- Symptoms and symptoms
- Causes constipation in women
- Causes of
- Features of differential diagnosis and treatment
- Problem in pregnancy and after childbirth
- Related videos
Constipation, or pathologically rare defecation, is one of the most frequent complaints in the gastroenterological area, despiteto the fact that many people suffering from this condition do not seek medical help at all, regarding it as not dangerous. Slow passage of food masses through the intestines, their retention in the sigmoid and rectum and, consequently, difficulties with the defecation process, which is characterized by constipation, are explained by a whole complex of factors and can be a manifestation of many serious pathologies.
In developed countries, this phenomenon is very often diagnosed, in almost 20% of the population. And constipation in women are much more common than in men, which is explained by the morphological and functional characteristics of the female body. In addition, the older a person becomes, the more likely it is that he has difficulties with defecation. For example, in the age group after 50 years, constipation in women is diagnosed in almost 40% of people, and in men - in 20%.
Signs and types of
Most people believe that the normal frequency of bowel movements is 1 time per day. However, from a medical point of view, this indicator is not so static and implies significant variability. Each person has his own body features, hormonal background, a certain profession and type of motor activity, as well as eating habits. Therefore, the frequency of the stool may be different. Normally, it ranges from 3 times a day to 3 times a week.
The frequency of defecation is indisputably the leading indicator in the process of diagnosing constipation, but other criteria, from quantity to hardness of stool, are also taken into account. In general, the presence of this condition in adult patients is indicated by the following symptoms, they are also diagnostic criteria:
- rare defecation;
- hard stools in the form of lumps, not less than 25% of cases of defecation;
- need to push;
- appearance after the stool sensation of insufficient bowel movement or presence of any obstruction in it;
- the need for manual assistance when releasing the rectum from stool.
The state of the large intestine largely determines the frequency of defecation
These signs are considered the main diagnostic markers of pathology. If the patient has at least 2 criteria from the list, which are available for 3 months, then the diagnosis of constipation is confirmed. However, there are additional symptoms that are also very important for the doctor. This feeling of raspiraniya and discomfort in the abdomen and in the zone of the anus, the heterogeneity of feces, increased gas formation and flatulence.
The severity of signs in women depends on various factors. Their intensity is affected by such factors as the level of the hormonal background, which largely determines the speed of intestinal motility( after 40-50 years it decreases), the presence of pregnancy, as well as the possible accompanying pathologies of the gastrointestinal tract.
Therefore, in clinical practice, there is the following classification of female constipation:
- primary, which does not diagnose any organic pathology of the intestine. Often they are also called functional or temporary, associated, for example, with menopause, pregnancy, or the postpartum period.
- secondary, formed against a background of serious diseases of the small or large intestine( benign or malignant neoplasms, diverticulosis, megacolon), against the background of neurological, endocrine, metabolic, psychiatric abnormalities.
Of course, both the therapeutic approaches in each case are different. There is also a further forecast for the woman's health. For example, in the menopause, to normalize intestinal motility and provide regular stools, it is necessary to achieve a hormonal balance in the female body, adjust diet and exercise. In cases where constipation is one of the manifestations of the tumor process, the therapeutic approach is more radical.
Do constipation in women
Unfortunately, not all patients are aware of the danger of emerging difficulties with defecation, so there are often cases of late diagnosis of serious organic diseases of the gastrointestinal tract. But, even in the absence of pathologies of the intestine, functional constipation can also bring considerable damage to the body. The accumulating stools become the focus of the formation of a huge amount of toxins, they begin to multiply bacteria and provoke the onset of inflammatory processes. Frequent straining during defecation and movement of solid fecal lumps can lead to rupture of the mucous membrane of the rectum and the formation of painful cracks, to the loss of the anus of the part of the intestine.
Discomfort and a feeling of abdominal distension often accompany constipation
In addition, unauthorized and uncontrolled intake of laxatives, helping, on the one hand, to empty the bowel, simultaneously leads to a decrease in the natural intestinal peristalsis. The more often the patient "leans" on medicines, the sooner his intestines "forget" himself to move the stool and the faster the chronic constipation will form.
As already indicated, the causes of constipation in women are determined not only by lifestyle, nutrition or work activity. The state of other internal organs, age, the degree of working capacity of the gonads, the presence of a period of pregnancy and lactation have a huge effect on the functionality of the intestine.
Therefore, all the variety of factors provoking the appearance of constipation can be expressed as follows:
- irrational and malnutrition, which is characterized by the prevalence of "fast" food, on the run and on dryness, without sufficient fiber and vitamins, with increasedthe content of carbohydrates and fats;
- addiction to various diets, especially mono-diets, a sharp change of products;
- insufficient fluid intake;At a daily volume of less than 2 liters, the stool masses naturally become denser and are more slowly excreted;
- is a "sedentary" lifestyle, without daily motor activity, which should stimulate the intestine to work;
- frequent course methods of antibacterial agents with various purposes, which has a very negative effect on the state and viability of normal intestinal microflora;
- pathological processes in the intestinal tract( tumors, hemorrhoids, ulcer lesions, anatomical-morphological anomalies);
- diseases of other internal organs( diabetes mellitus, Addison's disease, hypothyroidism, myotonic dystrophy, systemic lupus erythematosus, systemic sclerosis);
- neurological pathologies( neurofibromatosis, Parkinson's disease, polyneuritis, tumors and vascular diseases of the brain and spinal cord);
- psychiatric pathologies( anorexia, depression), drug use, smoking mixtures;
- metabolic disorders( hypokalemia, hypercalcemia);
- traumatic intestinal damage;
- physiological and hormonal changes in the female body during pregnancy and lactation;
- age changes.
The definition of the leading cause of constipation in a woman or their complex is the basis of the therapeutic approach. Eliminating the provoking factors, in most cases it is possible to solve the problem with the restoration of the intestinal functionality. But before charting a therapeutic scheme, it is important to differentiate a state, such as constipation, and determine its type, prescription, severity, prognosis.
Special baking and sweets can cause constipation formation
Differential diagnosis and treatment features of
In addition to the patient's complaints about difficulties with defecation for a long time, the specialist takes into account the following aspects:
- already diagnosed and confirmed pathology in the patient with the possibility of constipation;
- the age of a person( for example, the period of 30-40 years is less frequent with constipation than the age after 50 years);
- presence of rectal bleeding( from the rectum);
- presence of signs of intoxication( fever, weakness, decreased appetite);
- weight loss;
- decrease in hemoglobin of blood( anemia);
- palpable at examination of the patient.
It is necessary to do this in time to diagnose primary, or functional, and secondary constipation, which most often become the consequences of serious background diseases. In clinical practice, in most cases, about 70%, difficulties with defecation are explained by temporary and functional factors that require a conservative treatment approach. But in order to find out and correctly differentiate female constipation, it is important to conduct an additional examination of the patient: laboratory and instrumental.
Laboratory methods include the study of blood, which determines both the general parameters and C-reactive protein, the level of electrolytes, the glucose content, the amount of thyroid hormones and the pituitary gland. Urine and feces( coprogram, presence of enteropathogenic microflora) are also studied.
Very often, there are also instrumental diagnostic methods that give a maximum of information about changes in the structure and performance of the intestine, as well as its blood supply. These include X-ray examination, including with contrast material, colonoscopy, MRI, CT, anorectal manometry, balloon test, capsular endoscopy.
All medications with constipation are accepted only with the permission of the doctor
. All the information obtained helps to determine what constipations occur in the patient and how to prepare the treatment. In situations where background diseases are detected, therapy focuses on them, because it is necessary to first eliminate the leading cause. To further stimulate the small and large intestines, optimize the structure and amount of fecal matter and normalize the rate of their transit, the following treatment directions are used:
- Medications that soften fecal masses and affect the intestinal motility process:
- dosed use of laxatives of various mechanisms of action;
- increasing the volume of mass( Psillum, Methylcellulose);
- softening agents( Glycerin, natural oils);
- osmotic( Sorbitol, Lactulose, Polyethylene Glycol);
- stimulating and enterokinetic( Bisakodil, Senna, Lyubiprostan).
- according to the indications the methods of physiotherapy( ascending shower, electrophoresis with spasmolytic, UFO);
- sufficient drinking regime( at least 2 liters per day);
- diet with a decrease in carbohydrates and animal fats, with a predominance of vegetable fats, fiber fruits and vegetables;
- daily physical activity.
These treatment stages can only be prescribed by a doctor, no self-medication is allowed. The same applies to the methods of traditional medicine, which remain extremely popular among the population. Any forced stimulation of the intestine, not prescribed by a doctor and without appropriate diagnosis, can cause great harm to a woman's health.
The problem in pregnancy and after childbirth
Separately, it should be noted the situation where most of the pregnant women suffer from difficulties with defecation. This complaint is made by almost 60% of expectant mothers, and mainly in the last trimester. These constipations are temporary and, as a rule, completely disappear after childbirth or after the end of the period of breastfeeding of the baby. They can also be called functional, which do not have any "organic" basis and do not require medication.
Constipation during pregnancy is explained by a whole complex of causes
Factors that explain why constipation appeared during pregnancy or in the postpartum period, there are several:
- gradual increase in the size and mass of the uterus, which presses not only the bladder, causing frequent urination in small portions,but also squeezes the intestines, making it difficult for them to transit feces;
- changes in the hormonal background during pregnancy, which lead to a slowing of the intestinal peristalsis;
- features hormonal background during lactation, also reducing the functionality of the intestine;
- constipation in women who have given birth can be caused by weakness of the pelvic muscles, breaks of soft tissues of the pelvic floor, surgical interventions.
In order to overcome such manifestations and consequences of pregnancy and childbirth as soon as possible, it is necessary to consult a specialist who, in most cases, will limit himself to recommendations on nutrition and motor activity. Laxatives and other medicines, as well as physiotherapy, are not prescribed to pregnant and lactating women.
From foodstuffs one should prefer bread of coarse grind, vegetables and fruits, grains, vegetable oils, drink more liquids. It is important to limit sweets and other "fast" carbohydrates, animal fats, carbonated drinks. It is necessary to do every day gymnastic exercises, feasible for a woman, and also to make walks.
In any case, the problem of constipation in women requires a differentiated approach. First of all, it is necessary to find out their cause, which will determine the complex of therapeutic measures.