To functional diseases of a large intestine frustration its motive (motor), transport (vsasyvatelny and secretory) functions treat without irreversible structural changes of intestines. There are many synonyms for designation of this pathology: irritable colon, neurogenic mucous colitis, mucous colic, dyskinesia of a large intestine, etc. It is easy to notice that each name in a varying degree reflects features of functional disturbances. It is easy to resolve this task if to designate a disease as "functional disorder of a large intestine" and at the same time to specify disturbance type in the diagnosis.
Epidemiology Functional disorders of a large intestine belong to the most often found diseases of internals. They make the most numerous group of diseases of digestive organs at an out-patient and polyclinic stage of medical care. Only at the few patients these frustration accept a persistent long current and demand hospitalization.
Etiology and pathogeny As the reasons of functional disorders of a large intestine first of all the psychoemotional disturbances connected with pathological development in type of obsessivno-phobic, hypochiondrial, depressive or hysterical syndromes can serve. The various neurovegetative disturbances observed at these patients, inadequate reaction to stresses and other influences of external environment often lead to disorders of regulation of functions of a large intestine as it becomes at them critical body of mental disadaptation. Its essence consists in loss of normal regulation of the act of defecation.
Among other factors contributing to dysfunction of intestines the slow-moving way of life, irrational food with deficit in a diet of food fibers, and also intestinal infections and other diseases of digestive organs matter.
Classification The large intestine carries out 3 main functions: motor, transport and excretory, providing thereby forming and evacuation of fecal masses. The main options of functional disturbances include:
1. Motility disturbances: a) hyper motor (increase of a tone, the accelerated propulsion), b) hypomotor (decrease in a tone, the slowed-down propulsion).
2. Disturbances of transport: a) hypersecretion of ions and water in a gut gleam, b) the increased absorption of ions and waters in a large intestine.
3. Slime secretion disturbances: a) slime supersecretion, b) slime hyposecretion.
These features also find reflection at the formulation of the diagnosis: 1. Hyper motor dyskinesia with episodes of water diarrhea of a neurogenic geiyez; asthenoneurotic syndrome.
2. Functional disorder of a large intestine on hypomotor type with a syndrome of atonic locks.
3. Functional disorder of a large intestine on hyper motor type with a syndrome of spastic locks and hyperproduction of slime.
Preliminary diagnosis The main clinical symptoms are pain in a projection of a large intestine and disturbance of a chair — locks or a frequent liquid chair small portions. In the mental status of the patient symptoms of persistence, phobic and depressions quite often come to light. At patients postoperative hems on an abdominal wall are frequent. In these cases of commissure can create a background for constant pain in a stomach.
Clinical blood tests and urine it is normal. At proctologic research quite often reveal small cracks and erosion of the proctal channel, hemorrhoidal nodes. Introduction of a rektoskop is followed by considerable morbidity, spastic reductions of a gut, in a gleam of a gut it is possible to see a large amount of slime.
Irrigoskopiya of a large intestine with administration of barium in it allows not only to exclude organic diseases, but also to reveal some specific functional disturbances: uneven haustrations, sites of spasms and atony. Also incomplete emptying of a gut from barium is characteristic. With functional disorder of a large intestine at the persistent course of a disease it is desirable to involve the neuropsychiatrist in inspection and treatment of patients.
Verification of the diagnosis, differential diagnosis Histologic research of a mucous large intestine allows to exclude the pathological changes inherent to colitis (diffusion or atrophic changes of a mucous membrane) at patients.
The main objective of differential diagnosis is the exception of diseases with organic changes. It must be kept in mind intestines tumors, infectious and parasitic diseases (iyersinioz, etc.), an appendicism, the beginning inguinal hernia, chronic colitis (including ulcer), diseases of a small bowel, a stomach and a duodenum, bilious ways, an urolithiasis and a radicular syndrome at backbone diseases. Diagnostic difficulties can arise also at patients with the lowered kidney.
Untimely diagnosis of cancer of a straight line and colon is prevented by means of careful tool research of a large intestine.
Diagnostic difficulties can arise also at patients with the latent course of ulcer colitis when there are no bleedings, fervescences and changes of blood. In some cases at patients with spondiloosteokhondrozy the radicular syndrome can proceed with the pain reminding that at intestines diseases. The correct diagnosis is promoted by the careful analysis of complaints and survey of the patient with identification of characteristic painful points in a projection of the corresponding roots.
The differential diagnosis with the listed above diseases is based mainly on carrying out tool researches of a stomach, gall bladder, kidneys.
Treatment, prevention The rational psychotherapy has to begin with establishment of good contact between the doctor and the patient, creations at the sick reasonable relation to an illness, elimination of unreasonable alarm by the reasoned illness essence statement.
Sessions of gipnosuggestivny influence during which skills of autogenic training are given are effective. Acupressure of biologically active points is used.
Psychotherapeutic methods of treatment have to be combined with psychopharmacotherapy lasting not less than 2 months with the subsequent gradual dose decline of drugs up to their full cancellation. Approximate doses of the psychotropic drugs used in complex therapy of functional disorders of a large intestine of the neurogenic nature are given in the table.
The doses of psychotropic drugs recommended for treatment of patients with intestines diskineziya
Minimum and maximum (in brackets) a single dose,
Frequency rate of reception
Maximum daily dose,
2 — 4
Diazepam (Seduxenum, Relanium)
2 — 4
3 — 4
1 — 2
1 — 3
1 — 3
1 — 3
1 — 3
2 — 3
2 — 3
1 — 2
2 — 3
1 — 2
1 — 2
Treatment of patients includes the dietary food directed first of all to normalization of a chair. An important role is played by the products containing the increased amount of food fibers (wheat bran, bread with bran, vegetables, fruit). In the absence of an independent chair it is recommended to appoint bran on 1 tablespoon 3 times a day, previously razvariv them. If necessary it is possible to increase a dose of bran on 9 spoons a day.
Medicinal therapy depends on type of functional frustration. Cholinolytic drugs are shown to patients with the raised tone of the muscular device of a large intestine: 0,1% atropine solution on 8 drops in 2 — 3 times a day before food; Methacinum on 0,002 g 2 — 3 times a day before food, etc. At decrease in a tone of a gut drugs of group of Metoclopramidum are recommended: a raglan (cerucal) in a dose of 0,01 g 3 times a day before food.
At the ponosa connected with the accelerated propulsion and decrease in a tone of a gut, the drugs which are slowing down propulsive function and strengthening a tone of circular muscle fibers give symptomatic effect: Codeini phosphas on 0,015 g 3 times a day in 30 min. prior to food, imodium (loperamide) on 0,002 g (1 capsule) of 1 — 2 time a day, reasek on 1 tablet 3 times a day to food.
The frequent liquid chair is eliminated also with purpose of white clay, bismuth, Dermatolum and calcium carbonate on 0,5 g of each ingredient (on 1 powder 3 times a day in 15 — 30 min. prior to food). At simultaneous diseases of a stomach, pancreas, other digestive organs the drugs containing digestive enzymes are usually shown (Pancreatinum, festal, Polyzimum, etc.). After an extract from a hospital patients are recommended to continue systematically studies autogenic training and to accept psychopharmacological drugs within 1 — 3 month with a gradual dose decline. The preference is given in out-patient conditions to the drugs which are not giving side effects (Rudotelum, Azaphenum, Aminalonum).