Chronic lock – the chronic violation of functions of intestines which is followed by difficulty and delay of depletion or constant insufficiency of the act of defecation. Can be functional or organic, primary or secondary. The chronic lock is shown by increase in intervals between acts of defecation, consolidation of a chair, feeling of incomplete depletion of intestines, need for the strengthened natuzhivaniye and reception of laxatives. It is diagnosed on the basis of complaints, history of a disease, data of survey and a palpation of a stomach, a rectal research, laboratory analyses and tool researches. Treatment – a diet, laxatives, non-drug therapy.
Chronic lock (chronic konstipation) – the simptomokompleks including the reduction of frequency of acts of defecation and the expressed difficulties in the course of an excrement which are coming to light for half a year or more. The chronic lock is a polietiologichesky pathological state, can develop at organic damages of a large intestine, disorders of nervous and endocrine regulation of activity of a GIT, ipokhondrichesky personal frustration, violations of a diet etc. Is considered by modern proctologists and gastroenterologists as the major social and medical problem.
Pathology is extremely widespread. Experts believe that from chronic locks of various degree of expressiveness 30-50% of adults and 5-20% of children of the USA and the countries of Europe suffer. Exact statistical data on the frequency of locks in Russia are absent as patients hesitate or do not consider it necessary to see doctors and quite often self-medicate, independently buying depletive. With age the probability of development of a chronic lock increases. Treatment is carried out by experts in the field of a proktologiya and gastroenterology.
Criteria of a chronic lock
Nonspecialists quite often believe that a lock is the state at which the act of defecation is carried out less than is normal, at the same time norm consider depletion of intestines of 1 times a day. Such approach leads to independent hyper diagnostics of a chronic lock and unreasonable reception of laxative medicines. Meanwhile, physiological norm the frequency of excrements from 3 times a day to 3 times a week conditionally is considered. Not only increase in a time interval between excrements, but also reduction of number of fecal masses, the increased density, dryness and hardness a calla, and also feeling of incomplete depletion of intestines after the act of defecation is characteristic of a chronic lock. At a chronic lock both all listed signs, and one or two of them, at the same time expressiveness of this or that sign can be observed can strongly differ.
Taking into account big variability of manifestations of chronic locks, the Roman Fund made and published criteria of diagnosis of this pathology. Now these criteria are used in clinical practice by both foreign, and Russian experts. According to "The Roman criteria", the chronic lock is diagnosed in case at the patient within half a year one or several symptoms of a disease are observed, at the same time within three months two or more of the listed symptoms come to light:
- The patient with a chronic lock is forced to natuzhivatsya strongly more often than in 25% of defekation.
- Excessively firm excrements appear more often than in 25% of defekation.
- The patient feels incomplete depletion of intestines more often than 25% of defekation.
- The patient with a chronic lock feels blockade in the field of back pass more often than at 25% of defekation.
- The act of defecation is carried out less often than three times a week.
- In the course of depletion of intestines the patient is forced to help himself hands.
Reasons and classification of a chronic lock
Taking into account the reasons and provocative factors allocate functional and organic chronic locks. Organic locks, in turn, are subdivided on mechanical, proktogenny (at inflammatory diseases of a thick gut), caused by congenital malformations and the acquired defects of a large intestine. There is also a classification according to which chronic locks can be primary, secondary and idiopathic. Include in group of primary locks anomalies of development of a large intestine and congenital violations of an innervation of this anatomic zone.
The chronic locks which arose owing to diseases and damages (traumatic, postoperative) a large intestine, defeats of overlying departments of a gastrointestinal tract, other bodies and systems are considered as secondary. Besides, in this group of locks refer violations of a chair at reception of medicines. Carry locks at insufficient motor function of a large intestine of an unknown etiology to idiopathic chronic locks.
Taking into account pathogenesis allocate mechanical, alimentary and diskinetichesky chronic locks. Alimentary locks are caused by dehydration, reduction of quantity and violation of optimum structure of food (a lack of rough cellulose) as a result of which the volume of kalovy masses decreases. Mechanical obstacles to advance of intestinal contents (a tumor, narrowing of a gut and so forth) become the reason of mechanical chronic locks. Diskinetichesky locks develop at disorders of motor function of a thick gut and are the most widespread kind of locks.
Among the pathological states provoking chronic locks, experts call some diseases of the top departments of a gastrointestinal tract (cholecystitis, gastritis, stomach ulcer), an adhesive disease, a polyneuropathy at diabetes, the diseases and traumatic damages of TsNS which are followed by disorder of nervous regulation of activity of intestines and also obesity, portal hypertensia, emphysema of lungs and heart failure.
Chronic locks can arise at some mental disorders, in particular – at a depression. Violations of a chair are quite often observed in the period of a gestation. This pathology is often diagnosed for people of advanced age that is connected with age delay of a passage of intestinal contents and weakening of the muscles participating in the act of defecation. Medicamentous chronic locks develop at reception of antidepressants, opiates, ganglioblokator and some other medicines. Sometimes the reason of a lock does not manage to be established.
At emergence of chronic locks formation of a vicious circle – a mutual combination and aggravation of several mechanisms which are the cornerstone of violations of a chair is of great importance. Among mechanisms of development of a chronic lock – impossibility to make the act of defecation in the conditions of a stress, an uncomfortable or unusual situation, inaccessibility of a toilet, an inactive way of life, a jet delay of defecation in the conditions of constant psychoemotional pressure, reception of some medicines, etc.
Symptoms of a chronic lock
The clinical picture is defined by the cause, duration and expressiveness of a konstipation. The main symptoms of a chronic lock are increase in temporary intervals between acts of defecation, increase in duration of the act of defecation and the expressed difficulties in the course of an excrement (the strengthened natuzhivaniye, need to help themselves hands). Kalovy masses dry, dense. Along with the listed signs, at patients with a chronic lock the abdominal distension, belly-aches, feeling of weight in the lower part of a stomach and feeling of incomplete depletion of intestines after completion of defecation often come to light.
Gradual development is characteristic of a chronic lock. An important sign of a konstipation is change of an individual rhythm and character of acts of defecation. Depletion of intestines happens less often, defecation demands more efforts, the kcal is firmer also to the land, than earlier. Against the background of the constant complicated otkhozhdeniye of dry fecal masses after a chair delay some patients with a chronic lock can have ponosa which are followed by an otkhozhdeniye liquid a calla with slime impurity.
Deterioration in appetite, eructation air and an unpleasant smell from a mouth are possible. Constant problems with defecation, discomfort in a stomach and other symptoms of a chronic lock negatively influence a psychoemotional condition and efficiency of patients. In the presence of the main disease provoking a konstipation at patients with a chronic lock symptoms of the main pathology come to light: pains in subspoon area, heartburn, nausea and vomiting at damage of a stomach; short wind, weakening of breath and a barrel-shaped thorax at emphysema of lungs; short wind, heartbeat, heartaches and cardiac hypostases at heart failure etc.
Diagnostics of a chronic lock
In the course of diagnostics of this pathological state the expert considers that the chronic lock is not an independent disease, but display of other pathology or a consequence of features of the mode, diet and way of life. Taking into account this circumstance as the purpose of diagnostic search serves identification of the reasons and the contributing factors of development of a konstipation. During inspection the doctor excludes medicamentous chronic locks and a konstipation owing to organic pathology of intestines (a disease Krone, a colorectal cancer, a divertikulez, malformations and the acquired anomalies of a thick gut).
The plan of inspection of the patient with a chronic lock includes poll (clarification of complaints and history of a disease), the general survey, survey and a palpation of area of a stomach, a manual rectal research, radiological researches (a survey X-ray analysis of an abdominal cavity, an irrigoskopiya) and a kolonoskopiya. Depending on estimated pathology the doctor can appoint to the patient with a chronic lock an intestines biopsy, a koprogramma, the analysis a calla to the hidden blood, a bacteriological research a calla, manometrical techniques (an anorektometriya, a sfinkterometriya), and also consultations of the therapist, the endocrinologist, the cardiologist, the pulmonologist and other experts, laboratory and tool tests for detection of diseases of other bodies and systems.
Treatment of a chronic lock
Therapy of a chronic lock represents a difficult task because of existence of a vicious circle and accustoming of patients to constant use of enemas and laxative medicines. The plan of treatment of a chronic lock includes the following directions: correction of a diet, increase in physical activity, work with psychological state, medicamentous therapy, non-drug techniques of stimulation of defecation and activization of an oppressed reflex on defecation. Experts specify that the cheapest, the most productive and, at the same time, change of psychological state, correction of a diet and way of life, and also stimulation of a reflex on defecation become the most complex challenges for the patient with a chronic lock in most cases.
The diet at a chronic lock provides increase in amount of vegetable fibers, reduction of amount of greasy and fried food, and also the use of enough liquid. Restoration of an oppressed reflex of defecation assumes creation of comfortable conditions (a possibility of visit of a toilet at the same time, a convenient pose, lack of haste and external hindrances), self-massage and special exercises. The way of life is corrected taking into account age and the general condition of the patient suffering from a chronic lock. Recommend observance of a work-rest schedule, walk and moderate physical activity.
At inefficiency of the listed actions or in addition to these actions at a chronic lock appoint medicines for regulation of an intestinal vermicular movement, depletive, a probiotics, antidepressants, massage and electrostimulation. At inflammatory diseases of intestines laxatives are contraindicated. The forecast is defined by the reason of development of a chronic lock and readiness of the patient to implement recommendations of the doctor.