By kindlylives 
The number of young people experiencing defecation difficulties and defecation – related anxiety is on the rise. “My stomach is always bloated, and my mood for the whole day depends on whether I can have a bowel movement. If I can’t, it will make me even more anxious the next day,” described a 30 – year – old young patient during a visit to the doctor. Some young people are willing to spend hundreds of yuan at places like “intestinal SPA” institutions to relieve constipation. In fact, the problem of constipation is not simply an issue of the intestines, but rather an abnormal interaction between the intestine and the brain.
Defecation Anxiety Troubles Young People
Many people have a misunderstanding that they must have a bowel movement once a day, and if they don’t, it’s abnormal. They feel anxious when they can’t defecate, and also when they only have a small amount of bowel movement. In fact, the frequency of bowel movements among healthy people can vary greatly. Constipation is a common intestinal problem, and chronic constipation is defined as a condition with a course of at least 6 months. Chronic constipation is related to factors such as motility disorders, abnormal nervous system function, and changes in the gut microbiota.
Most of the causes of chronic constipation are functional diseases, including functional constipation, functional defecation disorders, and constipation – predominant irritable bowel syndrome. The Rome IV criteria internationally attribute the pathogenesis of functional constipation to “abnormal gut – brain interaction.” The gut – brain axis, which involves the interaction and two – way communication between the enteric nervous system and the central nervous system, connects the brain and the intestines and is related to multiple aspects such as the nervous, endocrine, and immune systems. By regulating the secretion of hormones, neurotransmitters, mucins, and other signaling molecules by nerve and endocrine cells, information is transmitted to the gastrointestinal tract, either exciting or inhibiting the effector cells of the gastrointestinal tract to maintain overall balance. In traditional Chinese medicine, it is believed that the brain and the intestines often affect each other when diseased. Emotional distress can affect the flow of qi, and “when qi stagnates internally, substances do not move.”
Functional constipation refers to a condition that cannot be explained by organic diseases or biochemical abnormalities, and its pathogenesis remains unclear. Due to its long – term recurrence, it reduces the quality of life of patients and is often accompanied by psychological distress. The global prevalence of functional constipation in adults is approximately 14%, and in China, it is about 10.9%. Long – term constipation can cause emotional problems such as anxiety and depression, increase the risk of colon cancer, cardiovascular and cerebrovascular diseases, and Alzheimer’s disease, posing great harm.
When constipated, the stools are dry, which can easily lead to anorectal diseases such as anal fissures, hemorrhoids, and rectal prolapse. Long – term constipation can cause high pressure in the anal canal area, resulting in blood stasis, increased abdominal pressure, and impaired anorectal blood return. The body of a constipated person has an increased amount of toxins (including more than 20 harmful substances such as ammonia, hydrogen sulfide, and indole), which can easily cause dull skin and bad breath. Ammonia is a neurotoxin, and when a large amount of it is absorbed into the blood, it can affect brain function, cause mood disorders, and in severe cases, lead to hepatic encephalopathy in patients with liver disease.
Why Are Defecation Difficulties Becoming More Common?
With changes in the diet structure, an accelerated pace of life, and the influence of social – psychological factors, the prevalence of chronic constipation is on the rise. Chronic constipation in young people is closely related to lifestyle, work pressure, mental and psychological factors.
Young people often prefer refined foods, which contain too little dietary fiber, resulting in a reduced amount of feces. At the same time, insufficient water intake makes the stools dry and difficult to excrete. Busy with work, they engage in too little physical activity, which slows down intestinal peristalsis. They also like to look at their mobile phones while defecating, which distracts their attention and easily inhibits the defecation reflex. Due to objective factors such as working or traveling outside, they may subjectively suppress the urge to defecate, leading to temporary constipation.
The gastrointestinal tract’s response is closely related to emotions. Interference from mental and psychological factors such as anxiety and depression may be an important cause of abnormal gastrointestinal function. These factors can act through the interaction with the gut – brain axis or affect the hypothalamus and the autonomic nervous system through the cerebral cortex, resulting in abnormal secretion of gastrointestinal hormones, damage to the intestinal epithelial barrier and mucosal immune function, and affecting the normal movement of the intestines and visceral sensation.
Anxiety and depression can increase the tension of the pelvic floor muscles, leading to disorders in the coordinated movement of the rectum and anus. Constipation may persist as a somatic symptom with the development of mental and psychological disorders such as anxiety and depression. Conversely, constipation can, through interaction with the gut – brain axis, cause or exacerbate the occurrence of mental and psychological disorders such as anxiety and depression. Anxiety and depression in young people may stem from various pressures in study, family, and the workplace. Some people are also impatient and irritable by nature, making them more prone to psychosomatic diseases. Research shows that 46.83% of patients with functional constipation have obvious sleep disorders, which aggravate their anxiety and depression and affect their quality of life.
“Letting Go” Enables “Letting It Out”
There are a wide variety of methods for treating constipation on the market. Some young people may drink senna leaf, various brands of laxative tea, rhubarb, etc., and end up having severe diarrhea after taking these medications on their own. However, they are unaware that the abuse of drugs can lead to consequences such as diarrhea, electrolyte imbalance, and painful cramps. For example, the popular laxative “Japanese Pink Pills” mainly contain bisacodyl, which acts on the enteric nervous system to enhance intestinal motility. But long – term use may lead to drug dependence and intestinal dysfunction. In addition, long – term use of anthraquinone – containing drugs can cause melanosis coli. It is recommended that constipated patients use stimulant laxatives for a short – term and intermittently.
Some massage institutions and “defecation bars” use enema drugs administered through the anus to lubricate and stimulate the intestinal wall, soften the feces, and make them easier to excrete. However, improper operation can cause damage and bleeding to the rectal mucosa. It is recommended that constipated patients with dry and hard feces or fecal impaction receive enema treatment at a regular medical institution.
Although constipation is common, it should never be taken lightly. Improving lifestyle habits and the diet structure, and combining with drug treatment when necessary, can prevent constipation.
- Adjust the lifestyle: A reasonable diet, adequate water intake, exercise, and developing good defecation habits are the basic treatment measures for chronic constipation. It is recommended to consume 25 – 35 grams of dietary fiber per day and drink at least 1.5 – 2.0 liters of water per day. Regular, moderate – intensity exercise can improve constipation, especially for those who sit for long periods and exercise little. The colon is most active when waking up in the morning and after meals. It is recommended that patients try to defecate within 2 hours after waking up or after meals, and focus their attention during defecation to reduce external interference.
- Drug treatment: It can relieve clinical symptoms through mechanisms such as improving defecation habits, promoting gastrointestinal motility, regulating the gut microbiota, and regulating the gastrointestinal nerves. However, drug treatment must be carried out under the professional guidance of a doctor. For those who need long – term use of laxatives for maintenance treatment, abuse of laxatives should be avoided.
- Mental and psychological treatment: Patients with mental and psychological disorders and sleep disorders should receive psychological guidance and cognitive therapy to fully understand the importance of a good mental state and sleep in relieving constipation symptoms. Constipated patients with obvious psychological disorders and severe mental and psychological abnormalities should seek specialized treatment at the department of psychiatry.