Comprehensive treatment plan for constipation (dysfunctional bowel movements)

Firstly, the type of constipation disease is identified through colonoscopy, abdominal CT, intestinal imaging, etc. Organic diseases such as colorectal tumors, megacolon, and intestinal obstruction are excluded

Firstly, the type of constipation disease is identified through colonoscopy, abdominal CT, intestinal imaging, etc. Organic diseases such as colorectal tumors, megacolon, and intestinal obstruction are excluded. The following is a comprehensive treatment plan for functional constipation.

1. Adjusting lifestyle and dietary habits: Drink plenty of water (about 2000ml of water per day), exercise regularly (about 2 hours of moderate exercise per day), have a balanced diet, do not be picky or anorexic, eat more coarse grains, fresh fruits, and vegetables rich in dietary fiber, avoid spicy, hard, and hot foods that stimulate the diet, avoid smoking and alcohol, maintain sufficient sleep, and have a regular schedule.

2. Develop the habit of regular bowel movements: Regularly use the toilet 1-2 times a day; About 1 hour after meals, due to gastrocolic reflex, it is the best time to defecate. You can also choose your own regular defecation habits based on your personal defecation habits. Every time you defecate for 5-10 minutes (regardless of the amount of bowel movement and the feeling of incomplete defecation), avoid prolonged sitting, squatting, and forceful defecation (within 15 minutes, if it is too long, it will worsen pelvic floor dysfunction), and establish a biological clock for timed defecation.

The above two points are important and must be achieved, as they are the foundation for all subsequent treatments;

3. Drug treatment

3.1 Preferred drugs with no or minimal side effects:

Probiotics:Medilac-s (Bacillus subtilis double live bacteria) 2 capsules, 3 times a day, or regular probiotics such as Peifeikang and whole intestines;

Dietary fiber products: Non bran (wheat fiber granules), 1 pack per time, 2 times per day, (purchased from doorstep pharmacies or online pharmacies);

3.2 If the above treatment is ineffective, laxatives can be added for treatment:

LactuloseLido or Dumike) 15-30ml/time (without defecation on the same day, taken before bedtime) orDuokuester Sodium TabletsOral administration. 1-3 tablets per day for adults. Adjust according to bowel movements;

Colonic motility drugs 1LactuloseDuokuester Sodium Tablets2

Linalotide 1 capsule per day, especially for constipation type irritable bowel syndrome and difficult bowel movements;

Oral administrationParaffin oil20ml/time, twice a day;

4. Psychotherapy

Maintain a good mood, and if there are psychological disorders such as sleep disorders, anxiety, and depression, it is recommended to seek medical attention at a specialized psychological clinic (Children's Psychology and Intestinal Microecology Clinic on Friday afternoon and Saturday morning), and take relevant medication accordingly.

If the above intervention effect is not satisfactory, on the basis of improving colonoscopy examination, Ma Ren Wan, polyethylene glycol, physiological saline or glycerol enema agent can be used for enema as appropriate; If you want further curative treatment,Require hospitalization for intestinal microbiota treatment or surgical treatment

5. Intestinal Microecological Therapy

Fecal microbiota transplantation (FMT) refers to the transplantation of functional microbiota from healthy human feces into the patient's intestines through a nasogastric tube or oral capsule pathway, regulating the imbalance of gut microbiota, rebuilding a functional gut microbiota, and providing assistance for the treatment of intestinal and extraintestinal diseases. The routine hospitalization period for bacterial colony transplantation is 9 days, and the cost is about 15000 yuan. More than 60% of patients have achieved effective improvement.

6Treatment of pelvic floor and perianal diseases

To evaluate the pelvic floor function, if there are pelvic floor problems such as anal delay and unclean defecation, biofeedback treatment should be carried out to train and coordinate the movement of anal muscles and abdominal muscles, correct abnormal myoelectric activities, adjust physiological reactions, re-establish correct defecation feedback channels, and achieve the purpose of treating constipation and pelvic floor muscle dysfunction. If there are rectal mucosal prolapse, hemorrhoids and other organic diseases around the anus, PPH surgery or other perianal surgeries can be considered;

7. Enema treatment

For elderly patients or those who heavily rely on enema for defecation, they can purchase a home enema device or other home enema treatments;

8. Surgical treatment

If the above treatment is not effective and the constipation is expected to be solved radically, surgery can be considered (total colectomy, ileal combined rectum or sigmoid colon anastomosis, etc.). The surgical cost is 60000 to 80000 yuan, the hospital stay is about 2 weeks, and the postoperative cure rate is about 95% (within 3 regular bowel movements).

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