便祕的定義是指排便的頻率少於一週三次, 或所有排便次數當中需要有四分之一是需要特別用力才能完成. 引起便祕的可能原因包括了食物中纖維素不足藥物, 激躁性腸道症候群憩室或憩室炎,
大腸良性腫瘤, 或大腸直腸癌. 慢性便秘是臨床上常見又不易處理的問題,有各式各樣的原因如上所述. 適當的治療必須經由機能檢查找出致病機轉。但若是阻塞性便秘,則往往藥物沒有良好的作用。
→激躁性腸道症候群是最常見也是最具代表性腸道運動機能障礙,臨床表現變化不定,且各種檢查又無特定的異常,長期治療反應也不穩定,病程延久,常造成病人與醫師間極大困擾。目前只能藉助特定的症狀群組合診斷.但實際臨床使用時,一般須符合以下三條件:
→慢性或反覆性腹痛、大便習慣改變,及排除器質性或繼發性的原因。它基本上是整個腸道機能的失調,包括胃、食道在內。而且其他的因素,如精神心理因素、飲食等在治療時都須加以考慮。治療上最重要是要建立良好的醫病關係,讓病人了解這種病不會致命,不是癌症,而且不需要太多檢查。若須藥物,則以不定期的症狀治療為原則。
→痔瘡是因肛門長期地用力不當,而使得肛門管黏膜下層的靜脈發生曲張造成,而由於肛門黏膜承受太大的張力,故久而久之,便合併黏膜和肛門周圍皮膚的脫垂。因此,痔瘡患者常會感覺到肛門部份突出,或一般所謂「脫肛」。
至於肛門用力不當的原因最常見者為慢性便秘或腹瀉,此外懷孕婦女因胎頭壓迫阻礙血液循環,個人先天體質造成肛門太緊或賀爾蒙因素,以及後天性疾病如肝硬化、慢性咳嗽、或甚至骨盆腫瘤等均可能為痔瘡的誘因。
痔瘡的類別和分級:痔瘡可以區分為「內痔」、「外痔」、及「混合痔」三種。痔瘡的嚴重度分成四個等級。第一級是沒有明顯的突出;第二級是痔瘡雖有突出但會自動縮回;第三級是突出的痔瘡必須用手方能推回;第四級是痔瘡無法推回。
痔瘡的併發症:痔瘡常見的症狀包括脫肛、出血、疼痛、劇癢、便後肛門無法擦拭乾淨。因此,痔瘡若沒有治療,不但上述症狀會持續存在,亦可能因出血而造成慢性貧血,或因持續腫脹而造成組織壞死。
為了確定痔瘡的存在,醫師例行性地會讓病患側睡露出肛門部,然後詳細視診及做肛門指診。若情況需要也會安排硬式或軟式直腸鏡檢、大腸鏡檢、或鋇劑灌腸攝影,以排除大腸直腸病變的可能性。
由於痔瘡的產生主要是因為排便不順暢引起,因此痔瘡的治療首重改善排便習慣,即慢性便秘者可藉著多攝取水分、高纖維飲食、軟便劑、瀉劑、以及消腫藥物而得到改善。目前市面上的「消痔丸」主要大概含有這些成分。至於慢性腹瀉患者,則必須服用止瀉劑。另外一些局部治療藥膏和塞劑亦可有效地緩解症狀,其主要含有消炎、止癢、止痛、收斂與潤滑的成分。痔瘡發作時要切忌「上火」的食物,如辛辣、油炸、花生、濃咖啡、以及酒精等。至於在溫水中坐浴,因能促進肛門部血液循環,放鬆肛門括約肌以緩解疼痛,亦為不錯的做法。
除上述之保守療法外,醫師也會根據病患的個別狀況做較積極地治療,其中包括:(1)注射療法 (2)橡皮筋結紮 (3)冷凍療法 (4)電燒或鐳射療法 (5)手術療法。
痔瘡患者的居家保健常識:「預防勝於治療」是一句老掉牙的話,然卻是最實用的。(1)保持排便的順暢是避免痔瘡的不二法門;(2)不要把報紙或雜誌帶進廁所閱讀;(3)積極攝取纖維質,多喝水,避免辛辣食物,酒精以及濃咖啡;(4)生活習慣要正常,避免熬夜或久坐;(5)家常菜才是對預防和消除便秘有效的健康食品;(6)保持適度的運動;(7)每天在廁所內以清水洗屁股,然後保持乾燥;(8)溫水坐浴;(9)症狀發生時找合格的醫師確定,以免造成癌症的發現延遲;(10)不要諱疾忌醫,早期診斷,早期治療。
一般被痔瘡困擾不已的患者們,雖然對痔瘡這種疾病的認知稍嫌不足,但不少人還是想要靠自己的力量偷偷治療。除此之外,乾脆就採用民間療法或消極地默默忍耐者亦不在少數。總而言之,在某些患者的心目中,仍舊十分排斥上醫院找專科醫師治療的途徑,而寧可去使用登載在報紙與雜誌中誇大不實的秘方。殊不知,此舉不但對目前「坐立難安」的困境無法消除,更可能導致痔瘡的日漸惡化,而成為永久的「後顧之憂」。所以對付便秘與痔瘡ㄝ唯有正本清源, 除“祕”務盡,除“痔”勿急。husband cheated on me
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