These 9 mistakes are the easiest to make when you encounter constipation!

*Only for medical professionals to read and reference 9 misunderstandings in diagnosis and treatment of constipation, let's see how many you have won! "Doctor X, family members of bed X are here to call you to see the stool!" When I heard these words, I was always shocked when I just entered the gastroenterology department
.

However, after a long period of tempering (the process is not detailed), I have become very used to the stool of diarrhea patients
.

At this stage, the most sad situation is that a familiar patient told me: "Doctor, I haven't solved my stool for another 3 days.
.
.
" Constipation is also a common clinical symptom in the gastroenterology department, in addition to seriously affecting the patient's daily life and In addition to the quality of life, some patients will repeatedly seek medical treatment or abuse laxatives, which increases medical expenses [1]
.

Compared with diarrhea, chronic, protracted, recurrent, unexplained constipation is even more elusive.
.
.
At the 21st National Conference on Digestive Diseases (CGC2021) of the Chinese Medical Association just held in 2021, Shao from Zhejiang University Professor Dai Ning from the Gastroenterology Department of Yifu Hospital explained in detail the misunderstandings in the diagnosis and treatment of chronic constipation, to prevent clinicians from stepping on pits! Not much to say, come and learn! 1Don't treat functional constipation and irritable bowel syndrome (IBS) as two diseases! According to the Rome IV diagnostic criteria for functional bowel disease promulgated by the Rome Committee in 2016, functional constipation and IBS are different manifestations of the same disease spectrum and can be converted to each other
.

Professor Dai Ning pointed out that functional bowel diseases are not isolated from each other, and often change with the progress of treatment and disease
.

Figure 1 IBS constipation and functional constipation often convert each other.
This may be the natural course of the disease, or it may be a response after treatment, or if both have 2 constipation, go to colonoscopy? wrong! Ashamed, I have really stepped on this pit! Colonoscopy in the gastroenterology department works like quantum mechanics, and I always feel that colonoscopy is the "gold standard
.
"
However, Professor Dai Ning pointed out: Functional constipation can be diagnosed based on symptoms, not a diagnosis of exclusion, and colonoscopy is not a necessary condition for evaluating functional constipation; only when the patient has "alarm symptoms", targeted assistance is needed Check to rule out other possible organic diseases
.

Figure 2 List of constipation alarm symptoms 3 Constipation is not necessarily related to slow colonic transit! In fact, the slow transmission type is just one type of constipation
.

In addition, constipation also includes: defecation disorder type, normal transmission type and mixed type
.

Professor Dai Ning pointed out: patients with slow colonic transit have drier stools and harder stools and fewer bowel movements [2]; but patients with slow colonic transit have fewer bowel movements.
There is still controversy [3].
Clinicians can combine stool characteristics to assist.
Determine the type of constipation
.

Patients with defecation disorders are often accompanied by laborious defecation, incomplete defecation, abdominal distension, and even require manual defecation[4], but these symptoms are not sensitive and/or specific for distinguishing patients with slow transit and defecation disorders[4] 5]
.

Symptomology has certain reference value for the classification of chronic constipation, but a clear diagnosis still requires intestinal motility, anal, and rectal function tests
.

4 Abdominal distension ≠ constipation Abdominal distension is the most typical complaint of constipation patients, but abdominal distension ≠ constipation! Professor Dai Ning talked about a special type of abdominal distension-volume-mediated abdominal distension caused by visceral-somatic reflex, which has nothing to do with constipation [6]
.

Under normal circumstances, the human diaphragm is generally in a relaxed state after eating, while the abdominal muscles are in a tightened state.
At this time, the human body will not show abdominal distension; but if the relevant nerve reflexes are abnormal, the diaphragm shrinks and the abdomen after eating When the muscles relax, they squeeze the gas in the intestines and cause abdominal distension
.

For this special type of abdominal distension, Professor Dai Ning suggested using the visual guidance provided by the electromyographic signal to activate the patient's abdominal muscle activity and reduce the intercostal muscle and diaphragm activity for treatment
.

Figure 3 Electromyography guided breathing directed biofeedback therapy 5 laxatives are more reliable than life>And it is not for constipation to eat! Doctors and patients often step on this "pit"! Indeed, proper exercise and increased fluid intake may relieve some of the symptoms of constipation, but a study in 2020 [7] pointed out that life>
.

Professor Dai Ning also agreed with this view: "Life>
.

" This involves constipation.
The most commonly used laxative for patients
.

Professor Dai Ning pointed out that clinicians have many misunderstandings about laxatives, including but not limited to the belief that laxatives are dependent and may become addictive
.

However, so far no studies have confirmed that laxatives have addictive side effects; at the same time, volumetric laxatives and osmotic laxatives are safe for long-term use; even some patients require maintenance therapy with small doses of laxatives [8]
.

Professor Dai Ning also emphasized: "Laxatives should be taken in accordance with normal bowel physiology, rather than being taken when constipation occurs, so as to maintain the frequency of bowel movements and avoid stool blockage[9]
.

For patients with diabetes, lactulose will not It can be absorbed by the intestine, so it can be used safely
.

"6 Melanosis of the colon is not directly related to colon cancer! Figure 4 Melanosis of the colon, Professor Dai Ning pointed out that Melanosis of the colon is a harmless and reversible brown change of the colonic mucosa; it is caused by long-term medication of anthraquinone laxatives that cause colonic epithelial cell apoptosis and macrophages It is caused by internal pigmentation and has nothing to do with colon cancer.
You don't have to see the colonoscopy darkening to associate with colon cancer
.

7 Constipation should eat more dietary fiber, but not all dietary fiber is useful! The World Health Organization and the Codex Alimentarius define: carbohydrates that are not digested and absorbed by the small intestine are called dietary fiber, and dietary fiber that can improve constipation has soluble non-fermented fiber (such as psyllium) and insoluble low-fermented fiber (such as wheat).
bran)
.

In addition, prunes, kiwi, mango, and figs do have the effect of improving constipation
.

Professor Dai Ning pointed out: The current scientific data confirms that prunes can increase the frequency of bowel movements, soften stools, and are more effective than plantain[10]; kiwifruit (2*2 times/day) can increase water retention in the small intestine and ascending colon , Promote defecation [11]; 300g of mango daily for 4 weeks can significantly improve the symptoms of constipation [12]
.

Figure 5 Prunes (Source: Wikipedia) 8 Treatment of constipation, the goal is not to defecate every day! The current FDA's setting for the efficacy endpoint of constipation-related clinical trials is: patients achieve complete spontaneous defecation 3 times a week
.

Professor Dai Ning believes that clinicians should understand the patient’s previous defecation baseline, and the goal of treatment is to restore the baseline.
Over-emphasizing daily defecation may aggravate the patient’s symptoms
.

Figure 6 Treatment goals for constipation 9 Lengthy colon will not cause constipation! The length of the colon may cause more fecal water loss in the colon, and this logic seems impeccable
.

But in fact, the variability of colon length in normal people is very high.
Earlier studies have confirmed that the length of the colon has nothing to do with the symptoms of constipation [13]
.

Of the 9 misunderstandings in the diagnosis and treatment of constipation mentioned above, how many have you gotten? Welcome to tell us in the comment area! Reference: [1] Expert consensus on chronic constipation in China (2019, Guangzhou).
"Chinese Journal of Digestion 39.
9(2019):577-598.
[2] Jaruvongvanich VJ Neurogastroenterol Motil.
2017 0ct 3023(4)561-568.
[ 3]JPediatr.
2013 Jun;162(6):1188-92.
[4]J Clin Gastroenterol2004:38:680-685.
[5]Dis Colon Rectum.
1997 Aug;40(8):902-6.
[6 ]Am J Gastroenterol 202011;115(11).
[7]Neurogastroenterol Motil 2020 05;32(5).
[8]Migeon-Duballet I,et al.
Curr Med Res Opin.
2006 Jun;22(6):1227- 35.
[9]Chinese Journal of Digestion 2016;36:291.
[10]Aliment Pharmacol Ther 2014 oct;40(7).
[11]Aliment Pharmacol Ther 2019 03;49(6).
[12]Mol Nutr Food Res 2018 06;62(12).
[13]Am J Gastroenterol 2005 Jan;100(1).