Ayamtim

**Ayamtim** ne sɛ nnipa ayamdeɛ yɛ den na ntumi mpui mma abɔten. Mpempii no yaane no den asan aho.  Nsɛnkyerɛnne foforɔ bi nso ne yam yadeɛ, yam bobom, ɛyɛ wosɛ wonyaa wo nan nwieɛ. Nnoɔma a ɛha agye wɔ ayamtuo ho ne hemorrhoids, anal fissure or fecal impaction. Mpɛn dodoɔ a ɛwɔ sɛ mpanimfoɔ gya wɔn nan yɛ mprɛnsa dabiara ɛna mprɛnsa nnwɔtwe biara. Nkwadaa ketewa deɛ yɛ mprɛnsa anaa mprɛ nan dabiara ɛna mmɔtofowa nso mprɛnu de rekɔ mprɛnsa dabiara. Nnoɔma a ɛde ayamtim ba dɔɔso. Nea ɛyɛ na ne agyanan a ɛntumi mma ntɛntɛm, irritable bowel syndrome ne pelvic for disorder. Yareɛ a ɛne no sɛ nehypothyroidism, diabetes, Parkinson's disease, celiac disease, non-celiac gluten sensitivity, colon cancer, diverticulitis, and inflammatory bowel disease. Nnuro a yɛde ma obi a wanya yamtuo neopioids, certain antacids, calcium channel blockers, and anticholinergics. Opioids boa ma obi a ne yam tuo yam tim. Nnipa ani ba ayamtim ho sɛ obi ahoɔden sɛ te a, anaa ɔnyaa anaemia, mmogya ba n'agyanan mu a, yɛwɔ abakɔsɛm a ɛfa kokoram anaa ayamtuo yi ho a ɛwɔ abusua mu anaasɛ ɛwɔ obi a wanyini so. Kwan a wɔfa so sa saa yareɛ no gyina  kwan a ɛfaa so baeɛ na nna dodoɔ a adi. Kwan a ɛbɛtumi aboa ne sɛ wonom nsuo pii, di nnuaba a nsuo wɔm, wodi ɛwoɔ na watenetene w'apom kakra. Sɛ anyɛ adwuma a, wɔbɛtumi de laxatives of the bulk forming agent, osmotic agent, stool softener, or lubricant type ama wo. Wɔde stimulant laxatives no ma wo sɛ ebia nnuro a wɔde maa wo no antumi ansa yareɛ noa. Nea yɛtumi de sa ayamtuo nso ne biofeedback anaasɛ yɛde sekan paepae obi mua. Ɔhamu nkyekyɛmu mmienu dekɔ aduasa na ɛtaa nya ayamtim. Mpanimfoɔ a nso deɛ firi ɔhamu nkyekyɛmu aduonum kɔpem aduoson.  Nnipa ɔwɔ United States bɛka bɛyɛ US$250 de tɔ aduro sa ayamtuo bɛyɛ afe.

## Nkyerɛaseɛ
Ayamtim yɛ nsɛnkyerɛnneɛ na ɛnyɛ yareɛ. Mpempii no, ayamtim yɛ adeɛ a yɛka sɛ yɛn ayamdeɛ ntumi mpui bɛyɛ mprɛnsa nnwɔtwe nnawɔtwe biara. Saa ara nso na, nnipa bɔsoɔ ka nnoɔma a ɛdidisoɔ yi.

* Ayamdeɛ a ɛkyɛ ansa na aba
* Wɔhia mmerɛ pii ansa na ayamdeɛ no aba
* Ayamdeɛ no yɛ den
* Ɛnam sɛ ayamdeɛ no kyɛ ansa na apii no nti ɛma no te yaw.
* Yam yadeɛ
* Mframa gyina ne yam
* the sensation of incomplete bowel evacuation.
Rome III Criteria yɛ nsɛnkyerɛnneɛ ahodoɔ bi a  ɛboa ma wɔyɛ nhwehwɛmu no nya gyinapen a ɛfa ayamtim ho a ɛgyina mfeɛ ahodoɔ so. Saa ɔkwan yi boa ma aduyɛfoɔ kyerɛ ayamtim mu yie wɔ gyinapɛn kwan so.

## Nnoɔma a ɛde ba
Nnoɔma a ɛde ayamtim ba no bɛtumi akyekyɛ ayɛ congenital,ordinary ne Secondary. Deɛ ɛyɛ na paa yɛ ordinary na ɛnha adwene. Ɛbɛtumi agyina mfeɛ a obi adi te sɛ mmɔfra ne mpanimfoɔ so akyekyɛmu. 

Primary anaa functional ayamtim kyerɛ nsɛnkyerɛnne bi a ɛkɔso wɔ nnipadua mu a ɛboro bosome nsia a ɛnyi a asɛm biara so te sɛ aduro a obi anom ho nsunsuansoɔ anaa tebea a obi wɔ yareɛ mu. Ɛmfa yam yadeɛ ho, ɛne sɛ ɛda nso firi irritable bowel syndrome ho. Ɛyɛ ayamtim a ɛyɛ na paa na ɛdɔɔso. Wɔ mpanimfoɔ mu no, nnoɔma a ɛde Primary ayamtim ba na ɛdidisoɔ yi: nnuane a yɛ di bi te sɛ nnuane a nsuo nnim, anaa suban bi a yɛda no adi te sɛ yɛn tenetene yɛn mpom. Wɔ mpanimfoɔ paa mu no, nnoɔma a ɛde ba no gyina nnuane a nsuo nnim a wɔdi, wɔnnom nsuo pii, wɔntenetene wɔn mpom, nsunsuansoɔ a wɔnya firi nnuro a wafa mu, hypothyroidism ne colorectal kokoram.  Adanseɛ a wɔde bɛsɔ saa nnoɔma yi asene yɛ adeɛ ebi nni hɔ. Ńoɔma a ɛde Secondary no ba yɛ nsunsuansoɔ a ɛwɔ nnuro a wɔnom mu bi te sɛ opiates, endocrine ne  metabolic disorders te sɛ hypothyroidism, ne obstruction a ɛfiri colorectal cancer anaa ovarian cancer. Celiac yareɛ ne  non-celiac gluten sensitivity nso bɛtumi ama ayamtim aba. Cystocele nso bɛtumi ama ayamtim ɛyɛ koankorɔ aba.

**Nnuane**

Nnuane a nsuo nnoma a yɛdi, nsuo a yɛnnom bɛtumi de ayamtim aba. Nnuane a nsuo wɔm tumi yi colonic transport time, ɛma ayamdeɛ dɔɔso na mmom ɛma no yɛ mmerɛ nso. Ne saa, nnuane a nsuo nnɔɔso wɔ mu no bɛtumi ama woanya ayamtim a yɛfrɛ no Primary.￼

**Nnuro** 

Nnuro pii nsunsuansoɔ yɛ ayamtim. Ɛbi ne ( na ɛnyɛ wei nika) opioids, diuretics, antidepressants, antihistamines, antispasmodics, anticonvulsants, tricyclic antidepressants, antiarrythmics, beta-adrenoceptor antagonists, anti-diarrheals, 5-HT3 receptor antagonists bi te sɛ ondansetron, ne aluminum antacids. Calcium channel blockers bi te sɛ nifedipine ne verapamil bɛtumi ama woanya ayamtim. Nnuane nnuro bi te sɛ calcium ne iron nso bɛtumi ama woanya ayamtim ho nsunsuansoɔ.

**Tebea a obi kɔ mu sɛ ɔnom aduro bi a** 

Metabolic ne endocrine haw a ɛbɛtumi de ayamtim aba ne:  pheochromocytoma, hypercalcemia, hypothyroidism, hyperparathyroidism, porphyria, chronic kidney disease, pan-hypopituitarism, diabetes mellitus, and cystic fibrosis. Ayamtim nso tumi ba nnipa a wɔwɔ muscular ne myotonic dystrophy.  Yareɛ a ɛdidisoɔ a ɛde ayamtim ba ne celiac disease and systemic sclerosis. Ayamtim wɔ kwan ahodoɔ ( mechanical, morphological, anatomical)  a ɛfa so ba a ɛne, wɔ ma kwan bɛda colon no a ɛsi ayamdeɛ kwan ma no ba bi te sɛ colorectal cancer, strictures, rectocoles, anal sphincter damage or malformation and post-surgical changes.  Nsorom nnoɔma bi a abɛka ho te sɛ malignancies bɛtumi de ayamtim aba.  Nea ɛde Ayamtim ba no bi yɛ Neurological, ebi ne anismus, descending perineum syndrome, and Hirschsprung's yareɛ. Hirschsprung yareɛ yɛ adeɛ a ɛyɛ na wɔ mmɔfra mu paa a ɛde ayamtim ba. Anismus ba nnipa kakra bi a wɔwɔ ayamtim a ɛyɛ koankorɔ anaa ayamdeɛ a ɛyɛ den sɛ ɛbɛpui. Akyi nkasɛɛ ne Neurological a ɛntotɔ N'akwan yie bi te sɛ Parkinson's yareɛ ne  pelvic floor dysfunction bɛtumi de ayamtim aba. Chagas yareɛ bɛtumi de ayamtim sɛ myenteric plexus sɛe a.

**Adwene mu nnoɔma**

Sɛ wohyɛ da ma yamdeɛ no ka wo mu kyɛ a ɛde ayamtim ba. Nea ɛbɛma obi ayɛ saa no sɛ na onikorɔ no suro yaw a ɛbɛba no, akwadworɔ anaa ɔsuro baabi a nnipadɔm siesie wɔn ho.  Sɛ abɔfra ma ne yamdeɛ ka ne mu a nkuranhyɛ, nsuo ne afaseduro a aka abom bɛtumi asi saa ɔhaw no ano kwan. Sɛ wodi wo ho so na wakura mu no nso bɛtumi de anka fissures aba.

**Congenital**

Nyarewa pii a ɛba wɔ awoɔ mu no nso tumi de ayamtim ba mmɔfra so. Ɛyɛ ekuo bi a ɛda nso firi Hirschsprung (HD) yareɛ a ɛyɛ na ho. Yɛwɔ congenital structural anomalies a ɛde ayamtim ba a ebi ne anterior displacement of the anus, imperforate anus, strictures, and small left colon syndrome.

## Beaeɛ a menyaa mmoa firiiɛ