Progress in Diagnosis And Treatment Of Primary Chronic ConstipationⅠ
Aug 28, 2023
Summary
Chronic constipation is one of the most common functional gastrointestinal diseases. The incidence rate has been increasing year by year, seriously endangering the health of the body, and the incidence trend is younger. Primary chronic constipation includes normal transit constipation, rectal emptying disorder, and slow transit constipation, and there are apparent overlaps among the subtypes, which brings difficulties to clinical diagnosis and treatment. With the continuous deepening of the understanding of primary chronic constipation, new diagnosis and treatment strategies have been applied clinically. This article summarizes the current definition, classification, epidemiological characteristics, pathophysiological mechanism, and progress in diagnosis and treatment of primary chronic constipation unrelated to opioid abuse, aiming to improve the understanding of chronic constipation and provide effective clinical treatment for constipation—diagnosis and treatment ideas.
Chronic constipation is a gastrointestinal dysfunction disease. With the aging of the population and the change of lifestyle, the incidence is increasing, and it has become one of the common diseases that affect people's quality of life. Chronic constipation not only has a significant impact on the work and life of patients but also causes mental and psychological diseases, which impose a burden on families and society. Therefore, the diagnosis and treatment of chronic constipation are very important to a healthy life, but the current understanding of chronic constipation is generally lacking. This article reviews the progress of primary chronic constipation.
I. Overview
1. Definition and classification: Chronic constipation is a common gastrointestinal disease, that refers to functional constipation, that is, non-organic decreased frequency of defecation or difficulty in defecation. Rome IV pointed out that chronic constipation is mainly manifested by decreased defecation frequency, difficulty in defecation, or a sense of incomplete defecation, which may be accompanied by abdominal pain, abdominal distension, and other symptoms, but it does not meet the diagnostic criteria of irritable bowel syndrome, and the symptoms have been present for at least 6 months. And have symptoms in the past 3 months. According to different causes, chronic constipation can be divided into primary constipation and secondary constipation, wherein primary constipation is more common. Primary constipation includes 3 types: normal-transit constipation (NTC), slow-transit constipation (STC), and rectal emptying disorder (also known as exit delay disorder, or defecation disorder).
2. Morbidity and risk factors: The global prevalence of chronic constipation is between 12% and 19% [1]. Compared with Asia, constipation is more common in North America and Europe, which may be related to diet, culture, environment, etc. Factors leading to constipation include age, gender, social status, economic strength, level of physical activity, drugs, and mental status [2]. Studies have shown that stress may also be one of the important factors leading to constipation [1]. The incidence of constipation in women is higher than that in men, and it is positively correlated with age. The incidence of constipation in people over 60 years old is as high as 33%. Pregnant women are more prone to constipation due to a significant increase in sex hormones, decreased bowel motility, and changes in mechanical stress that delay bowel emptying.
3. Hazards: Chronic constipation can lead to chronic diseases (such as diabetes and rheumatism), accompanied by potentially serious complications, such as fecal impaction, incontinence, hemorrhoids, anal fissure, bleeding, and even colon perforation, etc. [ 3]. Compared with ordinary people, the health status and quality of life of patients with constipation are seriously impaired, and they are more prone to anxiety, stress, depression, and other psychological diseases.
2. Regulation of intestinal flora
There are about 1013 to 1014 species of microorganisms in the human digestive system. These microorganisms are distributed in different positions in the intestinal tract, affecting the physiological functions of the intestinal tract and participating in the vital activities of the host [4]. Intestinal flora can participate in host metabolism, such as cholesterol and bile acid metabolism, hormone metabolism, etc., and produce a series of metabolites, some of which (such as indole derivatives, secondary bile acids, short-chain fatty acids) maintain The balance of water and electrolytes in the intestine, the normal structure of the intestinal flora, and even anti-inflammation, intestinal function, and immune regulation play a pivotal role. For example, short-chain fatty acids have a direct regulatory effect on gastrointestinal motility in patients with constipation [5].
Intestinal dysbiosis occurs under the condition of intestinal flora imbalance, which induces or aggravates chronic diseases. Recent advances in shotgun sequencing technology reduced sequencing costs, and advances in bioinformatics tools have enabled a more comprehensive understanding of the gut microbiota and its functional potential. Principal coordinate analysis of 16S rDNA sequencing technology data showed that the composition of gastrointestinal flora in patients with constipation was significantly different from that in normal individuals. The species diversity of the microbiota in patient samples was lower than in healthy subjects, and it was also accompanied by significantly lower concentrations of Bifidobacteria and Lactobacilli and an increased abundance of Desulfovibriolaceae. In addition, the levels of butyrate-producing bacteria (such as Faecalibacterium) in patients with constipation were significantly lower [5]. However, there is a lot of contradictory data on the changes in intestinal flora in patients with constipation, and there is no consensus on the relationship between intestinal flora and primary chronic constipation.
Natural Herbal Medicine For Relieving Constipation-Cistanche
Cistanche is a genus of parasitic plants that belongs to the family Orobanchaceae. These plants are known for their medicinal properties and have been used in Traditional Chinese Medicine (TCM) for centuries. Cistanche species are predominantly found in arid and desert regions of China, Mongolia, and other parts of Central Asia. Cistanche plants are characterized by their fleshy, yellowish stems and are highly valued for their potential health benefits. In TCM, Cistanche is believed to have tonic properties and is commonly used to nourish the kidney, enhance vitality, and support sexual function. It is also used to address issues related to aging, fatigue, and overall well-being. While Cistanche has a long history of use in traditional medicine, scientific research on its efficacy and safety is ongoing and limited. However, it is known to contain various bioactive compounds such as phenylethanoid glycosides, iridoids, lignans, and polysaccharides, which may contribute to its medicinal effects.
Wecistanche's cistanche powder, cistanche tablets, cistanche capsules, and other products are developed using desert cistanche as raw materials, all of which have a good effect on relieving constipation. The specific mechanism is as follows: Cistanche is believed to have potential benefits for relieving constipation based on its traditional use and certain compounds it contains. While scientific research specifically on Cistanche's effect on constipation is limited, it is thought to have multiple mechanisms that may contribute to its potential to relieve constipation. Laxative Effect: Cistanche has long been used in Traditional Chinese Medicine as a remedy for constipation. It is believed to have a mild laxative effect, which can help promote bowel movements and induce constipation. This effect may be attributed to various compounds found in Cistanche, such as phenylethanoid glycosides and polysaccharides. Moistening the Intestines: Based on traditional use, Cistanche is considered to have moisturizing properties, specifically targeting the Intestines. Promoting hydration and lubrication of the Intestines may help soften tools and facilitate easier passage, thereby relieving constipation. Anti-inflammatory Effect: Constipation can sometimes be associated with inflammation in the digestive tract. Cistanche contains certain compounds, including phenylethanoid glycosides and lignans, that are believed to have anti-inflammatory properties. By reducing inflammation in the intestines, it may help improve bowel movement regularity and relieve constipation.
