Management of Constipation in Adults便秘的人管理22页PPT

关于便秘的英语作文提纲Constipation is a common digestive problem that affects people of all ages. It occurs when bowel movements become difficult or infrequent, often resulting in discomfort and pain. In this article, we will explore the causes, symptoms, and potential remedies for constipation.Causes:1. Inadequate fiber intake: A diet lacking in fiber can lead to constipation. Fiber adds bulk to the stool and helps it move through the digestive system.2. Lack of physical activity: Regular exercise promotes healthy digestion and prevents constipation.3. Dehydration: Insufficient water intake can cause the stool to become hard and difficult to pass.4. Medications: Certain medications, such as painkillers, antidepressants, and iron supplements, can contribute to constipation.5. Stress: High levels of stress can disrupt the normal functioning of the digestive system, leading to constipation.Symptoms:1. Infrequent bowel movements: Bowel movements less than three times a week may indicate constipation.2. Hard or lumpy stools: Difficulty passing hard, dry stools is a common symptom.3. Abdominal discomfort: Cramping, bloating, and abdominal pain can occur due to constipation.4. Straining during bowel movements: Excessive straining or a feeling of incomplete evacuation is often experienced.5. Rectal bleeding: In some cases, constipation can cause small tears in the anus, leading to bleeding.Remedies:1. Increase fiber intake: Consuming more fruits, vegetables, whole grains, and legumes can help soften the stool and promote regular bowel movements.2. Stay hydrated: Drinking an adequate amount of water throughout the day can prevent dehydration and keep the stool soft.3. Exercise regularly: Engaging in physical activity, such as walking or jogging, stimulates the muscles in the intestines and promotes bowel movements.4. Establish a regular bathroom routine: Setting aside a specific time each day to use the bathroom can help train the body's digestive system.5. Avoid delaying the urge to go: Ignoring the urge to have a bowel movement can lead to constipation. Responding promptly to the body's signals is important.6. Over-the-counter remedies: In some cases, laxatives or stool softeners may be recommended by a healthcare professional to provide short-term relief.Prevention:1. Maintain a balanced diet: Consuming a diet rich in fiber, along with adequate fluid intake, can prevent constipation.2. Stay active: Regular exercise not only promotes overall health but also helps maintain proper bowel function.3. Manage stress levels: Practicing stress-reducing techniques, such as meditation or yoga, can help prevent constipation caused by stress.4. Avoid excessive use of laxatives: Overuse of laxatives can lead to dependency and worsen constipation in the long run.In conclusion, constipation is a common digestive issue that can cause discomfort and inconvenience. By understanding the causes, symptoms, and remedies discussed in this article, individuals can take proactive steps to prevent and manage constipation, leading to improved digestive health. Remember to consult a healthcare professional if constipation persists or is accompanied by severe symptoms.。

AMERICAN GASTROENTEROLOGICAL ASSOCIATION American Gastroenterological Association Medical Position Statement:Guidelines on ConstipationThis document presents the official recommendations of the American Gastroenterological Association(AGA)on constipation.It was approved by the Clinical Practice and Practice Economics Committee on March4,2000,and by the AGA Governing Board on May21,2000.S ymptoms of constipation are extremely common;the prevalence has been reported to be as high as20%. Many people seek medical care for constipation,but fortunately,most do not have a life-threatening or dis-abling disorder,and the primary need is for control of symptoms.The impressive number of people affected and the cost of most diagnostic tests dictate that,in the next century,we manage this symptom in a cost-effective manner.Therefore,internists and gastroenterologists must be efficient in excluding life-threatening or treat-able conditions,in identifying persons who may benefit from specialized testing,and in developing effective therapy that will relieve symptoms as much as possible. We suggest the following practice guidelines for the symptom of constipation;our rationale for these guide-lines is supported by the accompanying technical re-view.1Constipation is a symptom that can be associated with life-threatening diseases,although these are in this re-view primarily for exclusion.Thus,recommendations will relate to(1)more rational and,where possible,less invasive diagnostic approaches,and(2)more rational and efficacious therapies that will improve the quality of life, both of which should have(3)beneficialfiscal and logis-tic impacts on the health care system.DefinitionsAlthough physicians often focus mainly on the infrequency of bowel movements in the definition of constipation,patients have a broader set of complaints. The lower limit of normal stool frequency usually quoted is3per week,and2or fewer stools weekly has been included as one of the Rome consensus criteria for the symptom.In this Rome definition,frequency was only1 of6prime features(including straining,hard stools,and a feeling of incomplete evacuation).It has been estimated that the symptoms encompassed by the patients’defini-tions are(in decreasing importance)straining,stools that are excessively hard,unproductive urges,infrequency,and a feeling of incomplete evacuation.In practice,it is not unusual for patients to describe constipation while having their bowels move often on a daily,and even more frequent,basis!Clinical SubgroupsThe symptom of constipation may arise secondary to another condition.These include primary diseases of the colon(stricture,cancer,analfissure,proctitis),met-abolic disturbances(hypercalcemia,hypothyroidism,di-abetes mellitus),and neurologic disorders(parkinsonism, spinal cord lesions).Some of these will be amenable to specific therapies,but when they are not,the challenge remains one of symptomatic treatment of constipation. On the other hand,constipation is the major feature of 2disorders of colorectal motility.Slow-Transit ConstipationSlow-transit constipation(“colonic inertia”)is thought to have as a primary defect slower than nor-mal movement of contents from the proximal to the distal colon and rectum.In some individuals,the basis for slow transit may be dietary or even cultural.In others,slow colonic transit probably has a true patho-physiologic basis,although little is known about these mechanisms.Indeed,it has been suggested that there are2subtypes of slow-transit constipation:(1)colonic inertia,possibly related to decreased numbers of high-amplitude propagated contractions.These peristaltic sequences are thought to be the mechanism for the mass movement of colonic contents.Thus,their ab-sence is expressed as prolonged residence times of fecal residues in the right colon and(2)increased,uncoor-dinated motor activity in the distal colon that offers a functional barrier or resistance to normal transit.This distinction requires colonic manometry for its defini-tion,although this technique is not generally available and is not appropriate for most patients,except in research settings.GASTROENTEROLOGY2000;119:1761–1778Pelvic Floor DysfunctionPelvicfloor dysfunction is the other major patho-physiologic condition.It features normal or slightly slowed colonic transit overall,but a preferential storage of residue for prolonged periods in the rectum.In this instance,the primary failure is an inability to evacuate adequately contents from the rectum.This functional defect in coordinated evacuation has received numerous names(“outlet obstruction,”“obstructed defecation,”“dyschezia,”“anismus,”“pelvicfloor dyssynergia”).The plethora of pseudonyms expresses our incomplete under-standing of the mechanisms and has complicated,and perhaps confused,what otherwise is an important con-cept.Combination SyndromesCombination syndromes are often observed clini-cally,in which elements of slow transit and disorders of evacuation coexist,often in conjunction with other fea-tures of the irritable bowel syndrome(IBS).The presence of pain as a major component should evoke this possi-bility.Clinical EvaluationHistorical features are key,and the questioning of the patient must be specific.What feature does the patient rate as most distressing?Is it infrequency per se, straining,hard stools,unsatisfied defecation,or symp-toms that occur between infrequent bowel movements (bloating,pain,malaise)?Presence of these last charac-teristics suggests underlying IBS.Pelvicfloor dysfunction should be suspected strongly on the basis of a careful history and physical examination. Prolonged and excessive straining before elimination are suggestive;when evacuatory defects are pronounced,soft stools and even enemafluid may be difficult to pass.The need for perineal or vaginal pressure to allow stools to be passed or direct digital evacuation of stools is an even stronger clue.It is important to raise these questions early because evacuatory disorders do not respond well to standard laxative programs,and failure to recognize this component is a frequent reason for therapeutic failure. The current regime and bowel pattern should be re-corded.How often is a“call to stool”noted?Is the call always answered?What laxatives are being used,how often,and at what dosage?Are suppositories or enemas used in addition?How often are the bowels moved,and what is the consistency of the stools?Physicians and patients need to be aware that after a complete purge,it will take several days for residue to accumulate such that a normal fecal mass will be formed.Importantly,many commonly used medications have constipation as a no-table side effect(e.g.,anticholinergics,calcium channel blockers).A full record of prescription and over-the-counter medications must be obtained.The physical examination and screening tests,if deemed appropriate,should also eliminate diseases to which consti-pation is secondary(see technical review).Physicalfindings of more direct importance are confined to the perineal/rectal examination,but the following may be key:●In the left lateral position,with the buttocks sepa-rated,observe the descent of the perineum during simulated evacuation and the elevation during a squeeze aimed at retention.The perianal skin can be observed for evidence of fecal soiling and the anal reflex tested by a light pinprick or scratch.●During simulated defecation,the anal verge shouldbe observed for any patulous opening(suspect neu-rogenic constipation with or without incontinence) or prolapse of anorectal mucosa.●The digital examination should evaluate restingtone of the sphincter segment,and its augmentation by a squeezing effort.The voluntary external anal sphincter will be tightened by squeezing;the inter-nal sphincter will not.Above the internal sphincter is the puborectalis muscle,which should also be palpated during the squeeze and compressed be-tween the examiningfinger and the thumb.Acute localized pain along the border of the muscle is a feature of the puborectalis spasm syndrome.Finally, the patient should be instructed to integrate the expulsionary forces by requesting that she/he“expel myfinger.”●An examination should then be made to look for arectocele,or consideration be given to gynecologic consultation.After the initial history and physical,a set of focused tests should be considered to exclude disorders that are either treatable(e.g.,hypothyroidism)or important to diagnose early(e.g.,colon cancer).However,data do not exist to strictly evaluate and define the tests that need to be plete blood cell count and thyroid-stimu-lating hormone and serum glucose,creatinine,and cal-cium tests are inexpensive and serve a screening function.A structural evaluation of the colon is appropriate,espe-cially if the patient is older than50years or has not had previous screenings for colorectal cancer and colitis. Colonoscopy orflexible sigmoidoscopy and barium en-1762AMERICAN GASTROENTEROLOGICAL ASSOCIATION GASTROENTEROLOGY Vol.119,No.6ema should effectively exclude lesions that could cause constipation.If this evaluation leads to a diagnosis,the appropriate treatment can be offered.The patient’s medications can be adjusted when possible to avoid those with constipat-ing effects.Advice regarding exercise and water intake should be provided and a trial of fiber instituted.At the conclusion of this initial evaluation,the patient complaining of constipation can be tentatively diagnosed as having (1)IBS,when pain and the other features of IBS are present;(2)slow-transit constipa-tion;(3)rectal outlet obstruction;(4)a combination of (2)and (3);(5)organic constipation (mechanical ob-struction or drug side effect);or (6)constipation sec-ondary to systemic disease.Diagnostic TestsThe initial management of constipation as out-lined above should be performed by a primary care provider.Patients who do not respond to these mea-sures can be considered refractory.Such patientsmay benefit from special testing and treatments;these can be presented most simply as an algorithm (Algorithm 1).Interpretation of any single test must be guarded,because it must be recognized that patient cooperation comprises an important voluntary component of most tests of anorectal function.The tests themselves must be in a setting as private as possible,to reduce embarrass-ment and facilitate cooperation,but ideal conditions are often not possible.Medical ManagementAlgorithms 2and 3show treatments for the clinical subgroups.We suggest a gradual increase in fiber intake,as both foods included in the diet and as supple-ments.If more treatment is needed,the simplest pro-gram should begin with an inexpensive saline agent,such as milk of magnesia.Only later should stimulant agents (Dulcolax;Novartis Consumer Health,Summit,NJ)or more expensive agents such as lactulose and polyethylene glycol beconsidered.Algorithm 1.Diagnostic algorithm for refractory constipation.R/O,rule out.December 2000AMERICAN GASTROENTEROLOGICAL ASSOCIATION 1763However,before therapeutic regimens are initiated,major decisions need to be made relating to the contri-bution of pelvic floor dysfunction.Is the role of impaired evacuation sufficient to justify an intensive program of education and practice?Formal evaluations of biofeed-back training in constipation are sparse,and important practical details of individual programs are often not stated.However,results from the best integrated pro-grams are impressive.The motivation of the patient and therapist,together with the frequency and intensity of the retraining program,likely contributes importantly to the chances of success.The program offered at the Mayo Clinic,for example,features 3daily outpatient sessions for 2weeks.In addition to biofeedback therapists,die-titians and behavioral psychologists participate.Al-though the results of biofeedback in children have been disappointing,intensive programs in adults can have a better than 75%successrate.Algorithm 2.Treatment algorithm for normal-and slow-transit constipation.MOM,milk of magnesia;PEG,polyethylene glycol;p.r.n.,as needed.1764AMERICAN GASTROENTEROLOGICAL ASSOCIATION GASTROENTEROLOGY Vol.119,No.6Place of Surgery and Pelvic Floor Retraining ProgramSurgical Treatment of Slow-Transit ConstipationThe treatment of colonic inertia—when well docu-mented and assuming failure of an aggressive,prolonged trial of laxatives,fiber,and prokinetic agents—is total colectomy with ileorectal anastomosis.Patients need to be told that the procedure is designed to treat the symptom of constipation and that other symptoms (e.g.,abdominal pain)may not necessarily be relieved,even though reg-ular defecation may be achieved.Even in a tertiary center with a strong presence of surgical referrals,only 5%of this highly selected cohort justify surgical treatment.Pelvic Floor RetrainingBiofeedback and relaxation training have been quite successful and,importantly,free of morbidity.Biofeedback can be used to train patients to relax their pelvic floor muscles during straining and to correlate relaxation and pushing to achieve defecation.By the relearning process,the nonrelaxing pelvic floor is grad-ually suppressed and normal coordination restored.It should be pointed out that biofeedback is also used in the treatment of fecal incontinence.There are,however,ma-jor differences between the approaches to fecal inconti-nence and constipation.The incontinent patient with intact neural pathways is able to appreciate a sensation of muscular contractile activity,whereas the constipated patient does not have a similar sensation of muscular relaxation.Nevertheless,biofeedback has been shown to reduce obstructive symptoms,with an increase in the frequency of bowel actions,the ability to develop a more obtuse anorectal angle at the time of defecation,and more dynamic pelvic floor movements when the anal sphincter iscontracted.Algorithm 3.Algorithm for pelvic floor dysfunction and slow-transit constipation.MOM,milk of magnesia;PEG,polyethylene glycol;p.r.n.,as needed.December 2000AMERICAN GASTROENTEROLOGICAL ASSOCIATION 1765This Medical Position Statement has been endorsed in prin-ciple by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology.G.RICHARD LOCKE III,M.D.Division of GastroenterologyJOHN H.PEMBERTON,M.D.Division of Colon and Rectal SurgerySIDNEY F.PHILLIPS,M.D.Division of GastroenterologyMayo Clinic and Mayo Medical SchoolRochester,MinnesotaReferences1.Locke GR III,Pemberton JH,Phillips SF.AGA technical review onconstipation.Gastroenterology2000;119:1766–1778. Address requests for reprints to:Chair,Clinical Practice and Practice Economics Committee,AGA National Office,c/o Membership Depart-ment,7910Woodmont Avenue,7th Floor,Bethesda,Maryland 20814.Fax:(301)654-5920.©2000by the American Gastroenterological Association0016-5085/00/$10.00doi:10.1053/gast.2000.203901766AMERICAN GASTROENTEROLOGICAL ASSOCIATION GASTROENTEROLOGY Vol.119,No.6。

文献综述医药卫生脑卒中患者便秘的临床护理进展徐艳谭春丽北京中日友好医院，北京100029摘要：脑卒中患者的便秘因素多种多样，每个病人有着自己的特点，护理工作要因人而异，加强健康宣教，采取不同的方法帮助病人解除便秘的痛苦，预防便秘引发的并发症，减轻脑卒中患者便秘的痛苦，减轻病人焦虑抑郁的情绪，以利于病人早日康复。

关键词：脑卒中；便秘；护理脑卒中是指急性起病，由于脑局部血液循环障碍导致的神经功能缺损综合征，症状至少24小时[1]。

便秘是脑卒中常见并发症之一，长期卧床的脑卒中偏瘫患者便秘的比例在90%以上[2]。

便秘表现为排便次数减少、粪便干硬和（或）排便困难。

排便次数减少指每周排便少于3次。

排便困难包括排便费力、排除困难、排便不尽感、排便费时以及需手法辅助排便[3，4]。

脑卒中患者便秘时用力排便使腹内压和颅内压增高，易诱发脑血管破裂，使病情加重，甚至危及生命。

据报道，约有10％的患者致残的诱因为便秘。

Robain等[5]究表明，便秘可加重脑卒中患者的脑部损害，从而降低患者的活动能力。

Wiesel等[6，7]则认为便秘可以降低患者的生活质量。

因此，我们应该重视脑卒中患者便秘的护理，现就临床中的护理进展综述如下：1脑卒中便秘的原因1.1疾病病变部位因素茅新蕾等[8]研究表明，脑卒中患者急性期常发生便秘，基底节区脑卒中者便秘发生率较非基底节区脑卒中者高。

但卒中患者并发便秘的确切机制不清，有待进一步研究。

1.2患者心理因素脑卒中患者多为急性发病，因发病突然和对预后的担心，使患者产生紧张、焦虑、恐惧等心理变化，临床上大多只重视对便秘症状的护理，忽视了对心理因素的分析而导致便秘。

有时排便时间与其他治疗活动相冲突，以致排便时间仓促也可导致患者出现便秘情况。

1.3运动减少脑卒中患者常合并运动功能障碍，肢体乏力，无力排便，长期卧床，胃肠蠕动更加缓慢，使排便功能进一步衰弱。

1.4排便习惯及环境改变排便是个人隐私，当脑卒中卧床病人在床上排便需要他人协助解决时，会觉得丧失了隐私及日常习惯，甚至在病房内怕影响其他人，有便意时，就会强迫或克制不排便，导致便秘。

介绍便秘的英语作文Title: Understanding Constipation。

Constipation is a common gastrointestinal issue that affects millions of people worldwide. It occurs when bowel movements become less frequent or difficult to pass. This condition can be caused by various factors, including diet, lifestyle, medications, and underlying health conditions. In this essay, we will explore the causes, symptoms, effects, and treatments of constipation.One of the primary causes of constipation is a lack of fiber in the diet. Fiber helps to add bulk to stool and facilitates its passage through the digestive system. When there is insufficient fiber intake, the stool becomes hard and dry, making it difficult to pass. Additionally, not drinking enough water can exacerbate constipation because adequate hydration is essential for maintaining soft and easy-to-pass stools.Another common cause of constipation is a sedentary lifestyle. Lack of physical activity can slow down the digestive system and lead to sluggish bowel movements. Regular exercise helps to stimulate bowel motility and promotes regularity.Certain medications can also contribute to constipation. Drugs such as opioids, antidepressants, and antacids can disrupt normal bowel function and cause constipation as a side effect. It's essential to consult a healthcare professional if you suspect that your medication is causing constipation.Moreover, underlying health conditions such asirritable bowel syndrome (IBS), hypothyroidism, and neurological disorders can predispose individuals to constipation. In these cases, addressing the underlying condition is crucial for managing constipation effectively.The symptoms of constipation can vary from person to person but often include infrequent bowel movements, straining during bowel movements, abdominal discomfort,bloating, and a sensation of incomplete evacuation. Chronic constipation can significantly impact quality of life and may lead to complications such as hemorrhoids, anal fissures, and fecal impaction.Fortunately, there are several strategies for preventing and treating constipation. Dietary modifications play a crucial role in managing constipation. Increasing fiber intake by consuming fruits, vegetables, whole grains, and legumes can help soften stools and promote regular bowel movements. Additionally, staying hydrated by drinking plenty of water throughout the day is essential for maintaining bowel regularity.Lifestyle changes, such as engaging in regular physical activity and establishing a consistent toilet routine, can also help alleviate constipation symptoms. Exercise helps to stimulate bowel motility, while establishing a regular schedule for bowel movements can train the body to evacuate stools more efficiently.In some cases, over-the-counter laxatives may be usedto provide temporary relief from constipation. However,it's essential to use laxatives cautiously and under the guidance of a healthcare professional, as overuse can lead to dependence and worsen constipation in the long term.For individuals with chronic or severe constipation, prescription medications or other medical interventions may be necessary. These may include stool softeners, osmotic laxatives, or prescription medications that help regulate bowel function.In conclusion, constipation is a common digestive issue that can have a significant impact on daily life. By understanding the causes, symptoms, and treatment options for constipation, individuals can take proactive steps to manage this condition effectively. Making dietary and lifestyle changes, staying hydrated, and seeking medical advice when necessary are essential strategies for preventing and treating constipation. With proper management, constipation can be effectively controlled, allowing individuals to enjoy improved digestive health and overall well-being.。

便秘应急预案及处理流程English:Emergency plan and procedure for constipation:In case of constipation, it is important to have an emergency plan in place to alleviate the discomfort and prevent further complications. The first step is to identify the cause of constipation, which may include factors such as inadequate fiber intake, lack of physical activity, certain medications, or underlying medical conditions. Once the cause is determined, the treatment can be tailored accordingly. Increasing fiber intake through foods like fruits, vegetables, whole grains, and legumes can help soften the stool and promote regular bowel movements. Adequate hydration is also crucial as it helps in maintaining bowel regularity. Regular exercise, such as walking or jogging, can stimulate bowel movements and improve overall digestive health. If necessary, over-the-counter laxatives or stool softeners can be used for short-term relief, but it is important to consult a healthcare professional before using any medication. Additionally, establishing a consistent toilet routine, allowing ample time for bowel movements, and not delaying the urge to defecatecan also help prevent constipation. In cases where these measuresdo not provide relief, it is advisable to seek medical attention for further evaluation and treatment. The emergency procedure for constipation should include maintaining a healthy lifestyle with a balanced diet and regular exercise, as well as seeking medical advice for persistent or severe cases of constipation. This plan should be communicated to all relevant individuals, such as family members or caregivers, to ensure a swift and effective response to constipation-related emergencies.中文翻译:便秘的应急预案及处理流程:在发生便秘的情况下，有一项应急预案尤为重要，以缓解不适和防止进一步并发症。

日升月恒牌常舒胶囊润肠通便保健功能研究目的研究日升月恒牌常舒胶囊的润肠通便保健功能。

方法采用自身与组间两种对照设计，将年龄18～65岁的100例受试者随机分为试食组和对照组两组。

试食组试食日升月恒牌常舒胶囊，对照组为空白对照。

统计受试者排便次数，记录受试者排便状况和观察其粪便性状来研究日升月恒牌常舒胶囊的润肠通便功能。

结果试食组试食日升月恒牌常舒胶囊后，受试者每周排便次数、排便状况积分及粪便性状积分比较差异具有极显著意义（P＜0.01），与对照组比较差异亦具有极显著意义（P＜0.01）。

结论日升月恒牌常舒胶囊具有良好的促进肠道蠕动和排便功能。

标签：日升月恒牌常舒胶囊；便秘；润肠通便；保健日升月恒牌常舒胶囊是由生何首乌、火麻仁、当归、赤芍、玉竹、枳壳六味中药按一定比例配伍组方而成的纯中药保健食品。

全方选药精炼，配伍严谨，是通过多年临床实践探索总结出的临床经验方。

其功效为行气活血、润肠通便。

临床上主要用于气血阴津亏虚型便秘以及老年、病后等体虚型便秘。

结合便秘的临床表现，针对气机不畅、阴津亏耗、肠内干燥、肠蠕动乏力的主要病理变化[1]，日升月恒牌常舒胶囊避免了单纯用泻药攻下，通便的同时还考虑益气养阴，恢复脾胃功能，不但可以调整胃肠功能紊乱，而且还可以增强涉及排便能力的各内脏功能，从整体改善患者的体质状况。

服用润肠通便类保健食品更是良好的选择。

市场研究表明，来源于植物原料的产品更容易受到消费者青睐，日升月恒牌常舒胶囊是具有通便功能的硬胶囊剂型保健食品，以满足市场绿色保健食品的需求[2，3]。

本实验结果将为临床治疗便秘提供一定的实验依据。

1 资料与方法1.1 材料1.1.1样品日升月恒牌常舒胶囊（由河南海丝克生物科技股份有限公司研发的纯中药保健食品，国食健申G2*******）0.25g/粒。

人体推荐量为3次/d，2粒/次。

1.1.2受试人群1.1.2.1受试对象选择标准年满18～65周岁的成年人，排便次数减少和粪便硬度增加，大便少于3次/w，无器质性便秘或习惯性便秘者[4]。