排便と健康  [in Japanese] REGULAR BOWEL MOVEMENTS AND A HEALTHY LIFE  [in Japanese]

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Author(s)

    • 浦尾 正彦 URAO MASAHIKO
    • 順天堂大学医学部附属練馬病院小児外科 SECTION OF PEDIATRIC SURGERY, JUNTENDO UNIVERSITY NERIMA HOSPITAL

Abstract

便秘とは,排便の頻度が週2回以下で,便が硬く,排便困難,残便感がある状態といわれている.実際には放置されていたり自己流の対処をされていることが多い.が,便秘患者では労働生産性が障害されたり,肛門疾患や結腸癌などの様々なリスクも増加することが知られており,しっかり取り組むべき疾患である.<br>慢性便秘は,症候性,薬剤性,器質性,機能性便秘などに分類される.症候性便秘は神経疾患,内分泌疾患の症状の一部としてみられるもの,薬剤性便秘は薬剤によって誘発されるもので薬剤の中止変更で改善する.器質性便秘は結腸などの器質的変化によるもので時として手術を必要とする.特に排便時出血,50歳以上,大腸癌の家族歴,急激な体重減少がある場合は専門医に相談する必要がある.<br>ほとんどの慢性便秘は機能性便秘であり,生活習慣の改善でコントロールできることが多い.すなわち,①睡眠を十分にとる,②1日の生活リズムを整える,③朝食を食べる,④軽い運動を行う.また腸内環境を整えるために,⑤食物繊維を摂る,⑥1日2<i>l</i> の水分摂取,⑦ヨーグルトや整腸剤を摂取する.またスムーズな排便のために,⑧排便マッサージ,⑨排便姿勢の調整,⑩リラックスできる環境づくりなどがあげられる.機能性便秘を放置することで,さらにひどい便秘となり手術を要する疾患に発展することもあるので,重症化を予防するための日々の努力が重要である.

Constipation is a combination of symptoms, such as fewer than three bowel movements per week, hard stool and a sense of incomplete evacuation. Most patients with constipation treat themselves. However, this does not always produce good management and may induce another illness. It is known that patients with constipation show reduced labor productivity and various increased risks, such as for anal diseases and colon cancer.<br>There are many causes of constipation. The classifications of chronic constipation are as follows: 1) functional constipation including irritable bowel syndrome, 2) secondary constipation due to systemic diseases, 3) drug-induced constipation, 4) organic constipation due to digestive tract obstruction and 5) uncertain pathogenesis.<br>It is important to be systemic to make a differential diagnosis. By taking the patient’s history and performing a physical examination, secondary constipation can be diagnosed. If one of the following is found, extensive examination may be required and it may be necessary to consult with a medical specialist: 1) anal bleeding at defecation, 2) more than 50 years old, 3) a family history of colorectal cancer and 4) rapid weight reduction. If constipation improves after stopping medication, it is diagnosed as drug-induced constipation. Most cases of chronic constipation are functional constipation, which can be controlled by improvement of lifestyle in many cases. Namely, an appropriate life rhythm includes good sleep, exposure to sunlight, eating breakfast and regular light exercise. Moreover, in order to improve the intestinal environment, consuming yogurt and dietary fiber, as well as 2 liters of water per day, is favorable. In additional, abdominal massage, adjustment of the defecation posture and producing a relaxed environment promote smooth defecation.<br>There are several kinds of laxative, such as bulk-forming, stimulant and osmotic. 5-HT<sub>4</sub> receptor agonist and tegaserod are also effective for slow-transit constipation.<br>Although the main approach is always to start with changes in lifestyle and diet before commencing treatment with a laxative, functional constipation should be treated adequately with medicine since it may develop into severer constipation, which may require a surgical operation. However, aimless continuation of medication with stimulant laxatives is not recommended.

Journal

  • Juntendo Medical Journal

    Juntendo Medical Journal 60(1), 16-24, 2014

    The Juntendo Medical Society

Codes

  • NII Article ID (NAID)
    130004684311
  • Text Lang
    JPN
  • Journal Type
    大学紀要
  • ISSN
    2187-9737
  • NDL Article ID
    025559981
  • NDL Call No.
    Z19-432
  • Data Source
    NDL  J-STAGE 
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