老 年 人 便 秘 之 面 面 觀 臺 中 榮 民 總 醫 院 胃 腸 肝 膽 科 張 繼 森 醫 師
胃 腸 症 狀 之 三 個 月 盛 行 率 症 狀 描 述 陽 性 人 數 三 個 月 盛 行 率 (%) 1. 吃 完 飯 後 有 好 幾 小 時 覺 得 腹 脹, 或 是 覺 得 食 物 在 胃 中 停 留 過 久 133 13.0 2. 感 覺 吃 一 點 就 飽, 或 無 法 吃 完 正 常 份 量 的 一 餐 100 9.8 3. 飯 後 腹 部 明 顯 飽 脹, 有 時 必 須 放 鬆 衣 褲, 才 感 覺 舒 服 161 15.7 4. 是 否 曾 因 腸 胃 不 適, 而 有 噁 心 想 吐 的 感 覺 99 9.7 5. 飯 後 是 否 曾 發 生 嘔 吐 31 3.0 6. 曾 發 生 胃 部 疼 痛 的 情 形 199 19.4 7. 胃 部 有 夜 間 疼 痛, 或 空 腹 時 疼 痛 的 情 形 118 11.5 8. 感 覺 胸 骨 後 有 心 臟 灼 熱, 或 胸 口 有 灼 熱 的 感 覺 61 6.0 9. 喉 嚨 或 嘴 巴 裡 有 胃 逆 流 上 來 的 酸 味 或 苦 味 物 質 173 16.9 10. 經 常 重 複 打 嗝 150 14.6 11. 肚 臍 下 部 感 覺 疼 痛 63 6.1 12. 曾 發 生 大 便 很 稀 ( 腹 瀉 ) 的 情 形 266 26.0 13. 曾 發 生 排 便 困 難 ( 便 秘 ) 的 情 形 155 15.1 14. 曾 發 生 排 出 血 便 或 是 黑 便 的 情 形 64 6.2 15. 曾 發 生 因 為 忍 不 住 便 意 而 衝 到 廁 所 的 情 形 117 11.4 16. 排 便 時, 會 有 糞 便 排 不 乾 淨 的 情 形 254 24.8 有 效 樣 本 數 =1025
Quantifying the target group T constipated people, i.e. people who assessed themselves as constipated 16% 3% 3% Laxative users 3% 7% 1% 6% symptomatic people* not constipated or not symptomatic or not using laxatives 61% Base n = 1,020 * persons suffering from at least one symptom of the 3 defined ones at least once a month
Prevalence of constipation - in the last 12 months - the rest of the world - - self definition - 34% 46% indigestion constipation diarhoea Irritable Bowel Syndrome 30% 31% 29% 47% 25% 25% 20% 15% 13% 6% USA SK T none of these 50% none of these 40% none of these 37% Q1b _ Base: USA = 2,028 SK = 1,000 T = 1,020
Prevalence of constipation (self defined) - in the last 12 months - D UK 10% 6% USA 15% SK 25% - gender: females = 14% males = 5% - gender: females = 8% males = 4% 6% - gender: females = 20% males = 10% - gender: females = 12% males = 38% - age: less than 60 = 6% 60 and over = 19% - age: less than 60 = 6% 60 and over = 7% - age: less than 60 = 14% 60 and over = 19% - age: less than 60 = 25% 60 and over = 15% F 19% E 17% I 23% T 29% - gender: females = 26% males = 11% - gender: females = 24% males = 10% - gender: females = 30% males = 15% - gender: females = 37% males = 21% - age: less than 60 = 17% 60 and over = 25% - age: less than 60 = 16% 60 and over = 21% - age: less than 60 = 21% 60 and over = 30% - age: less than 60 = 28% 60 and over = 31% Q1b _ Base: USA = 2,028 UK = 2,000 D = 2,468 F = 2,023 E = 2,006 I = 2,001 SK = 1,000 T = 1,020
The colon is 120 to 200 cm in length and is highly distensible.
Approximately 8500 ml of fluid are added to the gastrointestinal tract daily, 1500 ml coming from the diet and 7000 ml coming from endogenous secretions from the stomach, small intestine, pancreas, and biliary tree. Of this amount, roughly 7000 ml is absorbed in the small intestine, leaving 1500 ml of fluid for the cecum to handle. In the cecum, proximal colon, and distal colon, a further 1400 ml is absorbed, leaving approximately 100 ml of fluid to be expelled with the solid fecal material in the stool. Sellin JH, 1994
Narducci F, Bassotti G, Gaburri M, et al, 1987 The motility of the colon from the transverse, descending, and rectosigmoid colons over a 24-hour period from healthy individuals. Motor activity shows similar diurnal and nocturnal changes in all three regions of the colon.
No cephalic phase, mechano- and chemoreceptors, fat>protein>cho
Loss of Interstitial Cells of Cajal and Inhibitory Innervation in Insulin-Dependent Diabetes C-kit-immunopositive structures are shown in white. A decrease in c-kit-positive immunoreactivity was seen in all regions of the jejunum in the diabetic patient compared with the control. He CL, 2001
The scintigraphic pattern of colonic transit in a normal individual is shown after cecal perfusion of a radiolabelled marker. In the earliest images, tracer activity concentrates in the right colon, but by 6 hours the radioligand has migrated to the transverse colon. Over the course of 1 to 2 days, the tracer is propelled into the ascending colon and rectosigmoid colon to be expelled in the feces. Krevsky B, et al, 1986
In this technique, radiopaque markers are taken per os, and abdominal radiographs are taken at specific intervals to locate the markers in the right colon (R), left colon (L), and rectosigmoid colon (RS). Transit times through these regions are calculated using a derived mathematical equation:
Metcalf AM, Phillips SF, Zinsmeister AF, et al, 1987 In both men and women, the markers reside in the rectosigmoid region for the longest period of time, indicative of a storage function for this region. There is also prolonged residence of the markers in the ascending colon. This portion of the colon has been hypothesized to possess storage capabilities as well, based on the directionality of contractile patterns in this region. The mean colonic transit is slightly longer in women than in men.
Colonic Transit Time by ROM
Slow-Transit Constipation
便 秘 病 人 處 理 流 程
95 歲 的 日 本 老 翁 原 口 浩 三 在 2005 年 6 月 20 日 以 22.04 秒 創 下 95 至 99 歲 級 百 米 世 界 紀 錄 他 也 曾 在 2000 年 創 下 90 至 94 歲 級 的 百 米 世 界 紀 錄, 成 績 為 18.08 秒 當 旁 人 問 到 他 是 否 計 劃 挑 戰 一 百 歲 級 的 百 米 世 界 紀 錄 時, 他 說 : 如 果 我 能 活 到 那 麼 久, 我 會 試 試 看