Diarrhea and constipation - causes and treatment When you need to consult a gastroenterologist

Constipation after diarrhea, like diarrhea after constipation, is a phenomenon that most people with irritable bowel syndrome, or IBS, experience.

This disruption of the gastrointestinal tract is accompanied by:

• nausea,
• increased gas formation,
• a feeling of incomplete bowel movement after visiting the toilet,
• admixture of mucus in feces.

However, IBS is only one of the likely causes of alternating constipation and diarrhea.

A similar bowel disorder can be observed in other cases, especially with:

• dehydration as a result of prolonged diarrhea caused by poisoning;
• uncontrolled use of anti-diarrhea medications;
• poor nutrition due to diarrhea, which leads to a decrease in stool volume;
• use of narcotic painkillers;
• natural slowdown of peristaltic activity;
• prolonged stress;
• violation of the quantitative and qualitative composition of the intestinal microflora.

In some cases, constipation after prolonged diarrhea is short-lived and goes away on its own. However, with prolonged stool retention, it is necessary to take a number of measures aimed at restoring normal bowel function.

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Defecation in an adult - norm and violations

The content of the article

Normal bowel habits vary greatly among individuals depending on age, individual health factors, diet, social and cultural backgrounds. For city dwellers, the frequency of bowel movements ranges from two to three times a day to two times a week, which individually can be considered normal.

Changes in the frequency, consistency, or volume of stools, as well as the presence of blood, mucus, pus, or excess fatty substances (eg, oil, grease, emulsion) in the stool may indicate a medical condition.

When should you seek help?

If you know exactly the reason for the change in stool (poisoning, change in diet on a business trip, taking medications), then you can limit yourself to remedies that eliminate discomfort. And when the cause of constipation or diarrhea is not clear and the appropriate medications do not give the desired effect, it is worth visiting our doctor.

Black or light-colored stool is also a signal that you should seek help from our clinic’s specialists. And of course, you should not delay visiting a doctor if there is blood in your stool.

What is diarrhea - mechanisms

Diarrhea is defined as frequent passage of large, loose, semi-liquid, or pasty stools more than 3 times a day, with a total stool volume exceeding 250 g and containing more than 7 g of fat. Often, diarrheal stool contains pus, blood, or mucus.

Every day, 7-8 liters of digestive juice (saliva, gastric, pancreatic and intestinal juices, bile) are poured into the lumen of the digestive tract. Taking into account the water contained in food, it can be assumed that almost 10 liters of liquid pass through the gastrointestinal tract during the day.

Even under conditions of complete fasting, the amount of digestive juices entering the lumen of the digestive tract is 3-4.5 l/day. Of this volume, about 1.5 liters of liquid reaches the colon every day, and only 100-200 ml are excreted in feces. Stool is 60-90% water, so simply put, diarrhea is the elimination of excess water in stool.

The normal process of digestion and absorption of food is based on the secretion of water and salt in the form of digestive juices into the lumen of the digestive tract, and then on reabsorption. Substances that actively interfere with absorption cause an imbalance between the amount of water excreted and absorbed and cause diarrhea. Most often these are osmotically active substances, such as sugars and some salts.

Another example of an imbalance between absorption and secretion are substances that stimulate the secretion of water into the lumen of the gastrointestinal tract, such as bacterial enterotoxins, viruses, bile salts, etc. A combination of these two mechanisms occurs in the diarrhea seen in malabsorption syndromes.

Malabsorption

Another mechanism that causes diarrhea is damage to the lining of the gastrointestinal tract and leakage of blood, plasma, and water into the intestinal lumen.

Another mechanism that causes diarrhea may be excess mucus production, such as occurs with gastrointestinal polyps.

Vasilenko V.V. Constipation and diarrhea / www.gastroscan.ru. 2022

Constipation and diarrhea

Bristol scale
Patients with digestive disorders often complain of constipation (constipation) and diarrhea (diarrhea).

However, this means a variety of unpleasant conditions, manifested not only by a change in the frequency of bowel movements (defecations), but also by a violation of the volume, consistency of stool, pain, excessive release of gases (flatulence) and even simply a change in the appearance of feces (color, presence of mucus). Moreover, in medicine there are also no clear definitions of these unpleasant conditions. It is no coincidence that the Latin names of complaints are given in parentheses: usually patients are embarrassed to talk about such a delicate matter, so variants of their designation may be useful to them.

Agree, it is difficult for a doctor to understand the problem if the patient simply talks about indigestion. To “facilitate mutual understanding”, as well as for an objective assessment of disorders and the impact of treatment on them, a visual analogue scale has been developed - in other words, a visual picture that shows options for the appearance of stool (feces) (Fig. 1.). The use of visual scales generally makes it easier to understand what we often cannot see.

It is better to control the body through an orderly way of life, as far as circumstances allow us, than to tease the disease with medicines, thereby making the problem ingrained. Plato

The strange thing is not so much that doctors use them quite rarely, but the fact that they were developed relatively recently.

The stool shape scale is called the Bristol scale after the name of the English city, whose university doctors developed it, began to use it, and presented it in its final form only in 1997.

If we further follow the long-standing predilection of doctors to compare what they see with something edible, we can say that type 2 resembles hazelnut churchkhela, type 3 resembles kupata, type 7 resembles rice porridge, and type 8 resembles rice water.

Types 3 and 4 stools are considered completely normal; type 4, which passes without effort, is ideal. Variants of constipation are types 1 and 2, and diarrhea - types 5 to 8.

The average time for mixed food to pass through the digestive tract is 50 hours for men and 57 for women, variations range from 20 to 100 hours. They change from day to day. A single serving is approximately 100 grams. The frequency of stool in healthy adults ranges from 3 times a week to 3 times a day.

Rice. 1. Type 1. Hard lumps like nuts Type 2. Lumpy sausage Type 3. Cracked sausage Type 4. Looks like a sausage or snake Type 5. Soft pieces with hard edges Type 6. Soft lumps with jagged edges Type 7. Watery stools. Type 8. More recently proposed.
Foul-smelling stool of mucous consistency with blisters Understanding the mechanism of constipation and selecting suitable remedies is impossible without a detailed conversation with the patient.

So, for example, you can detect: unsatisfactory filling of the colon (diet poor in ballast substances); slow movement of food masses through the intestines (lack of urge to empty the abdomen, bloating and a feeling of fullness, sufficient duration of suffering, possible decrease in thyroid function or the presence of diabetes); disturbances in the functioning of the rectum (feeling of incomplete emptying and delay when straining, severe straining despite the urge to empty and soft stool, the need to press with your hand on the rectal area or even remove stool with your finger).

A person is not able to foresee what he should avoid at any given moment. Horace

What new mothers need to know

Normal stool frequency in children (the first figure is the number of bowel movements per week, the second - on average per day; obtained based on long-term observations of a large number of infants): in the first three months of breastfeeding - 5-40 and 2.9; on artificial - 5–28 and 2; up to 1 year - 5–28 and 1.8; up to 3 years - 4–21 and 1.4; over 3 years old - 3–14 and 1.

Habitual constipation in women: fairy tales and true stories

Misconceptions about chronic, or habitual, constipation include overestimating the importance of an elongated bowel and specific female problems as factors causing constipation. There is no serious evidence that laxatives are harmful or addictive, nor is there any benefit from recommending increased fluid and fiber intake to combat habitual constipation. Let's consider the issue in more detail.

Tales of Reasons

There is no clear reason to believe that the elongation of the non-dilated colon, designated as dolichosigma (abroad - megarectum), plays a significant role.

Come on, people, defile your body with unspeakable delicacies. Ovid

From 15 to 50 years old, habitual constipation is more common in women. However, no differences were found in the rate of passage of food through the intestines depending on the phases of the menstrual cycle.

The fact that women with constipation are more likely to undergo gynecological surgery is explained by the misinterpretation of chronic gynecological or pelvic pain as caused by constipation (and vice versa).

Under physiological (normal) conditions, sex hormones do not play a role in constipation, but may contribute to changes in digestive functions and slower intestinal transit during pregnancy.

Patients with severe constipation exhibit certain abnormalities in the production of hormones in the digestive organs that regulate intestinal activity (for example, high levels of somatostatin and low levels of pancreatic glucagon). It is not known whether these deviations are primary (“causal”) or secondary; accordingly, there is no need for so-called arch-modern analyzes.

Among patients with constipation, decreased thyroid function (hypothyroidism) is rarely observed, so testing this function in the absence of other signs of hypothyroidism is inappropriate.

Tales of food

It has not been scientifically proven that constipation can be treated by increasing fluid intake unless there are signs of dehydration.

Ab abusu ad usum non valet consequentia. — Abuse of use is not an argument against the use itself.

A diet low in plant fiber cannot be considered a cause of constipation, but is a contributing factor to its intensification. The main source of fiber is plant foods: cereals, legumes, vegetables and fruits. One apple contains only 4 grams of fiber, while it is believed that an adult should consume at least 25 grams per day. In concentrated form it is wheat bran. People with chronic constipation and a real deficiency of plant fiber in the diet should consume them - this can improve the condition. However, the increased gas production associated with this predominantly vegetarian diet limits its use and tolerability.

The myth about the universal benefits of plant fibers has long been dispelled - much to the disappointment of their manufacturers. As serious studies have shown, the inclusion of industrially produced (mainly from cake) plant fibers in the diet in the amount of 25–60 grams per day or the use of food additives containing them:

• does not provide a preventive effect against intestinal cancer;
• does not “normalize the character” of microflora in the intestines;
• does not reduce the risk of atherosclerosis;
• does not reduce the risk of developing breast and uterine cancer;
• does not prevent the occurrence of hiatal hernia.

There is no need to feed too much at one time, but it is better to feed little by little and repeatedly. If you immediately feed to satiety, this often leads to stupor, bloating, and wind accumulation. Ibn Sina

Addiction to dietary fiber has a history. The Scottish doctor D. Burkitt is famous for the fact that, while working in Central Africa, he discovered a new type of malignant tumor (later named after him). Later studies convinced him that hemorrhoids, diverticulosis and intestinal cancer were rare among Africans who consumed a lot of plant foods.

In a 1971 paper published in the journal Cancer, Burkitt postulated that high intakes of plant fiber protect against colon cancer. Over the next three decades, the market for food products high in dietary fiber and related food additives operated successfully. Naturally, this wave has reached our country.

Research in recent years has finally refuted Burkitt's postulate - moreover, they have shown the low effectiveness of these substances in the treatment of habitual constipation and irritable bowel syndrome. It turned out that only obese people with diabetes and high blood cholesterol (as foods that help reduce body weight) really need dietary fiber in sufficient quantities.

And the best medicine will not help the patient if he refuses to take it. Cervantes

About laxatives

There are four types of laxatives, of which one group - drugs that increase bowel movements - causes some concern among people.

This group includes bisacodyl (aka dulcolax), sodium picosulfate (guttalax, laxigal) and numerous preparations from senna (cassia, Alexandria leaf). It is unlikely that the use of stimulants in normal doses is harmful to the intestines. Although habitual constipation may be associated with an increased risk of colon cancer, there is no evidence that the use of stimulant laxatives is an additional or independent risk factor.

Foods with laxative effects

Physiological stimulants of intestinal motility include bile produced by the body in response to food stimuli, sugary substances (especially in high concentrations), organic acids, saturated salt solutions, substances containing or forming carbon dioxide, fats, cold dishes (temperature below 16–17 ° C ), fiber and cell membranes, connective tissue.

The most pronounced laxative effects have:

• black bread;
• raw vegetables and fruits;
• dried fruits, especially prunes;
• dried apricots (apricots);
• white bread with an increased amount of bran (“medicinal” varieties of white bread);
• legumes, oatmeal, buckwheat, barley cereals (not semolina and rice);
• meat with a lot of connective tissue (vein);
• pickles, marinades;
• herring and other varieties of salted fish;
• canned snack foods;
• smoked meats;
• all soft drinks saturated with carbon dioxide (mineral waters, lemonade, fruit drinks), beer, kvass;
• various fats in large quantities, especially consumed in their pure form (sour cream and cream, 100 grams or more);
• very sweet dishes, especially in combination with organic acids (for example, jelly and compotes from gooseberries, black currants, cranberries, etc.).

The doctor himself is medicine. R. Balint

The laxative effect of fermented milk drinks varies depending on the method of their preparation and storage conditions.

If there is no effect from dietary measures, you can use osmotic laxatives, among which lactulose (Lizalak, Duphalac, Portalac and other names) and macrogol (Forlax) have proven themselves.

What is advisable to exclude from the diet

To improve intestinal motility, it is advisable to exclude bread made from premium flour, butter dough, fatty meats, smoked meats, canned food, spicy foods, chocolate, strong coffee and tea; limit the consumption of porridges made from semolina and rice, as well as dishes made from vermicelli and potatoes; rich in essential oils of turnip, radish, onion, garlic, radish.

Man is unhappy only because he has renounced nature. His mind is infected with prejudices. Paul Henri Holbach

Move more

Constipation is quite rare in physically active people. On the contrary, sedentary older people with signs of depression are more likely to experience constipation.

It is known that vigorous physical activity significantly increases the motor activity of the digestive tract (for example, prolonged intense running can even dramatically increase intestinal motility). Accordingly, sedentary people have lazy, leisurely movements of the stomach and intestines, hence the problems. Swimming or a brisk 20-minute walk or ski ride are surefire remedies for constipation. There are also physical exercises to combat habitual constipation.

1. Starting position lying on your back. Slowly raise and lower your body, spreading your arms to the sides and keeping your legs slightly bent at the knees off the floor. Watch your breathing.
2. Starting position standing. With your hands on your hips, perform deep squats.
3. Lean forward, place your palms on the floor and lift your heels.

At the same time, slightly turn your pelvis and knees to the right, then to the left (the upper part of the body is motionless).
Perform each exercise 15–20 times. Start the day with exercise for your stomach and intestines and a glass of cold tap water.

It’s very difficult to change without changing anything, but we will! M. Zhvanetsky

In addition to the usual functional constipation, irritable bowel syndrome with constipation occurs. This is a separate serious issue. When a patient is completely demoralized and gives up, turning to a psychotherapist or an experienced traditional healer is quite effective.

Acupuncture can be used, but in combination with other measures - therapeutic exercises, massage, physiotherapy. Healing in the full sense of the word, especially instantaneously, does not occur. One way or another, a person must monitor the state of digestion. Functional constipation never causes serious complications requiring surgery. It is more appropriate to start a massive, complex effect at a resort - with medicinal mineral waters.

The Research Institute of Nutrition of the Russian Academy of Medical Sciences offers “Basic principles for constructing a diet for irritable bowel syndrome with constipation,” which are presented without comment here.

The diet is balanced in terms of the main food ingredients and includes 80–90 g/day of protein, 70–80 g/day of fat and 320–350 g/day of carbohydrates.

Unfortunately, many of us doctors find it difficult to admit ignorance or misunderstanding of something, be it a disease or its essence. After all, we are often ready to answer any patient’s questions, although the level of medical science itself often cannot provide answers to them at present. N.V. Elshtein

The principles of the diet are the same as for diseases with metabolic disorders, namely:

• a physiologically complete diet with a caloric intake of 2200–2400 kcal. In real life, the needs of people with constipation are lower;
• increasing the content of dietary fiber in the diet (30–40 g/day) due to the inclusion in the diet of vegetables, fruits, some grains, wheat bran, wholemeal bread with the addition of bran, and dietary supplements; control of protein content in the diet: 14–15% of the total calorie content of the diet with equal amounts of animal and vegetable protein in it;
• control of the quantity and quality of fat: 30% of the total calorie content, inclusion of vegetable fats in the amount of 30% of the total amount of fat in the diet;
• control of the quantity and quality composition of carbohydrates: limiting refined carbohydrates to 30–40 g/day;
• enriching the diet with vitamins through both natural products and products for therapeutic and prophylactic purposes, dietary supplements, multivitamin preparations, as well as probiotics (Probiotics = preparations based on waste products of normal bacteria.).

Proper culinary processing of food, split meals - 5-6 times a day with an even distribution of nutrients and calories throughout the day.
Don't complain about pain - that's the best medicine. Khayyam

Diarrhea

Diarrhea, which many prefer to call more euphoniously “stomach upset” (although it is actually an intestinal disorder) or the Greek synonym “diarrhea” (meaning “discharge”), can be acute or chronic. An intermediate position is occupied by a nasty condition referred to as “irritable bowel syndrome with diarrhea.”

The leader in provoking acute diarrhea is various representatives of the microcosm, most often viruses, much less often microbes and parasites. Diarrhea can also occur with excessive eating of any dish, usually fatty, or simply with a sharp change in the usual diet or food excess.

Reasonable people understand that in the absence of a high fever, blood or pus in the stool, you should not see a doctor in the first 3-4 days (except to get a release from work).

Each family has its own, carefully passed down “inherited” ways of “taming” acute intestinal disorder. Let us recall only the simplest and most effective ones.

First, a little about nutrition. At first, it’s not a sin to simply go hungry, without limiting yourself, of course, in liquids.

The main food during a disorder should be boiled rice. In general, it is enough to adopt the basic feeding techniques for children with diarrhea, which are outlined in the humorous English abbreviation “BRAT Diet” (literally “diet for the brat”). The name is an abbreviation of the first letters of the words: bananas, rice, applesauce, toast (dried bread).

Doctors are the ones who Prescribe drugs they know little about, to treat diseases they know even less about, to people about whom they know nothing at all. F. Voltaire

Now about medicinal products. There is no need to abuse them. The intestines, of course, can organize their own work (if you don’t interfere with it), because all systems in the body are highly organized and self-regulating. You can take an additional tablespoon of chalk or tooth powder in the morning (in pharmacy terms “precipitated calcium carbonate”).

You can dilute and drink 1 teaspoon of white clay 3 times within 3 days.

Those who are afraid of such advice can take smecta, which is nothing more than clay. If your stomach is very seething, you can use adsorbents - enterodes, enterosgel, enterosorb or others, starting with activated carbon and ending with polyphepan.

A warm heating pad will soothe colic. Toilet the anus area with soap and water after each bowel movement.

General information for young parents of small children. Acute gastroenteritis in children can be caused by a considerable number of viruses and bacteria, as well as food containing their toxins (poisons). No preventative measures other than sanitary and hygienic measures are effective. If fever with severe diarrhea and/or vomiting occurs, the child is given special solutions to prevent dehydration, in particular oral rehydron according to the instructions. Urgent and independent use of antimicrobial, antidiarrheal and antipyretic drugs is inappropriate. The previously widely prescribed antibiotics tetracycline and chloramphenicol have in recent years lost their bactericidal properties against pathogens of acute diarrheal diseases.

Our nature hurries on the ascent and slows down on the descent, as the natural heat decreases and weakens, and the moisture thickens. Dante

Let us turn to chronic and episodic diarrhea. Prolonged diarrhea (usual or liquid bowel movements more than 3 times a day and/or the amount of feces more than 200 grams per day) can have many causes, most of which are rare. These include:

• inflammation or tumor of the colon;
• inflammation of the small intestine (in particular, the aforementioned celiac disease);
• malabsorption of nutrients in the small intestine;
• impaired digestion of food (maldigestion) due to deficiency of pancreatic enzymes;
• disturbances in intestinal motility (such as irritable bowel syndrome), other causes (the main one is alcohol abuse);
• a combination of several factors.

Prolonged or repeated diarrhea of ​​infectious and parasitic origin

Prolonged diarrhea in the middle zone climate is most often caused by the proliferation in the colon of one of the following bacteria: Shigella (Shigella, 4 species that cause bacterial dysentery), Salmonella (S. enterica, 6 subspecies and more than 2 thousand serotypes), Campylobacter (C. jejuni, C. fetus), spore-forming clostridia (C. perfringens, C. difficile), tuberculosis bacillus (Mycobacterium tuberculosis), as well as Aeromonas (bacteria of the genus Aeromonas spp.).

There are still only a few general remedies that you can rely on, namely routine, exercise, entertainment, time and nature. D. Diderot

Of the diseases caused by pathogenic protozoan unicellular organisms, protozooses, only three are subject to official registration in the Russian Federation. In total, there are about 70 such pathogens. Of these, in industrialized countries, prolonged diarrhea is caused by acid-fast cryptosporidia (cryptosporidiosis, pathogen Cryptosporidium parvum), cyclosporidium (causative agent Cyclospora cayetanensis), isospora (coccidiosis, pathogens Isospora belli and I. hominis) that live in the small intestine; in the large intestine - dysenteric amoeba (Entamoeba histolytica; manifestations - amoebic dysentery - are observed only in 10% of carriers, found mainly in residents and people from hot climates).

In Russia, approximately 70 species of worms have been discovered that parasitize the human body, 30 of which are widespread (but only 11 helminths are officially registered).

Of these, prolonged diarrhea is caused by intestinal eels living in the small intestine (strongyloidiasis, the causative agent Strongyloides stercoralis from the group of nematodes, i.e. roundworms), as well as whipworms living in the large intestine (trichocephalosis, the causative agent Trichocephalus trichiurus, or Trichuris trichiura, from the group of nematodes ) and schistosome (intestinal schistosomiasis, a pathogen from the group of fluke helminths).

Each of these diseases is accompanied by diarrhea, but also has other signs by which they can be suspected.

If there are compelling reasons, suspicions should be supported by appropriate tests.

It is better to die according to all the rules than to recover against the rules. Moliere character

Only an experienced doctor can understand this conglomerate. Signs of chronic diarrhea that are alarming in terms of serious illness include defecation at night, significant weight loss, and anemia.

If there are no alarming symptoms, then most often we are dealing with chronic banal diarrhea, which doctors call functional diarrhea, or irritable bowel syndrome with diarrhea. Here, as they say, “the matter of helping the drowning is the work of the drowning themselves” (Ilf and Petrov’s ironic play on the canonical saying of K. Marx, which Lenin repeated: “The liberation of the workers must be the work of the workers themselves.”). Let me give you a couple of recommendations: avoid the laxative foods listed above, and also use harmless astringents, fixing pharmaceutical products, mainly of plant origin.

Do not take anything to the extreme: a person who wants to eat too late runs the risk of eating the next day in the morning. Kozma Prutkov

Natural cures for diarrhea from the pharmacy

• A decoction or liquid extract (70% alcohol) of burnet rhizome and fireweed root - dilute 1 tablespoon in 1 glass of water. Drink the decoction 1 tablespoon 5-6 times a day, and the extract - 30-40 drops 3-4 times a day.
• Decoction of cinquefoil rhizome: 12 tablespoons per 1 glass of water. Take 1 tablespoon 3 times a day.
• Decoction or infusion (1:20) of bird cherry fruits. Take 0.5 cups 2-3 times a day.
• Infusion (1:20) of alder fruits. Take 1 tablespoon 3-4 times a day.
• Decoction or infusion of blueberries.
• Oak bark decoction (1:10).

For severe gas formation associated with diarrhea, the following remedies are effective: infusions of St. John's wort (1:10, 0.5 cup 3 times a day), alder cones (1:50, 1/3 cup 3 times a day), flowers tansy (15:200, 1 tablespoon 3-4 times a day), marshmallow root (15:200, 1/3 cup 3 times a day), sage leaves (1:20, 1-2 tablespoon 3 times per day), decoction of plantain (1:2, 1 tablespoon 3-4 times a day), decoction or infusion of knotweed herb (1:10, 1/3 cup 3 times a day), decoction of black currant fruits , bird cherry, blueberry (1:10, 1/2 cup 3 times a day).
A decoction of pomegranate peels is also recommended (medicine uses the bark of the roots, less often the bark of trunks and branches).

Habit is a monster. Proverb

Astringent intestinal preparations

(Using material previously published in the publication “Oh, it hurts!” - 2005. - No. 8 (special issue).)

• Mix equal parts of the rhizomes of the knotweed and the cinquefoil erect.
• Mix walnut leaves and oak bark (3:2).
• Mix equal parts of calamus rhizome, oak bark, thyme herb and walnut leaves.
• Mix 1.5 parts of blueberry leaves, blueberry fruits and chamomile flowers, 2 parts of cinquefoil rhizome.
• Mix the rhizome of the cinquefoil erecta, the thallus of Cetraria Icelandica (“Icelandic moss”) - 1.5 parts each, the flowers of chamomile, the fruits of blueberries - 2 parts each. The recipe for the above collections is the same: pour 1 teaspoon of a mixture of medicinal plants with a glass of cold water and leave for 6 hours; then simmer over low heat for 5-10 minutes. Drink the decoction in several doses throughout the day.
• A decoction of equal proportions of the rhizome of cinquefoil erecta, knotweed, the thallus of Icelandic cetraria, chamomile flowers and 1.5 parts each of plantain leaves and blueberry fruits. Drink 2 glasses of decoction in several doses throughout the day. In this case, it is necessary to follow a diet suitable for intestinal disorders.
• A decoction of equal parts of peppermint leaves, blueberries, stinging nettles, walnuts, cinquefoil rhizomes, and chamomile flowers. Take 2-3 glasses per day. Follow a diet suitable for intestinal disorders.
• A decoction of the rhizome of snakeweed, cinquefoil erecta - 1.5 parts each, shepherd's purse herb - 3 parts, cinquefoil herb, peppermint leaves, chamomile flowers - part each. Take 2-3 glasses a day for colitis.
• A decoction of knotweed herb, comfrey root - 3 parts each, flax seeds - 4 parts. Take 2-3 glasses a day for colitis.
• A decoction of burnet rhizome, cinquefoil erecta - 1 part each, shepherd's purse herb - 2 parts. Take 0.5 cups 3-4 times a day.
• A decoction of cinquefoil herb, knotweed - 1 part each, plantain leaves - 2 parts. Take 0.5 cups 3-4 times a day.
• An infusion of equal parts of peppermint leaves, cinquefoil rhizomes, and chamomile flowers. Take 2-3 glasses per day.

In this section we mentioned adsorbents. What is it?

You can admire antiquity, but you need to follow modernity. Publius

Adsorbents are means that can absorb various substances from gases or liquids on their surface. Porous adsorbents include coals of vegetable origin. The properties of the adsorbent depend on the area of ​​the “working” surface, the size and distribution structure of the pores. The denser the “primary” plant material, the more it is penetrated by pores and the higher the adsorption property of the resulting coal.

Woe to you, O land, when your king is a child, and when your princes eat early! It is good for you, land, when your king is from a noble family, and your princes eat at the right time, for strengthening, and not for satiety! Eccl. 6:7

In Russia, the bulk of charcoal is produced from a mixture of hardwoods, with hardwoods occupying a small share of the raw material. That is why a special technology for activating charcoal was developed.

In short, it is a treatment with high temperature (800-1000 ° C) steam or dehydrating chemicals followed by an acid wash - this wash removes metals, ash and other impurities.

Only those who are as stupid as us are smart. D. Diderot

As a result, many micropores with a diameter of 3 nanometers and above are formed and the specific surface of activated carbon reaches 1000 square meters. meters per 1 gram! (A nanometer is 10 to the minus 9th power of a meter.) Activated carbon is truly a pioneer of domestic nanotechnology!

The property of coal to bind substances allows it to be widely used as an antidote (in medical terms, an antidote). The history of the introduction of coal into the practice of combating poisoning is interesting. Already in the 15th century it was known that charcoal discolored colored solutions, but only at the end of the 18th century this forgotten property of charcoal was rediscovered.

Coal was first mentioned in literature as an antidote only in 1813.

(It is curious that the founder of homeopathy, Hahnemann, proposed in 1780 to drink a soap solution as an antidote to arsenic. Of course, there was no particular benefit from this.) Following this (1829), it was discovered that salt solutions when passed through charcoal lose metals. But experimental proof of the antidote significance of coal was obtained only in 1846 by Garrod. He proved that animals can be protected from the poisonous effects of strychnine, hydrocyanic acid and other potent poisons by introducing charcoal into the animal's stomach. However, until the beginning of the 20th century, coal was not recognized as an antidote. This very valuable property of his was forgotten again. And only since 1910 can one observe the final birth of coal as an antidote. This is associated with the name of the Czech pharmacologist Vichovsky, who developed a method for medical evaluation and standardization of activated carbons.

During the First World War, in battles near the city of Ypres (Belgium), German troops used chemical weapons for the first time in history. It was mustard gas, named mustard gas after the battle. It is necessary to note the merits of the outstanding Russian chemist N.D. Zelinsky and his students in the timely development of methods for activating carbon for gas masks. It is known that during that war, English and French engineers came to Russia more than once to see Zelinsky to get acquainted with the technology for producing gas-resistant coals. But the development of mustard gas did not pass without a trace. This poison of military chemistry, diluted 20 thousand times with petroleum jelly, is used as a remedy against psoriasis and alopecia areata (Psoriasin ointment).

In conclusion. There are many substances that can be called adsorbents.

The main thing is that they have a developed inner surface. It is because of this property that bread absorbs foreign odors. A good sorbent is puffed corn.

V.V. Vasilenko. Sixty essays on digestion (recommendations from a gastroenterologist to patients) Back to section

Causes of diarrhea that require and do not require treatment

At the beginning of the 20th century, Dr. Stanislav Breuer wrote in his "New House Doctor": ... diarrhea (diarrhea) is not always harmful, for example in children during teething; if the condition is not excessive; it prevents swelling. In addition, after eating unhealthy or excessive food, diarrhea is a symptom of self-healing, promoting the rapid elimination of harmful contents, so drugs that quickly suppress it are almost always harmful... Speaking of diarrhea, the author states: ... diarrhea occurs due to overeating or unhealthy food, unripe fruits, cold water, medication abuse, colds, often occurs in children during weaning and poor nutrition.

According to the teacher. Robert Hegglin, diarrhea occurs in the following conditions:

1. Infections with a known microbe are an infectious disease transmitted through an intestinal infection.
2. Diffuse anatomical lesions of the intestinal wall, the causative agent of which is unknown - catarrh of the small intestine, colitis, ulcerative colitis.
3. Limited changes in the intestinal wall - tuberculosis, cancer, segmental ileitis, syphilis, actinomycosis, gonorrhea.
4. Fermentation and putrid indigestion.
5. Diarrhea of ​​gastric origin.
6. Sprue - primary and secondary mold.
7. Diseases of the pancreas.
8. Intestinal lipodystrophy - Whipple's disease.
9. Endocrine disorders - hyperthyroidism, adrenal insufficiency (Addison's disease), parathyroid insufficiency, diabetes.
10. Diarrhea of ​​allergic origin.
11. Diarrhea of ​​nervous origin.
12. Toxic changes in the intestines - uremia, severe general infectious diseases, mercury and arsenic poisoning.
13. Infections with intestinal parasites.

Diabetes
Another division, depending on the pathophysiological mechanism underlying the excessive excretion of water in the feces, divides diarrhea into 5 main groups:

1. Osmotic diarrhea
   is when the absorption of water from the intestinal lumen is difficult due to the presence of osmotically active food components. Substances such as sugar or osmotically active sulfate salts and phosphates, such as those administered as laxatives, can increase stool bulk. Sugar intolerance and excessive intake of substances that replace sugar in dietary products (sorbitol, hexitol, mannitol) are often the cause of diarrhea. An example is diarrhea caused by chewing gum, where peristalsis is stimulated by chewing and the sugar substitutes contained in the gum inhibit absorption.
2. Secretory diarrhea
   is most often observed in the practice of a gastroenterologist. Diarrhea occurs as a result of the presence in the intestinal lumen of substances that increase the secretion of water and salt into the lumen of the digestive tract. These substances are bacterial enterotoxins, viruses, bile salts, fats (due to improper digestion or given as a laxative), certain hormones such as secretin, calcitonin or VIP (vasoactive intestinal peptide) secreted by certain hormonally active tumors or drugs, for example prostaglandins.
3. Diarrhea due to malabsorption syndrome
   - observed when diarrhea occurs due to the accumulation in the gastrointestinal tract of unabsorbed water-soluble products with an osmotically active effect or water-insoluble fats with a secretory effect.
4. Exudative diarrhea
   is the root cause - a lesion caused by pathological processes in the mucous membrane of the gastrointestinal tract. The cause may be limited inflammatory bowel disease, ulcerative colitis and neoplastic diseases. Damage to the mucosa causes loss of blood, plasma, water, electrolytes and mucus, and damage to the rectal mucosa can cause a feeling of urge to defecate and severe pain.
5. Diarrhea as a result of impaired intestinal transit
   is very often observed after surgical resection of the intestine, stomach, or anastomotic bypass, which leads to faster discharge and insufficient absorption of water from the gastrointestinal tract. Some drugs, hormones and prostaglandins have similar effects.

It is also useful to divide diarrhea into acute ones, lasting up to 14 days, most often caused by infections. The most common reasons include:

• rotaviruses;
• adenoviruses;
• Norwalk factor;
• bacterial infections caused by bacteria from the Yersinia group, Salmonella, Shigella, enetrotoxin-producing E. coli, Clostridium difficile, Campylobacter jejuni and Klebsiella.

Chronic diarrhea lasting more than 14 days can be caused by infectious agents (E. coli, Giardia, amoebiasis, cryptosporidium, and Clostridium difficile) and other conditions, such as:

• ulcerative colitis;
• Crohn's disease;
• cystic fibrosis;
• Johanson Blizzard syndrome;
• disturbances in the production and outflow of bile salts;
• celiac disease;
• immune disorders, including HIV;
• short bowel syndrome;
• food intolerance, allergic causes;
• neoplastic diseases, including diseases located outside the gastrointestinal tract - nonruoblastoma, Ganglioneuroma;
• Hirschsprung's disease;
• intensive chemotherapy and radiation therapy.

These, of course, are not all the reasons that can cause diarrhea.

It should be remembered that any diarrhea, especially in the elderly or in children, can quickly lead to dehydration, electrolyte disturbances, metabolic acidosis, hypokalemia and hypomagnesemia. Symptoms of diarrhea are especially dangerous, such as the appearance of fat, mucus, blood, and purulent discharge in the stool.

That's why it's important to be aware of the many diseases that can cause diarrhea. The mechanisms themselves, presented earlier, are not very mysterious and, recalling them, one can easily explain why the patient experiences disturbances in the frequency, quality and quantity of bowel movements. On the other hand, the most important element is to notice all the symptoms of the disease, and not stop at the diagnosis and simple treatment of diarrhea.

Treatment of diarrhea

Diarrhea is most often a symptom of another underlying disease. Treatment should consist of treating the underlying disease. However, symptomatic treatment may also be required. Severe and prolonged diarrhea requires fluids and electrolytes. Concomitant vomiting and possible gastrointestinal bleeding should be considered.

Parenteral fluid administration is based mainly on crystalloid solutions. However, the main problem is the spread of the simple method of oral rehydration. The supply of fluid orally is possible in cases where vomiting does not occur. Drugs that slow down peristalsis (opiates, loperamide) may also be useful.

Parenteral fluid administration

It should be borne in mind that during diarrhea, the most common phenomenon is intolerance to sugars and proteins contained in milk. The best way is to drink water properly and avoid foods containing sugar and protein. Antibacterial agents may be required.

The key to making a diagnosis is to answer the following questions:

• Who is sick - age, gender, occupation, etc.;
• Symptoms - fever, vomiting, bradycardia, general condition;
• Where did diarrhea begin - at home, on the road, on vacation in the tropics;
• The circle of sick people is alone, with family, with company.

Constipation - individual medical practice

Constipation of stool is one of the most common human diseases in highly developed countries. This is indicated not only by statistical data on patients seeking medical help, but also, above all, by an analysis of drug consumption, which shows that laxatives are the most frequently used.

Constipation is a pathological condition in which stool is passed less than three times a week. However, it should be remembered that some people feel good and healthy when they have fewer bowel movements.

Constipation

At the beginning of this century, Dr. Stanislav Breuer wrote in The New Home Doctor: “Constipation is very often caused by poorly treated intestinal catarrh in childhood, ulcers, dysentery, typhus, and also excessive overeating. Chronic constipation has a very bad effect on the entire body, impedes blood circulation, causes changes in the lungs, liver, catarrh, shortness of breath, palpitations, anemia, back pain and nervous disorders.”

The act of defecation itself is a complex process consisting of three phases and controlled by the central centers of the brain and spinal cord and the peripheral centers of the sigmoid and rectum.

• In the first phase, stool moves from the sigmoid colon to the rectum, which causes a feeling of pressure.
• In the second phase, the sigmoid colon reflexively contracts and straightens, which facilitates the further movement of stool into the rectum.
• In the third phase, with the participation of the abdominal press and as a result of massive peristaltic movements, with simultaneous contraction of the levator ani muscles and relaxation of the anal sphincter muscles, feces are expelled.

Constipation most often occurs as a result of obstruction of bowel movements (dyschezia) or, less commonly, obstruction of passage through the large intestine. Smoking, physical inactivity, and a diet low in fiber predispose to constipation.

Rectal cancer

A key link in the development of cancer is poor nutrition.

The rectum is a certain section in the digestive system, passing through it, all digestive products are excreted.

Oncology of this organ can be provoked by: chronic colitis, polyploid growths, heredity. A key link in the development of cancer is poor nutrition.

Constipation begins when the diet includes an excessive amount of fried and fatty foods and a small proportion of vegetables and fruits.

An important factor in the development of this disease will be excess weight, as well as physical inactivity. During rectal cancer, the following symptoms are observed:

• modified feces;
• constipation;
• diarrhea alternating with diarrhea;
• pain during bowel movements;
• black stool mixed with blood.

Sometimes rectal cancer is mistakenly recognized as hemorrhoids. But during hemorrhoids, the blood is located outside the stool, and during cancer, it mixes with them. However, constipation differs in its duration.

Causes of constipation

The causes of constipation can be organic or functional.

Organic causes of defecation disorders are:

• weakening of the strength of the abdominal muscles
  and perineal muscles due to debilitating diseases, lying down and a sedentary lifestyle;
• enlargement of the large intestine
  (megacolon, megarectum) congenital or acquired, for example, due to frequent enemas;
• diseases of the nervous system
  (pathologies of the spinal cord, tumors).

The functional causes of defecation disorders are:

• habitual constipation caused by abstaining from bowel movements, incorrect position during bowel movements;
• contraction of the anal sphincter during neuroses, hemorrhoids, anal fissures.

Intestinal transit disorders are also caused by organic and functional causes.

Organic reasons:

• intestinal obstruction;
• cancer;
• inflammatory diseases leading to strictures - granulomatous diseases, Crohn's disease, tuberculosis, syphilis, ulcerative colitis and radiation enteritis.

The functional causes of intestinal transit disorders are:

• Spastic constipation: (intestinal irritability);
• neuroses;
• peptic ulcer;
• cholelithiasis;
• stones in the kidneys;
• adnexitis, etc.

Atonic constipation:

• endocrine disorders - hypothyroidism, pathologies of the pituitary gland, hormonal fluctuations during pregnancy;
• metabolic disorders - hypercalcemia, hypokalemia;
• neurological and mental illnesses, such as depression;
• Hirschsprung's disease;
• the effect of medications - papaverine, antidepressants, opiates.

As you can see, there are many causes of constipation; constipation is often the first symptom of the disease, which lasts a long time. In medical practice, such ailments are very common, especially in elderly and bedridden patients.

A big step in the spread of colon diseases was the civilizational leap associated with the popularization of industrial grinding of cereals. A decrease in dietary fiber content has contributed to an increased incidence of diseases such as diverticular disease of the colon, angiodysplasia and colorectal cancer. It can be assumed that the dietary habits of highly developed societies lead to a systematic decrease in the amount of fiber and fiber in the diet, which contributes to the much higher incidence of constipation, as well as many other symptoms,

Diagnosis of constipation - start with simple tests

The most important thing in a doctor's practice seems to be to identify those cases of constipation that may indicate another serious illness. Therefore, it seems reasonable to reiterate that absolutely all patients should be subjected to a basic proctological examination. An old Latin aphorism says that a wise doctor always examines a patient through the anus. "Medicus sapiens digitum suum semper in ano tenet."

It should be remembered that almost 2/3 of all cases of colorectal cancer are available in the basic diagnostic tests that are in the arsenal of tests of any doctor.

Stool analysis and proctoscopy do not require special preparation of the patient; they are extremely simple and cheap to perform. Detection of changes in the wall of the end of the colon, as well as the presence, consistency and color of stool, provides a lot of information, facilitating further management of patients visiting a gastroenterologist. In unclear cases, the diagnosis can be expanded by contrast examination of the colon and colonoscopy.

Proctoscopy

Survey

First of all, our specialist will perform an external examination and palpation of the abdomen, and, if necessary, a rectal digital examination. For a more accurate diagnosis, you will have to take some tests (blood, urine and, of course, feces), as well as undergo an ultrasound of the abdominal organs.

If a doctor at our clinic suspects a specific disease, there may be a need to conduct additional research at a diagnostic center. In particular, you may be prescribed:

• gastroscopy
• computed tomography of the abdomen and pelvic organs
• colonoscopy
• ERCP
• irrigoscopy
• sigmoidoscopy.

Thanks to the use of new generation equipment and the professionalism of our doctors, discomfort from the procedures is minimized.

See also : Make an appointment with a gastroenterologist.