Atonic Constipation: Symptoms And Treatment, Causes

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Atonic constipation

The content of the article:

1. Features:
2. Causes of occurrence
3. Symptoms of atonic constipation

4. Treatment of atonic constipation

   1. General principles of drug therapy
   2. Medicines used
   3. Lifestyle correction
5. Video

Constipation is a persistent disorder of the large intestine with a decrease in stool frequency of less than 3 times a week. Atonic constipation, or slow transit constipation, is understood as a condition that is associated with a decrease in muscle tone in the area of the intestine or almost throughout its entire length (peristalsis failure).

May be the result of structural, mechanical, metabolic and cortico-visceral influences on the colon.

Constipation is talked about when you have less than three bowel movements per week

Features:

It is a subtype of chronic constipation and has the following features:

1. Adults (middle and elderly) suffer more often. The child rarely occurs and is usually a symptom of another disease with anatomical abnormalities in the intestinal wall (Hirschsprung's disease).
2. Has a long course with periods of exacerbation. Often, symptoms of the disease are observed throughout life.
3. Often accompanied by the appearance of anal fissures due to the increased density of feces.
4. A typical symptom is a feeling of incomplete bowel movement.
5. Correlation dependence on gender: more often occurs in women.
6. Due to the unclearness of the main cause of the disease, a long course of treatment is required (often, as a result of therapy, dependence on laxatives arises).

Diagnosis is based on Roman criteria (Roman Consensus IV):

• less than 3 bowel movements per week;
• separation of high-density feces;
• lack of a feeling of complete bowel movement after a bowel movement;
• the presence of a feeling of "blockage" of the contents in the rectum during attempts;
• the need for strong attempts;
• the need for digital removal of contents from the rectum, support with the fingers of the pelvic floor.

These criteria are the same for all forms and types of constipation, including its atonic form.

Causes of occurrence

The pathogenesis of the pathology is not based on the typical for other forms of outlet obstruction, since feces as such do not block the intestine. In this case, due to various motility disorders and prolonged presence of feces in the intestine, their final volume decreases, which leads to rare urge to defecate. The main reasons are presented in the table.

View	Typical diseases
Primary constipation	Anomalies and malformations of the intestines, as a result of which the evacuation of the contents is disrupted (slowed down): 1. Dolichosigma, dolichocolon, megacolon - an abnormal enlargement of the intestine, which leads to a delay in intestinal contents at one of the levels (transverse, colon, sigmoid). 2. Pyr's syndrome. Associated with the high location of the splenic flexure of the colon under the diaphragm. This causes the retention of gases and intestinal contents. 3. Hilaiditi syndrome. Associated with the high location of the flexure of the colon (from the liver). Symptoms are similar to Payr's syndrome, but the clinic takes a little longer to develop. 4. Hirschsprung's disease. It is associated with a violation of innervation in the area of the colon. We are talking about complete atony (immobility) along some length of the colon. In this case, the overlying departments are stretched due to the overflow of feces.
Secondary constipation (symptomatic)	The disorders are associated with a number of diseases, one of the symptoms of which is a weakening of the motility of the large intestine: 1. Damage to the rectum at any of its intervals (anal fissure, hemorrhoids). 2. Disorders of the endocrine system (diabetes mellitus, hypothyroidism). 3. Neurological disorders of the type of multiple sclerosis. This also includes constipation resulting from a spinal cord injury at the lumbar level. 4. Taking a number of medications (anticonvulsants, iron supplements). 5. Intoxication associated with the characteristics of the profession (intoxication with heavy metals in miners). 6. Constipation during pregnancy (simultaneous action of progesterone and mechanical pressure on the intestines). 7. Eating disorders (decrease in food volume, excessive consumption of protein products, starvation, a sharp change in diet). 8. Mechanical compression of the intestine by various formations as a result of an adhesive or spastic process.
Idiopathic constipation	Has no established cause of occurrence (examination results do not reveal the anatomical substrate of the disease).

Predisposing factors:

• bad habits;
• emotional disorders (depression);
• dehydration.

Symptoms of atonic constipation

This form of constipation has several degrees of motor impairment, on which the clinical picture depends:

1. A compensated form that practically does not manifest itself clinically. The amplitude and duration of responses to all types of influences are slightly reduced.
2. Subcompensated form of the disease with decreased responses to food and mechanical stimulation.
3. Decompensated form with all clinical manifestations. It is characterized by a lack of response to food, mechanical and electrical stimulation.

Typical symptoms of atonic constipation include:

1. Bloating and flatulence. It occurs due to prolonged standing of feces in the intestinal lumen and excessive absorption of water from them.
2. Pain in different parts of the intestine. It occurs due to the same gas formation processes and resembles the clinical picture of intestinal colic (it appears periodically, of medium intensity, for a short time and without a clear localization).
3. The act of defecation 1 time in 2-3 weeks. There are no intermediate urges. Periodically, due to overstretching of the ampoule, convulsive pain in the rectum and tenesmus occurs. Defecation is accompanied by severe pain syndrome.
4. The stool has a dense character (dry "sheep" feces). In the feces, impurities of blood (the occurrence of anal fissures) and mucus are possible. It is extremely rare to observe fecal impaction.
5. Attacks of nausea / vomiting. They are not a typical manifestation of the disease, but due to intoxication (increased absorption in the large intestine, including toxic waste products) may occur. Other symptoms of intoxication include a deterioration in general condition, headaches, malaise, and decreased appetite.

Symptoms appear for many years without any visible positive dynamics.

Treatment of atonic constipation

Treatment can be carried out for a long time, and even so often does not bring a complete cure for the disease.

General principles of drug therapy

1. Strictly individual selection of the treatment regimen. The choice of laxative is made depending on the cause and pathogenetic picture. It often takes a long time to select an effective remedy.
2. In the case of complex or unclear motor disorders, it is permissible to prescribe 2-3 drugs of different groups at the same time.
3. The dosage of drugs may vary. Interruptions in therapy for 1-2 weeks are also possible.
4. In case of complete loss of the urge to defecate, local irritants are prescribed (suppositories with glycerin, bisacodyl).
5. In the case of a direct connection between impaired normal motility and the development of depression, a course of antidepressants is indicated.

Medicines used

Facilities	Features:
Means that increase the volume of stool	Mostly herbal preparations that have a mild stimulating effect on the intestines. By increasing the volume of feces, irritation of the intestinal receptors occurs, which stimulate peristaltic waves. Best used in the morning. Long-term reception is allowed. Example drugs: · flax seed; · Preparations of plantain seeds (Mukofalk); · microcrystalline cellulose.
Osmotic laxatives	They increase the volume of feces, but without direct irritation of the mechanoreceptors. They contain a number of ions that prevent water from being absorbed, which leads to some softening of stool and easier bowel movements. Examples: Lactulose; · Macrogol.
Intestinal receptor irritants	Two groups of drugs: · Containing anthraquinones (senna, buckthorn, rhubarb); · Derivatives of diphenylmethane. Provide some irritation of the intestinal musculature and have a pronounced secretory activity (increase the production of fluid into the intestinal lumen). They regulate the concentration of potassium ions (when it decreases, muscle relaxation and increased constipation occur).
Emollient laxatives	They do not affect peristalsis, but they reduce the stress during bowel movements and are the prevention of anal fissures. Examples: · Vaseline oil; · olive oil.
Motor regulators	Motor controllers include: Antispasmodics (meteospasmil, duspatalin); · Prokinetics (prucaloprid). Both groups have a stimulating effect on the motility of the large intestine (increased peristaltic waves due to the contraction of smooth muscles).

With atonic constipation, laxatives are selected on an individual basis, this may take a long time

Laxatives have a number of contraindications:

• inflammatory processes in the gastrointestinal tract (necrotizing ulcerative colitis);
• benign or malignant tumors localized in the lumen of the intestine or causing its external compression;
• gastrointestinal bleeding;
• renal failure.

During pregnancy and lactation, laxatives are used with caution and only after consulting a doctor.

Lifestyle correction

The atonic form of constipation should be treated with a mandatory change in lifestyle. In particular, an increase in physical activity and adherence to a special diet are required (with this form of constipation, diets are not recommended).

Meals include:

• food with a lot of dietary fiber (cellulose, lignin);
• a large amount of water (up to 2 liters per day);
• the predominance of plant foods (vegetables, fruits);
• daily consumption of fermented milk products (yogurt, kefir).

Such nutrition improves the functioning of the digestive tract, increases the volume of feces and accelerates their movement through the intestines, and is also a substrate for endogenous anaerobic microflora. Bran is useful - it is a kind of natural laxative, because it binds and retains fatty acids, delivers them to the colon.

In the diet, you should reduce the amount of foods that thicken the stool (bread, potatoes, fatty meats), as well as foods that cause gas production (legumes, cabbage).

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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