Intussusception 5/5 (11)

Intestinal obstruction (Latin ileus) is a syndrome indicating partial or complete completion of the process of advancing the food flow, which is considered to be a consequence of the presence of an obstacle or cessation of the intestinal motor function.

Obstruction is divided into acute course and partial course of the disease. The acute course of the disease means a sharp cessation of the work of the intestinal walls to move food and juices. Partial leakage means the presence of adhesions and tumors. Symptoms are mild and protracted.

What is constipation

Constipation is said to occur when a person has infrequent or difficult bowel movements.
On average, it is believed that the number of bowel movements should not be less than 3 times a week, although in fact there are no required minimums or maximums. Also, defecation should occur without tension, frequent and prolonged straining. And after defecation, a person should not have the feeling of incomplete bowel movement. Constipation is defined as slow or difficult bowel movements. In the medical literature, this condition is also called constipation or obstipation. Moreover, the term “constipation” itself is not just colloquial and appears in the International Classification of Diseases ICD-10.

Important! According to statistics, up to half of the population of developed countries experience difficulties with defecation. At the same time, constipation is not only a problem for adults. Constipation also occurs in 5-20% of children. With age, the likelihood of constipation (as well as other gastrointestinal disorders) increases. Thus, in older people over 65 years of age, constipation occurs 4-5 times more often than in young people.

People of all ages experience constipation for various reasons. According to the etiological factor, constipation is divided into organic and functional.

Organic constipation

Constipation is considered organic if it is caused by congenital developmental abnormalities, inflammatory or tumor diseases of the intestine. For example, constipation occurs with congenital intussusception, volvulus, inflammatory damage to the omentum and a number of other pathologies. In other words, such constipation develops against the background of organic intestinal lesions.

Functional constipation

Functional constipation develops against the background of impairment of certain functions. For example, secretory or suction. Constipation often occurs due to disruption of the nervous system, including under severe stress.

With functional constipation (FC), there are no organic intestinal lesions. In children and adolescents, FZ is determined by criteria including: infrequent and hard stools, fecal incontinence, painful bowel movements - provided that these symptoms are not explained by another medical condition, according to the Rome IV criteria (functional gastrointestinal diseases). In adults, the criteria are slightly different, including a feeling of straining or obstruction, a feeling of not completely emptying the bowels, and infrequent (less than 3 times a week) hard stools in at least a quarter of all bowel movements. However, sometimes patients may have bloating or abdominal pain - but these are not the predominant symptoms of FZ.

According to the nature of the course, constipation is divided into acute and chronic. Let's take a closer look at the features of acute and chronic constipation.

Acute constipation

This is episodic constipation that occurs suddenly and lasts no more than 12 weeks. Most often, acute constipation occurs due to poor nutrition and organic intestinal lesions, and less often due to functional disorders.

Acute constipation can occur with intestinal obstruction, inflammatory diseases of the gastrointestinal tract, disorders of the nervous system, endocrine pathologies, physical inactivity and other diseases and circumstances. Sometimes severe constipation occurs as a side effect of taking certain medications.

Chronic constipation

With chronic constipation, difficult or infrequent bowel movements occur for 12 weeks or more. People suffering from chronic constipation have bowel movements less than 3 times a week for a long period of time. This condition significantly reduces the quality of life and is also fraught with the development of a number of complications. In particular, chronic constipation can lead to anal fissure, hemorrhoids, rectal prolapse and other complications.

Symptoms of intestinal obstruction

The first sign is bloating. The second sign is the appearance of sharp pain in the abdomen. The pain is accompanied by nausea and vomiting. First, the vomiting will be food, then bile, and at the last stage - the contents of the intestines with the smell of feces. The third sign is constipation and the inability to pass gas. An unbearable desire to go to the toilet “in a big way” will appear. But it will be impossible to do this. Even after a cleansing enema and the release of a large amount of stool and gas, it is impossible to experience relief, or it will not last long.

Causes of constipation

Constipation develops against the background of congenital or acquired organic changes in the intestine. As a rule, these are anatomical abnormalities of the intestines that slow down the movement of feces. Such pathologies include:

• Dolichocolon is an abnormal elongation of one of the sections or the entire colon. Thus, the movement of feces through the large intestine slows down. Dolichocolon can be congenital or acquired. If the congenital pathology is not treated, then in adulthood the colon will be elongated. Acquired dolichocolon in adults develops against the background of frequent use of enemas and abuse of laxatives. Lengthening of the colon is also possible if metabolic processes in the large intestine are disrupted.
• Megacolon is a pathological enlargement of the large intestine that occurs due to congenital disorders of the innervation (supplying the organ with nerves - provides communication with the central nervous system) of the colon. Like dolichocolon, megacolon can be congenital or acquired. With congenital megacolon, already from the first years of life, the child experiences constipation due to slow passage of feces. Sometimes constipation also bothers newborns who are diagnosed with Hirschsprung's disease.
• Dolichosigma is an increase in the size of the sigmoid colon. This pathology is also congenital or acquired. Congenital dolichosigma is a consequence of a violation of intrauterine development of the fetus. In adults, the sigmoid intestine lengthens with a sedentary lifestyle against the background of fermentation and/or putrefaction processes in the large intestine. With dolichosigma, the frequency of bowel movements is approximately once every 3 days. In severe cases, stool retention reaches up to 8-10 days. In this state of affairs, there is a risk of intestinal obstruction and even peritonitis, which can develop with intestinal perforations due to constipation.

Slow passage of feces in the sigmoid colon is also possible in the presence of additional loops and kinks in this section of the intestine.

• Colonoptosis is a prolapse of the colon associated with weakness of the mesenteric ligaments (thanks to it, the intestines are attached to the posterior wall of the abdomen). It is not uncommon for the colon to prolapse in women after childbirth. Against the background of colonoptosis, intestinal motility worsens, which is why constipation occurs. One of the variants of colonoptosis is transversoptosis, in which prolapse of the transverse colon occurs. Transvertoptosis often develops against the background of spinal diseases - scoliosis or lordosis.
• Ileocecal valve dysfunction. The ileocecal valve (bauginian valve) is located at the border between the small and large intestines. This valve prevents the contents of the large intestine from refluxing into the small intestine. If the functioning of the bauhinium valve is disrupted, then the movement of feces through the colon slows down, which leads to constipation and/or diarrhea. Often with this pathology, a person alternates between periods of constipation and diarrhea.
• Diverticulosis is a protrusion of one of the sections of the large intestine. The most common protrusion is the sigmoid colon. As a rule, diverticulosis is acquired and most often occurs in older people. The appearance of such diverticula leads to slower stool passage, pain, bloating and intestinal bleeding.

Figure 1. Main causes of constipation. Source: MedPortal

Causes of acute constipation

Now let’s take a closer look at the reasons for the development of acute constipation in adults and children. Acute constipation most often develops with intestinal obstruction, an acute condition that is caused by fecal impaction, hernia, adhesions, volvulus, or tumors in the intestine.

Separately, there is a dynamic intestinal obstruction (caused by impaired peristalsis), which, for example, occurs with peritonitis, severe injuries to the brain and spinal cord, as well as with prolonged physical inactivity (for example, bed rest).

Acute constipation due to medication use

Some medications have side effects that include disturbances in the functioning of the gastrointestinal tract, in particular constipation. These medications include, for example, drugs with anticholinergic effects. These are allergy medications (antihistamines), antispasmodics and antipsychotics. Constipation can also be caused by taking medications containing bismuth, iron, barium, calcium and aluminum.

Taking antibiotics also leads to changes in the functioning of the large intestine. The exact reasons for the development of constipation while taking antibiotics are still unknown. According to most researchers and doctors, constipation occurs due to dysbiosis, which develops with long-term use of systemic antibacterial drugs. Obviously, with dysbacteriosis, the physiological activity of the large intestine decreases, which causes peristalsis to worsen and the movement of feces through the intestine to slow down.

Constipation due to a sedentary lifestyle

Almost all bedridden patients, as well as most people leading a sedentary lifestyle, sooner or later experience constipation. This is due to the fact that the lower part of the rectum is most sensitive to the pressure exerted by the rectum filled with feces. Therefore, the urge to defecate increases in an upright position.

Constipation after surgery

Temporary constipation often occurs in patients who have had gallbladder removal or intestinal surgery. When the gallbladder is removed, the leading cause of constipation is postcholecystectomy syndrome, which reduces intestinal tone. Partial removal of the intestine, anastomosis, suturing of the intestinal wound and other surgical interventions on the intestine are also fraught with stool problems - constipation or diarrhea.

Causes of chronic constipation

As for chronic constipation, they are most often caused by the following diseases and circumstances:

• Tumors of the colon, most often parts of the sigmoid colon.
• Endocrine diseases - diabetes mellitus, hypothyroidism (lack of thyroid hormones), hypo- and hypercalcemia (lack or excess of calcium in the body). Constipation also occurs due to hormonal changes during pregnancy.
• Diseases of the nervous system. These are various pathologies of the central and peripheral nervous system. Most often, constipation is accompanied by Parkinson's disease, circulatory disorders, spinal cord pathologies, multiple sclerosis, neuropathies, neurofibromatosis, Hirschsprung's disease and others.
• Functional disorders. Most often these are diseases combined into irritable bowel syndrome.
• Nutritional features. Depending on your eating habits, constipation can be episodic or long-lasting. Insufficient consumption of dietary fiber (fiber), as well as lack of fluid, are the main reasons contributing to the retention of feces in the intestines. Foods that slow down the movement of feces: rice, potatoes, meat and meat products, as well as pasta and bread.

Why is constipation dangerous?

Source: ru.freepik.com
The danger of constipation depends on the stage - compensated, subcompensated and decompensated.

• Compensated constipation is most often observed in people under 45-50 years of age. This form of constipation does not pose a serious danger to the body. As a rule, dietary adjustments and physical activity are sufficient to eliminate such constipation.
• Subcompensated constipation is a more serious form of constipation, in which some pathological changes in the gastrointestinal tract are already noted. At this stage, people experience liver damage, abdominal pain, as well as damage to other organs and systems.
• Decompensated constipation is observed against the background of serious pathological changes in the body. With decompensated constipation, bowel movements may not occur for up to 7 days or more. Undesirable consequences of constipation include inflammatory bowel disease, bleeding during bowel movements, hemorrhoids, and the risk of tumors.

Constipation in pregnant women

During pregnancy, constipation often occurs due to hormonal changes. The situation is aggravated by dietary violations and taking iron and calcium supplements. Already in late pregnancy, constipation occurs due to decreased physical activity, increased size and changes in the position of the fetus (when the baby's head puts strong pressure on the intestines), as well as emotional experiences.

Common consequences of constipation in pregnant women include:

• disturbances of intestinal microflora;
• inflammatory diseases of the female genital organs;
• intoxication of the body due to putrefactive processes in the intestines;
• premature birth (due to strong straining during bowel movements).

Constipation in a child

Constipation in children is a fairly common problem. However, the causes of constipation in children are not the same as in adults. Most often, the causes of constipation in children are allergies, improper feeding of the child, as well as congenital abnormalities of intestinal development.

Early potty training and inadequate sanitary conditions in the place of residence or study also contribute to the appearance of constipation in a child.

As in adults, frequent and prolonged constipation in children can trigger the development of inflammatory diseases of the gastrointestinal tract. In addition, constipation weakens the child’s immunity and contributes to frequent colds and other infectious diseases.

When to see a doctor

Occasional constipation happens to everyone. Most likely, the cause is poor nutrition or stress. Such cases do not require medical intervention and go away on their own with normalization of nutrition. You should consult a doctor if constipation bothers you often and for a long time. The fact that laxatives are needed for normal bowel movements already suggests that it’s time to see a doctor.

Treatment

Treatment of constipation involves correction of diet and lifestyle, as well as the use of folk remedies and medications. If constipation develops against the background of another disease, then treatment should be aimed at eliminating the causative pathology. In severe cases, treatment of constipation includes surgery (for example, in case of acute intestinal obstruction).

What to do if you are constipated

If you have constipation, your doctor will usually recommend reconsidering your eating habits. Here are some tips to follow when treating constipation:

• Eat more dietary fiber (fiber). They are found in vegetables, fruits, legumes and whole grain bread.
• Move more. Try to spend more time on physical activity. Regular walking at a medium or fast pace will be helpful. This speeds up intestinal motility and promotes freer movement of feces.
• Drink more fluids.
• Don't be patient. If you feel the urge to defecate, go to the toilet immediately. If you often ignore the urge to defecate, over time these signals weaken, which leads to bowel dysfunction.
• Less stress. It is better to avoid stress, since constipation often occurs against the background of emotional experiences.

Medicines

If correction of diet and lifestyle is not enough to get rid of constipation, then in this case the person is prescribed medications that accelerate the evacuation of feces and relieve the unpleasant symptoms that accompany constipation. These medications include:

• Secretory laxatives - have an irritating effect on intestinal receptors.
• Bulk laxatives – increase the volume of stool by absorbing water, thereby speeding up the passage of stool.
• Osmotic laxatives are drugs that increase the osmotic pressure in the intestines, which promotes the flow of water.
• Emollients – soften stool, speeding up its elimination from the intestines. Unlike stimulants, emollients act more slowly.
• Probiotics are preparations containing live cultures of beneficial bacteria. These medications can help with dysbiosis.

Home Remedies

The following home remedies can help relieve constipation:

• A glass of water on an empty stomach has a stimulating effect on the intestines.
• Dried fruits have a laxative effect. Prepare a puree from pre-soaked dried fruits (dried apricots, prunes, raisins, figs and dates) and honey. Take morning and evening instead of dessert.
• Cucumbers, plums and beets – eat more of these vegetables and fruits as they have a laxative effect.
• Morning coffee has a stimulating effect on the intestinal mucosa, stimulating peristalsis.

ethnoscience

Humanity encountered constipation long before the advent of pharmacological agents. There are several more or less effective remedies, but before using them it is best to consult a doctor. There are four such means:

• Herbs with a laxative and stimulating effect - senna leaves, dill seeds, plantain seeds, cumin.
• Vegetable oils - flaxseed, olive, castor, pumpkin, sea buckthorn and sesame.
• Bran – wheat, buckwheat, oat and others.
• Freshly prepared vegetable juices - potato, cucumber, beet, carrot and celery juice.

How to quickly get rid of constipation

It all depends on the cause and stage of constipation. If this is episodic constipation, then quick relief occurs with correction of nutrition and physical activity. In more complex cases, it is necessary to follow all the doctor’s recommendations. And remember that when taking medications for constipation, adjustments to your diet and lifestyle are necessary. Only an integrated approach will allow you to effectively cope with the problem.

How to treat dysphagia?

The first step in the treatment of dysphagia of organic etiology is to influence impaired motor skills and eliminate causative factors.

Correction of motility is carried out with the help of medications that have a stimulating or inhibitory effect on the muscular apparatus of the esophagus.

1. Treatment with drugs that have an stimulating effect (prokinetics): selective - domperidone and non-selective drug - metoclopramide. Metoclopramide enhances the muscle tone of the lower esophageal sphincter, its peristalsis, and causes the fastest passage of food from the stomach and throughout the intestines. The average dosage of metoclopramide is 10 mg. three times a day, the drug is taken half an hour before meals. Sometimes a fourth dose of metoclopramide can be added. If the drug is prescribed parenterally, the dose will be 10 mg. 1-2 times a day. Another drug that has a selective mechanism of action is domperidone. The effects of the drug are the same, except for the effect on the large and small intestines. There are far fewer side effects than metoclopramide. Dosage 10 mg. three times a day, take 30 minutes before meals or before bed.
2. If a patient's dysphagia is accompanied by hypermotility of the digestive system, it is advisable to begin treatment with antispastic medications. These include non-selective anticholinergics, calcium channel blockers, nitrates and myotropic antispasmodics. The best effect is achieved by the selective anticholinergic blocker of M1 receptors - gastrocepin. Take 50 mg. twice a day. Of the calcium channel blockers, dicetel is most often used at a dose of 50-100 mg three times a day. Of the nitrates, preference is given to prolonged ones - isosorbide mononitrate (0.01-0.02 g twice a day), isosorbide dinitrate (0.005-0.01 three or four times a day). Of the myotropic antispasmodics, noshpa (0.04 g), nikoshpan tablet, and duspatalin 0.2 g twice a day are quite effective.
3. Treatment of each type of dysphagia has certain subtleties, for example, the main treatment for esophageal achalasia is the balloon pneumocardiodilation method. Less commonly used is a technique based on botulinum toxin - it is injected into the thickness of the lower sphincter of the esophagus. If conservative treatment turns out to be ineffective, they resort to surgical methods, most often myotomy operations.