Fathallah Nadia, Bouchard Dominique, de Parades Vincent
Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France; Groupe hospitalier Paris Saint-Joseph, service de gastroentérologie, 185, rue Raymond-Losserand, 75014 Paris, France; Hôpital européen Georges-Pompidou, service de gastroentérologie, 20, rue Leblanc, 75015 Paris, France.
Hôpital Bagatelle, service de proctologie médico-chirurgicale, 201, rue Robespierre, 33400 Talence, France.
Presse Med. 2017 Jan;46(1):23-30. doi: 10.1016/j.lpm.2016.03.019. Epub 2017 Jan 5.
Chronic constipation is one of the most common chronic gastrointestinal complaints and a frequent reason for consultation. Lifestyle modification and dietary advice attract a lot of patients, often dissatisfied with a long-term drug intake. These behavioral modifications are recommended as a first-line approach in the treatment of chronic mild constipation in the majority of current guidelines despite a low level of evidence. Fiber supplementation is probably the most relevant measure because of a satisfactory level of proof. It improves stool frequency and consistency. It has a positive effect on excessive straining and colonic transit time. The recommended daily fiber intake is at least 20 to 25g. To avoid side effects like bloating and abdominal pain, it must be gradually adjusted after a several days period. The benefice of increasing water intake or daily physical exercise in the treatment of chronic constipation have a lack of evidence, except specific situations such as elderly, hospitalized, institutionalized, dehydrated people or people consuming fluids less than 500mL/day. Change in environmental defecation conditions or bowel habits are probably anecdotal recommendations.
慢性便秘是最常见的慢性胃肠道疾病之一，也是患者经常咨询的问题。生活方式的改变和饮食建议吸引了很多患者，他们往往对长期服药不满。尽管证据水平较低，但在大多数现行指南中，这些行为改变被推荐为治疗慢性轻度便秘的一线方法。由于有充分的证据，补充纤维可能是最相关的措施。它能改善排便频率和大便稠度。对过度用力排便和结肠传输时间有积极影响。建议的每日纤维摄入量至少为20至25克。为避免腹胀和腹痛等副作用，必须在几天后逐渐调整。除了老年人、住院患者、机构化照护者、脱水者或每日液体摄入量少于500毫升的人群等特定情况外，增加水分摄入或日常体育锻炼对治疗慢性便秘的益处缺乏证据。改变排便环境条件或排便习惯可能只是传闻性的建议。
