations, when straining is especially harmful to the patient (in the acute period of myocardial infarction, in the early period after surgical interventions on the abdominal organs), the prevention and treatment of constipation becomes especially important.
Temporary retention of stool is far from in all cases should be considered as a sign of any pathological condition. However, the occurrence of constipation in a middle-aged or elderly patient should first of all cause oncological alertness.
According to J.E. Lannard-Jones identifies the following types of chronic constipation:
1) associated with lifestyle;
2) related to the impact of external factors;
3) associated with endocrine and metabolic disorders;
4) associated with neurological factors;
5) associated with psychogenic factors;
6) associated with gastroenterological diseases;
7) associated with the pathology of the anorectal zone.
Table 1 lists the most common diseases and conditions associated with chronic constipation.
Nutrition plays an important role in the regulation of intestinal motility. Long-term use of mechanically gentle, high-calorie, low-volume food, the absence of foods containing coarse fiber or dietary fiber in the diet contribute to constipation. There are products that have a fixing effect. These are strong coffee and tea, cocoa, cottage cheese, rice, pomegranates, pears, quince, astringent products, chocolate, flour. Improper diet and lack of physical activity are the main cause of constipation among the population of developed countries.
If we do not take into account the cases of constipation associated with the peculiarities of lifestyle, then, according to E.K. Hammad, G.A. Grigoryeva, among the causes of chronic constipation in the age group up to 20 years, the anatomical features of the large intestine dominate; at the age of 20-40 years - pathology of the ano-rectal zone; after 40 years - psychogenic, neurogenic, endocrine, gastroenterological causes of constipation and causes associated with the pathology of the anorectal zone are equally common.
Constipation is a very characteristic symptom of such endocrine diseases as hypothyroidism, hyperparathyroidism. Thyroid hormone deficiency and hypercalcemia are accompanied by intestinal hypotension.
The timing of the onset of constipation in diabetic patients depends on the severity of the course of the disease.
In recent years, the pathogenesis of functional constipation within the framework of irritable bowel syndrome has been intensively studied. Violation of the emptying of the colon in functional constipation is associated with a change in the peristaltic activity of the intestinal wall. Constipation is spastic in nature, when the tone of some part of the intestine is increased and the feces cannot overcome this place. The stool takes on the appearance of a "sheep". Hypotonic or atonic functional constipation is associated with a loss of tone in the colon. In this case, the delay in defecation can reach 5-7 days, the feces can be large in volume, loose in consistency. Diagnosis of irritable bowel syndrome requires a thorough examination to rule out other possible causes of constipation.
Soreness of defecation (with thrombosis of external, anal fissures) acts as an additional factor predisposing to stool retention.
Many drugs cause constipation when overdosed or as a side effect. Narcotic analgesics, anticholinergics, some antihypertensive drugs inhibit the peristaltic activity of the intestine, affecting its nervous regulation. Aluminum-containing antacids, iron preparations also cause constipation.
Systemic diseases accompanied by damage to the vessels and nerves of the intestine (diabetes mellitus, scleroderma, myopathies) form a picture of chronic intestinal obstruction - the syndrome of intestinal pseudo-obstruction.
Examination of a patient with impaired bowel syndrome should include a thorough questioning and examination of the patient, assessment of lifestyle, collection of a "drug" anamnesis, digital examination "per rectum", a study of general and biochemical blood tests, coprograms. The data obtained determine the algorithm for further examination. Identification of symptoms of "anxiety" (asthenic manifestations, fever, weight loss, anemia, increased ESR, the presence of blood in the feces) makes it necessary to conduct an endoscopic / x-ray examination of the intestine.
The main principle of constipation treatment should be etiotropic therapy, elimination of the cause leading to impaired bowel function.
As mentioned above, very often the only reason for the violation of the normal peristaltic activity of the intestine in residents of developed countries is the lack of dietary fiber, as well as a decrease in motor activity. In this regard, the first step in the treatment of constipation should be measures aimed at maintaining a healthy lifestyle. The basic principles of non-drug correction of bowel function include:
1) Eating foods high in dietary fiber. Indigestible dietary fiber contributes to water retention, increases the volume of stool and makes it soft, which contributes to the establishment of peristalsis. It is recommended to eat raw vegetables, fruits, gourds, sea kale, stone fruits, bananas, fermented milk products, crumbly cereals, wholemeal bread, vegetable oil. It is advisable to reduce the consumption of foods that have a fixing effect (cottage cheese, tea, coffee, cocoa, rice, chocolate, flour). The medical industry produces nutritional supplements containing natural or synthetic dietary fiber: food bran, Psyllium, Metamucil, etc.;
2) regular meals (breakfast is especially important);
3) sufficient fluid intake (preferably up to 2 liters per day);
4) adhere to the rule of regular bowel movements. The activity of the colon increases after waking up and after eating, so that urges are observed mainly after breakfast. The urge to defecate should not be ignored, as this may result in a decrease in the threshold of excitability of rectal receptors;
5) daily physical activity. It helps to increase the peristaltic activity of the intestine.
In the absence or insufficient effectiveness of etiotropic therapy and non-drug methods for restoring stools, symptomatic therapy for constipation is resorted to. For this purpose, drugs are used that increase the peristaltic activity of the intestine artificially - laxatives.
Table 2 presents the modern classification of drugs used in the treatment of constipation, proposed by D.A. Kharkevich (1999) .
The classification of laxatives can be based on the mechanism and localization of their action (Tables 3 and 4).
With occasional constipation, it is possible to use magnesium-containing drugs (magnesium oxide - 3-5 g per night, magnesium sulfate - 2-3 tablespoons of a 20-25% solution per night), Guttalax (10-20 drops per night), suppositories with glycerin. In addition, you can resort to setting warm water enemas of small volume (250 ml).
With prolonged (over 6-12 months) taking laxatives, psychological dependence can develop and, along with this, the phenomenon of addiction.
In this regard, the constant and daily intake of laxatives can be recommended only for special groups of patients - for example, oncological patients receiving high doses of narcotic analgesics.
An overdose of laxatives is accompanied by the development of diarrhea and, as a result, dehydration and electrolyte disturbances (potassium and magnesium deficiency). The appointment of laxatives in combination with diuretics, glucocorticoids, cardiac glycosides requires special care due to the high risk of electrolyte imbalance. The most common overdose symptoms are observed when taking saline laxatives; the use of drugs of this class requires an individually selected dosage.
Taking laxatives is contraindicated in acute inflammatory diseases of the abdominal organs, acute intestinal obstruction, with severe dehydration and hypersensitivity to drugs.
It is necessary to dwell separately on the characterization of the negative aspects of preparations containing anthraglycosides (drugs of rhubarb, senna and buckthorn), which are especially widely used by patients in self-medication. Herbal origin, availability and ease of use are deceptive positive aspects of these drugs.
It has been shown that with long-term use of drugs containing anthraglycosides, their metabolites accumulate in the intestinal mucosa, macrophages of the mucosal lamina propria, and ganglion plexus neurons. At the same time, atrophy of the mucous and muscular layers of the intestinal wall develops, as well as a violation of autonomic innervation. Degenerative changes in smooth muscles and nerve plexuses over time can lead to severe inhibition of peristalsis, up to atony. Such changes are called "laxative colon". Decrease in peristaltic activity, decrease or absence of haustration, areas of spastic contractions are determined radiologically.
Based on his experiments, Westendorf J. suggests that one of the mechanisms of action of laxatives containing anthraglycosides - an increase in the water content in feces - is associated with a violation of the integrity of the mucous membrane due to the cytotoxic effect of anthraglycoside metabolites. In some patients, with prolonged use of these drugs, inflammatory changes in the intestines are found, similar to ulcerative colitis.
In addition, complications from the procto-anal section were noted: the development of cracks and lacunae of the anal canal (with a frequency of 11-25%), cicatricial stenosis of the anus (with a frequency of 31%), thrombosis and prolapse of hemorrhoids (with a frequency of 7-12 %) .
After at least a year of use of laxatives containing anthraglycosides, patients develop a reversible phenomenon of pseudomelanosis of the colon - a black staining of the mucous membrane, probably due to the accumulation of anthraglycoside metabolites in macrophages of the lamina propria. Colon pseudomelanosis does not appear to be a precancerous condition. However, in a study by Siegers C.P. et al. it has been shown that in patients taking laxatives containing anthraglycosides for a long time, the risk of developing colorectal cancer is three times higher than in the general population. At the same time, the presence of chronic constipation itself is not associated with an increased risk of developing a malignant tumor of the colon.
In experiments on rats, it was shown that the metabolites of antraglycosides - anthraquinones - have a mutagenic potential. Anthraquinones catalyze oxidative reactions, which result in the formation of semiquinone and oxygen radicals that damage the cell genome.
Metabolites of antraglycosides - anthranoids - have potential hepatotoxicity. The possible role of anthraquinones in the development of degenerative-inflammatory changes in the kidneys is discussed.
Anthraquinones cross the placenta and into breast milk. At present, the mutagenic / carcinogenic effects of anthraquinones on the body of the fetus and infant cannot be ruled out in principle.
Recently, drugs that stimulate nerve endings in the colon mucosa, which is accompanied by an increase in peristaltic activity, have become increasingly popular in the treatment of episodic and chronic constipation. The representative of this group is Guttalax (sodium picosulfate) of the German pharmaceutical company Boehringer Ingelheim. This drug is a "prodrug". Sodium picosulfate is converted to the active form of diphenol in the lumen of the colon by the action of bacterial enzymes - sulfatases.
The mechanism of action of Guttalax is the stimulation of the receptors of the colon mucosa, which is accompanied by an increase in peristaltic activity.
Guttalax is practically not absorbed from the gastrointestinal tract and is not metabolized in the liver. The laxative effect, as a rule, develops 6-12 hours after taking the drug.
Guttalax is available in the form of a solution (7.5 mg / ml) in plastic dropper bottles, which allows the patient to accurately select the required amount of solution (based on the individual response to laxatives) and avoid overdose. The usual dose for adults and children over 10 years of age is 10-20 drops (with persistent and severe constipation - up to 30 drops); for children 4-10 years old - 5-10 drops. It is advisable to take the drug at night. The mild action of Guttalax provides the expected effect by morning.
It should also be borne in mind that when prescribing antibiotics, the laxative effect of Guttalax may decrease.
The most typical situations in which the use of this drug is optimal are constipation in patients on bed rest, temporary constipation associated with a change in the nature of food, emotional stress and uncomfortable conditions for defecation ("travelers' constipation"), painful defecation due to pathological processes in the area anus (fissures, hemorrhoids). Guttalax is effective in eliminating constipation in cancer patients receiving high doses of opioids (used at a dose of 2.5-15 mg / day).
Reports on clinical trials of the drug (including placebo-controlled) reported its good tolerability in all age groups; side effects were observed rarely - no more than 10% of patients and consisted in the appearance of mild flatulence or abdominal pain immediately before defecation. There was no addiction to the drug.
Guttalax, if necessary, after consultation with an obstetrician-gynecologist, can be prescribed to pregnant women (effective at a dose of 2-10 mg / day). As a result of the study (128 patients), chronic inflammatory diseases of the genital tract significantly prevailed in pregnant women with functional constipation compared with pregnant women with gestational constipation and pregnant women without constipation. The appointment of the laxative Guttalax led to the normalization of the content of the intestinal and genital microflora, as well as intestinal permeability and a decrease in the development of various complications during pregnancy, childbirth and the postpartum period. Guttalax did not have a negative effect on the fetus and no effect on the contractile activity of the uterus. The drug does not penetrate into breast milk, however, if necessary, its use during lactation, breastfeeding should be discontinued.
Successful treatment of constipation lies in establishing the causes and choosing the right treatment program. Timely treatment of constipation is a reliable prevention of the pathology of the upstream sections of the gastrointestinal tract and other body systems.

Such treatment helps to restore the urge to defecate. Frequent urge to defecate in medicine is called tenesmus. When a person wants to empty his bowels, he has an urge to defecate.

Previously, I often had constipation, but the urge was always there, although not every day. Since September, the urge has disappeared altogether. As the urge disappeared, I switched to a diet (that is, nothing flour and meat, only vegetables, fruits and cereals). So the problem is not the wrong diet.

Statistics show that the vast majority of people have urge to stool in the morning - between 7 and 9 o'clock local time, and much less often in the evening - between 19 and 23 o'clock. If the reflex to defecate at the same time of the day is lost, it is necessary to direct the main efforts to restore it, which is often a difficult task.

No urge to defecate

The act of defecation is also helped by massage of the abdomen with hands, rhythmic retraction of the anus, pressure on the area between the coccyx and the anus.

The urge to defecate occurs when feces, entering the rectum, stretch it and irritate the receptors (nerve endings) in the mucous membrane. Violation of the function of the muscles of the pelvic floor - rectocele, prolapse of the rectum, violation of the physiological act of defecation.

Inappropriate time or conditions for defecation. In cases where lifestyle and dietary changes fail to restore regular bowel movements, laxatives are usually the next treatment option. The reflex of the act of defecation weakens and the sensitivity of the rectum decreases: older people often do not feel the filling of the rectum and do not feel the urge to defecate.

There are situations when these urges turn out to be false. This is due to the fact that the muscles of the intestine convulsively contract and cause pain. In people with some serious intestinal infection, the urge to defecate may be false.

How to restore a bowel movement with constipation

Frequent urge to defecate accompanied by convulsive contraction of the sphincter and rectum. Since the rectum is most often empty, the act of defecation does not occur.

PROCTOLOG81.RU / Coloproctology (proctology). Treatment. / no urge to defecate

This stable set of disorders of a functional nature is accompanied by pain in the abdomen, discomfort, flatulence and frequent urge to defecate. With IBS, the stomach swells and the process of defecation changes, that is, with a strong urge to defecate, there is a feeling that the intestines are not completely empty.

Diseases that have a symptom Lack of urge to defecate

It is somewhat similar to mucofalk, which I used to drink with simple constipation (then it helped me, but now neither it nor phytomucil helps).

Why is there no urge to defecate?, Constantly have to use laxatives and enemas

Thus, hypermotor disorders in constipation are more common than hypomotor disorders.

Discoordination of the act of defecation

Separately, one should dwell on drugs that can cause constipation, especially with prolonged use. Constipation is often caused by inflammatory bowel disease.

There are two main mechanisms for the development of chronic constipation - dyskinesia of the colon and violation of the act of defecation (dyschezia).

These laxatives can be used to treat occasional (not chronic) constipation, as they are more addictive than all other groups of drugs.

Many people know that the normal frequency of defecation is 1 time per day. This indicates a good functioning of the digestive system. It is also important to pay attention to the consistency of feces. may signal infection or poisoning.

Constipation is a common problem. Different forms of this condition are characterized by their symptoms. So, with its spastic form, the intestines are in good shape, which provokes a desire to empty it. In some cases, the urge to defecate is completely absent. This condition can be seen in

Diet adjustment

Any type of constipation can be provoked by malnutrition, so it is especially important to properly compose a diet. This will normalize the work of the entire gastrointestinal tract.

Is not strict. The main rule is the daily consumption of fruits and vegetables. The body needs fiber to restore normal bowel frequency. Cereals are another source of this substance. You can safely eat any cereal, with the exception of rice. This cereal has the ability to fix the stool. Rice congee is a popular folk remedy for diarrhea.

It is better to refuse heavy food, the digestion of which takes a lot of time and energy. Such dishes are smoked meats, as well as all fatty and fried foods.

Dairy products must be included in the menu. They stimulate the growth of beneficial microflora in the intestines. This ensures normal digestion and excellent prevention of dysbacteriosis.

They may be absent due to prolonged fasting, which is associated with a small amount of digested food in the intestines. This condition does not require medical treatment, it is enough to adjust the frequency of meals.

Treatment tactics

With a long absence

urge to defecate, you need to pay attention to general well-being. Warning symptoms are:

soreness;
gas formation;
pallor of the skin;
weakness.

These signs signal the accumulation of feces in the intestines. The condition is dangerous because the processes of fermentation and decay develop in the digestive system. The toxins released during this poison the body. It is important to adjust the work of the intestines in a timely manner.

It is not recommended to take measures to empty the intestines on your own. It's best to see a doctor. The therapist, if necessary, will refer to a gastroenterologist to determine if there are internal pathologies of the digestive system.

No urge to defecate

may be caused by insufficient secretion of bile by the liver. Because of this, the process of splitting nutrients in the duodenum is disrupted. In this case, it is recommended to take drugs that enhance secretion. Allochol has a choleretic effect. Gastroenterologists often recommend these tablets for the atonic form.

If the tests show that the liver is working without failure, effective laxatives will be recommended to help normalize intestinal motility.

Local laxatives

One of the most effective laxatives are considered irritating. These are usually topical agents that work directly in the rectum. The active ingredients have an irritating effect on the receptors of the mucous membranes. As a result, peristalsis increases, which causes defecation.

Pharmacies offer a wide range of irritants. The best option will be selected by the doctor. There is:

The main advantage of topical laxatives is the rapid onset of results. The first urge to defecate is noted within an hour. Complete emptying of the intestine occurs after 6-8 hours.

Doctors warn that irritants should not be used all the time. It's addictive. In the future, the intestine loses the ability to contract, and a person suffering from constipation cannot do without the necessary medicines.

Constipation- this is a violation of the evacuation function of the intestine, characterized by the presence of difficult rare (2 times a week or less) defecation with a feeling of incomplete emptying of the intestine.

Types of constipation:

neurogenic (with functional or organic diseases of the central nervous system, frequent conscious suppression of the reflex to defecate, due to living or working conditions - lack of a toilet, work of a driver, seller, etc.);
reflex (with organic lesions of the digestive organs, as well as other organs and systems), including proctogenic;
toxic (for chronic poisoning with lead preparations, opium derivatives, nicotine, nitrobenzene, long-term use of high doses of anticholinergics and antispasmodics);
"endocrine" - with a decrease in the function of the pituitary gland, thyroid gland, ovaries;
alimentary (with insufficient intake of fiber, mineral salts and liquids with food);
hypokinetic (with insufficient physical activity, mainly a sedentary lifestyle);
mechanical (due to narrowing of the intestine by a tumor, scar or congenital pathological lengthening of the colon, underdevelopment of its intramural nerve plexuses - megacolon, Hirschsprung's disease).

The diagnosis of "functional constipation" suggests the absence of organic pathology and the presence of the following signs listed below.

I.
Symptoms, in descending order: excessive strain during defecation, hard or “sheepy” feces, unproductive urge to defecate, infrequent stools, and a feeling of incomplete emptying of the bowels.

II. Violations of the act of defecation, including in more than 95% of cases a decrease in the frequency of defecation (two or less times a week).

III. Decrease in stool weight - less than 35 g per day or straining, which takes more than 25% of the bowel movement.

IV. An increase in transit time, determined using a radiographic mark: in the small and large intestine - up to 93 hours or more, in the large intestine - up to 47-70 hours.

There are two types of functional constipation: spastic and atonic.

Causes of functional constipation:

Constipation is caused by a violation of the processes of formation and movement of feces through the intestines. The main reasons for this are disorders of intestinal motility, weakening of the urge to defecate, changes in the anorectal region and the pelvic floor. It is also impossible not to consider anamnestic moments as etiopathogenetic factors: in childhood - lack of education in the hygiene of the act of defecation, as a result of which a fear of defecation develops; in adulthood - an increased level of anxiety, the presence of stress factors.

Usually, two main causes of impaired motor activity of the colon are distinguished: its inertness and slowing down of transit. Inertness of the colon is defined as a weakening of motility, characterized by a decrease in the tone of the intestine and its contractile activity. This pathology is more common in women and the elderly.

The delay in transit occurs due to an increase in segmental contractility of the rectosigmoid region, which leads to a delay in fecal masses and the occurrence of their reflux in the proximal direction. In this case, there is a delay in the flow of contents into the rectum. An increase in the time of contact of the mucous membrane with stool leads to increased absorption of water, resulting in a hard stool, there is a feeling of incomplete evacuation of intestinal contents.

One of the options for functional disorders of the anorectal zone is dyschezia - difficulty in the act of defecation. This phenomenon, as noted by many authors, occurs in 25% of cases of constipation. The act of defecation, according to the patients themselves, requires considerable effort, leaves a feeling of incompleteness, or is accompanied by the need for manual bowel emptying. The causes of dyschezia, in addition to the dysfunction of the colon described above, can be:

Dyssynergy of the pelvic floor muscles, which is characterized by a paradoxical contraction or inability to relax the muscles of the pelvic floor when trying to perform an act of defecation;

Dysfunction of the internal anal sphincter, characterized by an insufficient inhibitory reflex or its complete absence and / or an increase in the tone of the anal canal in the absence of organic causes that explain this condition.

Symptoms of functional constipation:

Characterized by a long delay in defecation. With atonic constipation, fecal masses are plentiful, formed, sausage-shaped; often the initial portion is very dense, larger than normal diameter, the final portion is semi-formed. Defecation is carried out with great difficulty, very painful; due to tears of the mucous membrane of the anal canal, streaks of fresh blood may appear on the surface of the feces.

In spastic constipation, the stools take the form of sheep's feces (fragmented stools). Constipation is often accompanied by flatulence, a feeling of pressure, fullness, spasmodic pain in the abdomen. Prolonged constipation is often accompanied by fatigue, lethargy, decreased performance. Long-term constipation can cause various complications: secondary colitis, proctosigmoiditis; contributes to the appearance of various diseases of the rectum. Most often, hemorrhoids occur, as well as anal fissures, less often paraproctitis. Acquired megacolon can become a complication of long-term constipation.

The diagnostic criteria for functional constipation, adopted in Rome in 1999, include two or more of the following symptoms occurring for 12 weeks per year:
straining during the act of defecation, which takes at least 1/4 of its time;
fragmented and/or hard stools in at least one of four bowel movements;
a feeling of incomplete evacuation of intestinal contents at least in one of the four acts of defecation;
feeling of obstruction in the passage of feces in the case of one of the four acts of defecation;
the need for manipulations that facilitate the act of defecation, more than one act of defecation out of four;
reduction in the number of bowel movements (less than three per week).

It is assumed that the patient does not have loose stools, as well as a sufficient number of criteria necessary for the diagnosis of irritable bowel syndrome. The criteria lose their diagnostic value when the patient is taking laxatives.

Diagnosis and differential diagnosis:

If the patient's complaints fall under the above criteria, it is necessary, firstly, to conduct diagnostic studies (sigmoidoscopy and irrigoscopy, which allows you to assess the anatomical condition of the colon: irritation or its normal state with functional disorders and exclude any organic pathology - tumors, anomalies or megacolon characteristic of obstruction, hypogangliosis, idiopathic enlargement). If necessary, colonoscopy, histological and histochemical studies of biopsies of the intestinal mucosa can be performed.

Secondly, the presence of factors contributing to the development of constipation as a symptom of certain conditions, such as dietary habits, medication, concomitant diseases, should be excluded. If during the examination it was not possible to identify an organic lesion of the intestine and constipation is not a symptom of another disease or a consequence of taking medications, it can be considered that the patient suffers from functional constipation.

To clarify the mechanism of development of functional constipation, special research methods are needed. Violation of the motor and evacuation functions of the intestine is confirmed during an X-ray examination of the abdominal cavity according to the following method: for 5 days after the patient has received a radioactive label, fluoroscopy is performed to determine the time of transit through the intestine. Passage during this time of at least 80% of the radionuclide indicates a normal transit time. The retention of the marker in the proximal colon suggests the presence of colon dysfunction (its inertia or slowing down of transit).

To detect anorectal dysfunction, more complex studies are required - such as manometry and electromyography, confirming impaired contractility and muscle relaxation during defecation.

Treatment of functional constipation:

In the treatment of functional constipation, it is necessary to take into account the causes that caused it (if any could be established), the type of dysmotility, and the severity of the symptoms. Many patients achieve good results with non-specific treatments.

Non-specific methods of treatment primarily include dietary recommendations. Thus, the laxative property of dietary fiber is well known. According to a number of studies, they are believed to increase the mass of the stool. However, other studies have not confirmed this assumption. No correlation was found between high fiber intake and intestinal transit time.

However, it can still be considered a generally accepted fact that foods containing a sufficient amount of fiber, as well as nutritional supplements, are successfully used in the treatment of constipation. The laxative effect of dietary fiber is complex and not fully understood. Probably, their effect is associated with mechanical stretching of the intestinal wall with an indigestible mass, retention of water molecules, and an increase in the bacterial mass. Another possible mechanism is stimulation of intestinal mucosal receptors by particulate matter. Thus, it is advisable to recommend to patients the inclusion in the diet of products containing indigestible fiber: cereals, root crops, mushrooms, algae, fruits, vegetables.

Laxatives: In the absence of the effect of changing the nature of the diet, it becomes necessary to take laxatives. First of all, laxatives are used, which increase the volume of feces. Mucofalk belongs to this group of drugs. Hydrophilic fibers from the outer shell of psyllium seeds, which are part of the preparation, are able to retain water around them in an amount many times greater than their own weight. Due to this, the feces acquire a softer texture and increase in volume.

Thus, mukofalk normalizes bowel function without irritating; in addition, the drug is not absorbed and is not addictive. Another positive property of mucofalk is the ability of the drug to lower cholesterol and very low density lipoproteins. It is prescribed in a dose of 5 mg 2-6 times a day. If there is no effect during treatment with drugs of this group, it is possible to prescribe osmotic laxatives or poorly absorbed di- and oligosaccharides.

Osmotic laxatives are substances that slow down the absorption of water and increase the volume of intestinal contents, followed by irritation of the interoreceptors. The most well-known drug of this group today is forlax (the active substance is high-molecular macrogol-4000).

The drug causes an increase in the volume of intestinal contents and its dilution due to the formation of hydrogen bonds with water molecules, its retention and accumulation in the intestinal lumen. Due to its high molecular weight, forlax is not absorbed or metabolized in the gastrointestinal tract, and also does not cause structural changes in the colon and addiction. When taken regularly, forlax has an important property for laxatives - it helps to restore the natural urge to defecate and maintains regular stools without requiring an increase in dosage.

The drug allows to achieve a stable therapeutic effect in patients of different ages. Does not interact with other drugs. The recommended dose is 4 sachets per day (in two divided doses). In this dosage, the drug is used until the first independent satisfactory act of defecation occurs, then the dose can be halved (1 sachet 2 times a day).

Poorly absorbable di- and oligosaccharides. This group of drugs includes duphalac, the active ingredient of which is lactulose, a synthetic disaccharide synthesized by chemical isomerization from lactose. The drug in unchanged form reaches the colon, where it becomes a substrate for bacteria that hydrolyze duphalac to short-chain fatty acids.

Such a transformation of it causes a number of physiological effects in the colon: firstly, the pH decreases and, as a result, peristalsis increases, and secondly, the osmotic pressure in the intestinal lumen increases, leading to water retention, an increase in the volume of chyme and acceleration of its movement. The combination of two physiological mechanisms of moderate strength causes a clinical effect comparable to that of other laxatives. Since dufalac is an indigestible disaccharide, it is practically not absorbed and has no side effects. The dose is selected individually for each patient and can range from 15 to 60 ml per day.

Laxatives that increase motility. The drugs in this group include bisacodyl, senna preparations, cisapride. Bisacodyl accelerates and enhances peristalsis by direct stimulation of nerve endings in the colonic mucosa, and also enhances mucus formation in the colon. Does not cause serious side effects. It can be prescribed at a dose of 5-15 mg per day, when taking per os, the effect occurs after 6-8 hours, when using rectal suppositories - after 15 minutes.

Under the influence of senna preparations, absorption of sodium and water ions from the intestinal lumen is inhibited, which leads to an increase in the volume of intestinal contents and increased motility. The drugs are not absorbed. It is recommended to take 1-3 tablets at night. The effect develops after 8-10 hours, the stool returns to normal after a few days of regular use.

Cisapride is a 5HT4 receptor agonist. The mechanism of action is associated with an increase in the release of acetylcholine from the endings of the cholinergic nerves of the mesenteric plexus of the intestine and an increase in the sensitivity of the M-cholinergic receptors of the smooth muscles of the intestine to it. The drug has no dopaminergic effect. The maximum daily dose is 40 mg divided into four doses. Caution should be given to patients with cardiac arrhythmias (may cause prolongation of the P-Q interval). It should be borne in mind that when taking drugs of this group, the appearance or intensification of spastic pain in the abdomen is possible.

Fecal softening agents (sodium docusate, liquid paraffin) are not currently recommended for widespread use due to the presence of severe side effects.

An important role in the prevention and treatment of constipation is the observance of an active motor regimen. Late getting out of bed in the morning, prolonged lying is unacceptable. Walking or skiing, swimming, cycling and other physical activities are very useful. Physical exercises stimulate the motor activity of the intestines, strengthen the muscles of the abdominal wall, increase the tone of the whole organism, and have a beneficial effect on the neuropsychic sphere. Increased physical activity leads to increased intestinal motility and strengthening of the muscles of the abdomen and pelvic floor, which favorably affects the process of bowel movement and the treatment of chronic constipation.

For patients with constipation, mineral waters are shown: Essentuki No. 4, Batalinskaya, Slavyanovskaya, Jermuk, etc. With a decrease in the motor activity of the intestine, as evidenced by a large amount of feces, they recommend more mineralized water Essentuki No. 17. For constipation with increased intestinal contractility, for pain in the stomach, it is preferable to take warm mineral water.

If possible, it is necessary to cancel (or replace with others) drugs that can cause or exacerbate constipation. These include opiates, antacids, ganglionic blockers, diuretics, iron supplements, psychotherapy, and oral contraceptives.

A very important point is the restoration of bowel function. Patients who abuse laxatives, as well as patients with severe suppression of the reflex to defecate, may be recommended a method for restoring the normal motor function of the intestine.

Its main provisions are as follows:
stop taking laxatives that stimulate motility;
the appointment of a diet high in fiber;
being in the toilet for 15-20 minutes every day (preferably in the morning after eating), without the obligatory act of defecation;
in the absence of a chair for 48-72 hours - the use of a cleansing enema. The method is effective in children in 50-75% of cases. In adults, its effectiveness is slightly lower.

Specific methods of treatment include subtotal colectomy with ileorectal anastomosis. This operation is recommended only for patients with a pronounced violation of the tone of the intestine and its propulsive ability with normal function of the anorectal zone. Clinical improvement is observed in 50-100% of cases. However, this method has a number of complications - such as small bowel obstruction (in more than 1/3 of patients), diarrhea, continued constipation.

In this regard, when appointing an operation, all the arguments for and against should be carefully weighed. Intervention is justified only when all attempts at conservative therapy have been ineffective. If a patient is suspected of having anorectal dysfunction, it is advisable to refer him to a specialized institution for the selection of therapy, since the methods used in the treatment of such patients are quite specific.

For example, with dyssynergy of the pelvic floor muscles, biofeedback therapy (a technique based on teaching the patient to conscious contraction-relaxation of the pelvic floor muscles) is successfully used; with dysfunction of the internal anal sphincter - anorectal myotomy. However, different authors evaluate the effectiveness of this treatment method differently. According to the results of some studies, for two years after biofeedback therapy, a gradual return of the patient to the initial state is noted.

Thus, successful treatment of patients with functional constipation involves their thorough examination in order to identify the leading pathogenetic mechanism and determine the tactics of subsequent differentiated therapy.

Good day! It does not really matter at what age there is constipation, since they are most often of a functional nature. Restoring bowel function is not an easy process. One of the causes of constipation is an unhealthy diet. In this case, it is necessary to follow all the recommendations, and in this case the situation can be changed for the better. It is necessary to constantly engage in physical education - this is one of the main recommendations. You can't give up exercise. Another important recommendation to follow is proper nutrition. It is necessary to analyze your daily diet, and, if necessary, correct it. You need to know that for the stable functioning of the intestines, about 30–35 g of fiber is needed every day. Foods such as cereals, fruits and vegetables contain a sufficient amount of fiber. It is required to make a diet so that as much fiber as possible is included in each meal, but not more than normal. To do this, the Internet will help you, everything is explained in detail in the tables. You also need to know that fiber is well absorbed with the right level of fluid in the body. Increase the amount of fiber in your diet gradually. At the initial stage of treatment, in addition to a gradual increase in the level of fiber in the diet, for the occurrence of rhythmic urge to defecate, a laxative course is used for up to one month. Talk to your doctor about the use of any drug from this group. Drinking regime should be plentiful. The amount of liquid consumed per day should be at least 350 ml per 10 kg of body weight. At the initial stage, refrain from using spicy marinades, spices, and alcoholic beverages in your diet. Organize your daily meal in such a way that meals with a lot of fiber are combined with other meals. Remember to alternate plant-based foods with foods that contain proteins and carbohydrates. To constantly support the defecation reflex, it is necessary to drink a glass of cool water on an empty stomach before breakfast. These recommendations will be effective at the entire stage of treatment, the effect will not come very quickly if the rectal reflexes fail due to an unbalanced diet that was before. I would recommend that you make an appointment with your doctor so that in the future you can clarify the course of treatment and diet. If all of the above fails, then it is necessary to continue to investigate the causes that disrupt the functioning of the intestine. Full therapy should be under the guidance of a proctologist.

Violation of the process of urination is a fairly common pathology in the field of urology. As a rule, men and women of advanced age are subject to it. Problems with urination are observed in children and young people, but not as often. In a child, problems with urination are usually caused by the anatomical structure of the body. Urinary disorders include urinary retention, incontinence, urinary pain, and frequent urination. However, all problems with urination are only a bright signal of serious diseases in the pelvic organs or kidneys.

Symptoms

This disease is accompanied by a number of symptoms in patients. First of all, when the patient's bladder is full, the urge to urinate disappears. A healthy person excretes approximately one and a half liters of urine per day, with an approximate frequency of four to six times a day. With urinary retention, a person is unable to completely empty the bladder on their own. Also a characteristic sign of this pathology is pain during emptying. During pregnancy, women suffer from the problem of incomplete emptying of the bladder. The patient's urine changes color, becomes darker, and may also contain blood. General malaise, nausea and often increased pressure are added to the above symptoms.

Causes

There are several reasons why a patient does not have the urge to urinate. Ishuria and anuria are the name of diseases in which. The main causes of these diseases are the presence of stones or tumors in the urethra, kidney problems and damage to the spinal cord.

Diseases and special conditions of the body

When a patient does not urinate, the doctor immediately understands that serious diseases are the cause. It can be cancer of the genitourinary organs, prostatitis in an acute form, or hyperplasia in a benign form. A serious disease, one of the symptoms of which is the lack of desire to empty the bladder and painful sensations at the same time, is urethral stricture. Also, stones in the genitourinary system can become the cause. Urinary retention often occurs after pelvic surgery. Most often, these problems are diagnosed in women after a caesarean section. Injuries to the groin also cause problems with emptying the urethra. A disease such as phimosis also refers to a special condition of the body, in which the patient experiences cramps during urination.

Video: Do you have problems with urination

Diseases of the nervous system

Diseases of the central nervous system are often accompanied by ischuria. If the patient has a tumor or various kinds of injuries in the area of the spinal cord, difficulty with urination is a fairly common accompanying symptom. In this case, the patient cannot empty the urethra, overflowing with urine. Urinary retention in this case is acute (if it came unexpectedly) and chronic (with a prolonged growing pathology). Patients who have had a stroke are diagnosed with others. Also, this pathology is a complication of some brain diseases.

Psychological disorders

Many diseases in the human body are psychosomatic in nature. Difficulty emptying the bladder is no exception. With a disorder of a somatic nature, functional deviations of the internal organs of a person are diagnosed. The cause for urinary dysfunction is often severe stress or upheaval in the patient's life. In medicine, namely in the field of neurology, there is a diagnosis of hysterical anuria, but not all medical professionals and researchers agree with it. Although the fact that urinary retention, which lasts no more than a day and a half, is caused by stress or exhaustion of the patient, is not in doubt.

Violation of reflex activity

The reflex activity of the pelvic organs is carried out along the pelvic nerves. Problems with the excretion of urine from the body, caused by a violation of the reflex activity of the nervous system, have the most complicated form. The urge to urinate occurs in humans at the level of reflexes. If this function is violated, a person feels the filling of the bladder, but cannot empty it on his own.

Features of the structure of the body

The anatomical structure of the body of each person has its own characteristics, which sometimes become the reasons for the occurrence of deviations in the functioning of the body. These deviations lead to the emergence of various diseases in humans, as a rule, these diseases have a chronic form. In men, such features as narrowing of the foreskin, prolapse of the genitals and an underdeveloped state of the genitals are distinguished. In women, problems with urination occur due to genital endometriosis, inflammation of the labia and their subsequent deformation.

Diagnostics

If the patient does not feel the urge to urinate, the doctor first of all directs him to a general urine test, if the patient can pass it. With anuria, the patient is not able to pass urine for analysis, so he is sent for anamnesis. Also, to confirm the fact that the patient has no urine, they are sent for an ultrasound examination. Also, with such a pathology, computed tomography is prescribed.

Treatment of ischuria and anuria

Treatment of these diseases should be prescribed by a doctor after a complete diagnosis. Anuria has several types, based on an accurate diagnosis, treatment is prescribed. In the presence of bleeding, drugs are prescribed that stop it and stabilize the pressure in the veins. Treatment of ischuria and anuria is carried out, as a rule, in a hospital. Bladder catheterization is often prescribed. This occurs by inserting a catheter into the urethra treated before this antiseptic. In this case, resorting to self-medication is strictly prohibited. Self-medication will cause complications, which will be difficult to get rid of.

Prevention

The main and most effective method of preventing these pathologies is the timely treatment of kidney diseases, as well as diseases of the pelvic organs. It is also recommended to conduct periodic examinations with a urologist, adhere to proper nutrition and observe the correct drinking regimen.

Video: Urinary retention: causes and treatment

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