小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 排便次数减少
- 排便困难
- 排便不尽感
- 特别费力
其他诊断因素
- 粪便干结
- 腹部肿块
- 提示潜在疾病的体征
- 肛门直肠病变
- 直肠指检（DRE）异常
危险因素
- 女性
- 年龄＞65 岁
- 非洲人血统
- 社会经济状况较差
- 家族史
- 久坐不动的生活方式
- 低纤维摄入
- 热量摄入不足
- 液体摄入不足
- 外科手术及分娩
- 诱发便秘的药物
诊断性检查
首要检查
- 全血细胞计数 (FBC)
- 甲状腺功能检测
- 血清电解质、钙和镁
- 血糖
- 粪便免疫化学定量检测
- 腹部 X 线检查
- 钡灌肠
需考虑的检查
- 钡剂排粪造影
- 磁共振排便粪造影
- 结肠镜检查
- 结肠传输试验
- 肛门直肠测压
- 气囊排出检查
- 结肠测压
治疗流程
阿片类药物诱导的
非阿片类药物诱发：症状持续时间＜3 个月
非阿片类药物诱发：症状持续时间≥3 个月
怀疑存在协同障碍或药物治疗无效
撰稿人
作者
Satish Rao, MD, PhD, FRCP (Lon), FACG, AGAF
Professor of Medicine
Chief, Section of Gastroenterology and Hepatology
Director, Digestive Health Center and Neurogastroenterology and GI Motility
Medical College of Georgia
Georgia Regents University
Augusta
GA
利益声明
SR serves on the advisory board for Vibrant Limited, Sanofi Pharmaceuticals, Viatris Pharmaceuticals, and Takeda Pharmaceuticals of North America. SR is an author of a number of references cited in this topic.
Dariush Shahsavari, MD
Senior Gastroenterology Fellow
Internal Medicine, Division of Gastroenterology/Hepatology
Augusta University
Augusta
GA
利益声明
DS declares that he has no competing interests.
鸣谢
Dr Satish Rao and Dr Dariush Shahsavari would like to gratefully acknowledge Dr Amol Sharma, Dr Humberto Sifuentes, and Dr Ashok Attaluri, previous contributors to this topic.
利益声明
AS declares that he is on the advisory board for Ironwood Pharmaceuticals. HS declares that he has no competing interests. AA is an author of one reference cited in this topic.
同行评议者
Stefan Muller-Lissner, MD
Professor
Abteilung fur Innere Medizin
Park-Klinik Weissensee
Berlin
Germany
利益声明
SML declares that he has no competing interests.
Eamonn M.M. Quigley, MD, FRCP, FACP, FACG, FRCPI
Professor of Medicine and Human Physiology
Department of Medicine
Clinical Sciences Building
Cork University Hospital
Cork
Ireland
利益声明
EMMQ has served as a consultant or on advisory boards for the following companies: Sucampo, Movetis, Norgine, Procter and Gamble, Boehringer Ingelheim, Reckitts Benckiser, Schering, Novartis, Salix, Ironwood, and McNeill Consumer Health and has been paid for his time involved. EMMQ is an author of several references cited in this topic.
Ned Snyder, MD
Chief of Gastroenterology and Hepatology
Kelsey-Seybold Clinic
Adjunct Professor of Medicine
University of Texas Medical Branch
Houston
TX
利益声明
Not disclosed.
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