Slow evacuation of food from the stomach. Coprological changes during accelerated evacuation from various parts of the intestine

To understand why people avoid responsibility, the first step is to ask yourself next questions: What is responsibility? and “How to understand where a person takes it upon himself, and where not?”

I would call responsibility scope of human control. We take responsibility in those situations where we exercise control over what is happening, take part in it, perform some actions that contribute to obtaining the results that we need.

It turns out that avoidance of responsibility- this is a refusal for one reason or another to influence the situation, the expectation that the situation will change itself, or someone will change it for us. When someone is told: “Take responsibility for your life”, they usually mean: “Finally start doing something so that your life becomes the way you want, instead of complaining about the circumstances, continuing” to go with the flow".

Here it is worth recalling such a well-known concept in psychology as locus of control. This property of the individual to attribute their successes or failures to internal or external factors. Usually, if a person is more accustomed to considering himself the cause of those things that happen to him in life, it is considered that he internal locus of control(internal). If a person believes that in general he does not particularly affect anything in life, and what happens is determined by fate, karma, God, aliens, different people or any other circumstances, then it is considered that he has external locus of control(external).

Of course, in a normal situation, for most people, this indicator will be somewhere between the two extremes, shifted more towards one or the other pole.

People whose locus of control is very much shifted to the outside usually play the role of a victim of circumstances. Everything is wrong with them, they do not influence anything, others are to blame for everything. They are not at all responsible for their lives, they move where the stream takes them. Like small children who experience helplessness in the face of emerging problems and instead of a solution, they can only be offended or blame others.

For example, a person has no friends, but he blames others for this, is offended by them and even angry because they do not understand him, do not want to understand, do not appreciate and do not love, instead of understanding the real reason, and that change something in yourself, take some action to build the desired relationship with others.

People who have a highly inward locus of control often take responsibility even for things they cannot influence. For example, for other people's emotions or decisions. These people tend to strong feeling guilt and self-blame when something goes wrong.

A good example would be working with a guy who experienced a number of unpleasant emotions if a girl refused him when he met. He always took any refusal personally, believing that he was doing something wrong, while believing that if he had done everything right, he would have received a positive answer. He could not understand in any way that there were other circumstances that he could not influence with all his desire and with all the “correctness” of his actions. When we began to understand, it turned out that something similar was happening in other areas - the conviction that everything always depends on him. But this, of course, is not so. There are always a number of factors that influence, especially when there is an interaction with any other living system: an animal, a person, a group of people. I once really liked the wonderful example that Robert Dilts gave: if we kick the ball, with some experience and skill, we can calculate the trajectory of the ball, where it will land. If we kick a dog, we never know for sure where the dog will be in a few seconds.

Of course, if we have known a person for some time, we know his habits and features, then in this case it is already possible to more or less calculate how he will react to our action. But also not always. Moreover, we cannot control everything and always in this world. Many things happen one way or another against our will, and nothing can be done about it.

Remember the peace prayer? “Lord, give me the peace of mind to accept what I cannot change, give me the courage to change what I can, and the wisdom to distinguish one from the other” – this is just about a balanced locus of control. It is very important to be able to take responsibility and take action where possible and just let go of control, accept the inevitability where there is no possibility to change anything.

It is also worth noting that when talking about the locus of control of a person, a certain general indicator is calculated by averaging the level of control in different situations. That is, the general tendency of a person to take responsibility for events in different areas of his life on himself or to shift it to the outside world. But, interestingly, despite the common denominator, in some areas a person can have a completely opposite locus of control. For example, in the areas of business, health, self-development, a person takes responsibility for the results (internal locus of control), and in the sphere of personal relationships, he is convinced that nothing depends on him (external locus of control).

My experience is that this has a lot to do with the person's beliefs that have been formed in the process of growing up. For example, a person may have an external locus of control in the sphere of relationships, because at some stage of his life he formed the belief that God or fate will send him a "soul mate", that everything should happen by itself, so no special actions are taken. undertakes in this area.

Sometimes, on the contrary, a person believes that he has a “crown of celibacy” on him and also does nothing, but goes to psychics, hoping to “remove” the curse, instead of analyzing the reasons for failures and changing something in himself. It turns out that here he shifts responsibility for the result in this area of ​​his life to others.

Now that it has become more clear with responsibility, let's try to figure out the reasons why people avoid responsibility in different areas of their lives.

A few main reasons that come to mind:

1. The conviction of a person that it does not depend on him, that he cannot influence it. When, for one reason or another, there were convictions that this cannot be changed. I already gave one example above, but more can be added. For example, the belief "Nothing will ever change in this country." With such a conviction, a person does not even try to change anything.
In this case, it is necessary to work with these beliefs, expand the understanding of a particular area, help in finding methods to change the situation and achieve results.

2. Avoidance of responsibility due to inability and ignorance of how to do something, and as a result of waiting for someone else to do it for me.

Usually such a problem occurs in dependent people, those who have been super-cared for since childhood and were not allowed to do anything on their own. Such people simply do not know how and are not accustomed to straining to get something done. They were taught from childhood that if they tried something and didn’t work out the first time, their mother would come running and arrange everything. Usually such people, even in adulthood, if something did not work out right away, do not seek to independently find a solution, make efforts. They make a bewildered helpless look and wait for their mother to come, or for someone adult to replace their mother. And if they are not helped, they sincerely do not understand why, and take offense at bad people around who don't like them because they don't want to help. Often the problem is aggravated by the fact that since for many years all problems and tasks were solved by others, a person has not formed enough skills and personal experience on which he can rely. The scope of work is very large. When a person wants to do something, it all piles up at once, it seems unbearable, and it is easier for him to return to his usual patterns of behavior. By the way, often such people have inner feeling that they are, as it were, still small and do not know what is right, but the rest of the adults know better what to do.

Of course, I described an extreme case, but such extremes occur. For some, this is manifested partially or in certain areas of life. Someone in all at once.

Therapeutic work with such people will consist in the consistent learning of independence, the development of strategies for finding solutions and achieving results, in the formation of skills and confidence that he himself knows what to do. All this should eventually lead to the gradual maturation of the personality or that part of the personality that is stuck in childhood.

3. Avoiding responsibility for fear of making mistakes. Usually this reason for throwing off responsibility is manifested in people who were constantly punished, criticized for mistakes and failures, who were exposed to excessive demands. Sometimes they simply showed how the fact that he did not cope with something badly and terribly, how much upsets his mother. In general, to put it simply, a person’s failures / mistakes are associated with something terrible and painful, so he tries to avoid them by any means. Usually such people are perfectionists, because how else can you avoid mistakes? That's right, do everything perfectly, be perfect. But there is nothing perfect in the world and cannot be. Moreover, a person cannot but make mistakes, because this is a normal part of any training. Therefore, as a rule, those areas where it will not work out perfectly, a person avoids, tries not to take responsibility for the results, because any failure will be painful for him. Surprisingly, such people are super-responsible and can feel guilty even where they cannot do anything. But at the same time, those situations in which they are not sure that they will cope 100%, perfectionists will try to avoid. They often play the game “I didn’t really want to” with themselves. That is, they simply do not do something that they can fail at, thereby maintaining the illusion of ideality. Usually such people are not prone to experiments and rarely go beyond the usual. Any attempt to do something new with them is accompanied by strong anxiety and resistance until they gain the proper degree so as not to make mistakes. Often another problem is the desire to do everything the first time. If it doesn’t work right away, the person gets upset and doesn’t try anymore. Even once it is very painful to experience failure.

In many ways, of course, they take responsibility and get results. But in areas where they may fail, where there may be criticism against them, they will avoid taking responsibility at all costs.

Therapeutic work with such people will consist in removing the fear of failure/mistake, working through the feeling of guilt, learning to accept one's imperfection and love oneself as one is, regardless of one's achievements or failures.

4. Unwillingness to take responsibility due to disbelief in one's own abilities. A person ceases to believe that he can cope with something in the case when there were a lot of failures in the past. As a result of multiple unsuccessful experiences, he develops the belief that he can’t do anything or that something is wrong with him. And with this conviction, he no longer even tries to try, because he expects failure in advance. Moreover, each new failure "clings" and lifts up the pain of past failures, forcing a person even more convinced that something is wrong with him and he is not capable of anything. Then a person simply does not even try to do something and manage something, he avoids any responsibility. Why, if all the same, as a result, nothing will come of it except pain and disappointment?

Therapeutic work with such a person will consist in finding internal resources, in reassessing past experience and clarifying real reasons failures in the formation effective strategies achieving results, forming positive beliefs instead of negative ones about their abilities and reinforcing them with successful experience. He will need to gradually build a “foundation of success”, first achieving results in small things, and then relying on these achievements as a resource, gradually achieving more in his life.

Of course, "pure variants" are described here, but in real life they are often intermixed, so the work goes on several different fronts. And such work is worth doing, it can change lives very much. Studies show that people with an internal locus of control are happier, more likely to realize themselves in various fields life, less anxious. It is not surprising that such people live much better than those who have an external locus of control. The latter, not having enough influence on what happens to them, often become victims of circumstances, experience anxiety due to the inability to influence what is happening and are forced to rely on others, which makes them dependent. Under the yoke of external events, they make the wrong decisions, go in the wrong direction, and, in the end, just live the wrong life. But work on oneself allows one to turn from a “victim of circumstances” into a “master of life”, who plans, acts, makes decisions, achieves results, and builds his life himself. In the end, this is not something magical, but a set of supportive beliefs and effective thought patterns that can be taught to a person. And these are not empty words. For example, when I went through a program to work with drug addicts with Frank Pucelik, he told how, in his centers, from essentially dead people, whose personality is destroyed by drugs and the way of life that they led, they make quite successful members of society. Not all of course, only those who had the strength and desire to go through a long program (from one and a half years). And I saw these guys, talked to them. They are open, they have a clear speech, they are self-confident, they work, raise children, they do not look like former drug addicts. I want to be friends with such people. Looking at them, you understand what a person’s potential for positive changes is, you just need to help him open up. It's not easy, but it's quite possible.

Why are some men reluctant to take over? Many believe that a stable and long-term relationship should lead to marriage. Currently, young people are in no hurry to legitimize their relationship and settle down, realizing that this is quite serious. This means that for starters, all other aspects of their life, first of all, should be in order, i.e.: after graduating from college, get Good work with a good salary to feed his family.

Men generally don't want to think seriously about a future together, so if women don't nurture a shared future in a relationship, nothing can happen, and that's why women tend to.

It seems to women that usually, as a rule, serious dating should lead to marriage and recognition that she deserves to be a wife and mother. But when a man refuses a legal relationship, she tends to blame herself. Feeling guilty or inferior, not allowing yourself to think rationally, as a man usually does.

For men, marriage is an important commitment to supporting the family and raising children. And unlike a woman, a man can understand that he is not ready to make a commitment to anyone and be the perfect husband. If he gives up and calms down when he's not ready for it, the woman picks up and reminds him of him again. Marriage inevitably changes relationships.

In marriage, both parties receive new rights and responsibilities, while people just living together have a sense of freedom, carelessness and no obligations. But if a man and a woman are officially married, the purchases made while they are legally married belong to both spouses, and if they want to get a divorce, then the divorce process will be long and painful.

For some people, getting married is a major milestone in life and it can take some time to get used to each other. For some, before a man and a woman go to the nearest registry office, they must live together for some time to see how compatible they are. Boyfriend first, not wife. On the initial stage their relationship, people need to find out what their mutual interests and life priorities are.

Do you just want to test your relationship or marry him? People who really love each other, sooner or later for the sake of their children. Be sure that your man loves you the way you are and is ready to take full responsibility and fulfill certain ones, even if you are not officially married.

Much needed advice. I myself got stuck. I wrote a lot to make it clear. And just so you know what I've already tried...
Our family is already 8 years old, at first we lived in a civil marriage, we got married two years ago. There were never any particular problems. During these years, only one thing did not suit me: my husband treats me like a mother (it's not about age, he's a little older than me). It is expressed in everything. For example, if I don't wash his socks, he will wear dirty ones. At the same time, he is able to throw things into the washing machine himself and press the button. And he does it periodically. But they rarely figure it out on their own. I have to tell him to do laundry. And so it is with everything. He does not want to make decisions and take responsibility. His plastic card with a salary is always with me. He gave his salary - he did his job. And what the money goes for, whether it is enough or not, what to do when it is not enough - he is not interested. I say - problems with housing, you need to increase the area, he answers - well, if you want, please. He won't even express his opinion. And if something goes wrong, I'm the only one to blame.
However, he refuses to help me. If I say that something needs to be cooked to eat (with an indication of what exactly, otherwise he will cook pasta), he can do it. He grumbles, but he does it. I'll tell you to tidy up - grumble and tidy up. However, it must be controlled. Otherwise, the pasta may not be salty, and the cleaning may not be of high quality.
And so they lived. I decided everything for myself and for him. It's hard to think about everything, remember everything, rely only on yourself. AT last years I even had to think about how his parents and friends would not be offended by us.
Sometimes my husband bucks, saying that he does not like the decisions that I make. At the same time, he does not offer his own. He is only really interested in poker on the Internet. Lives a dream that he will win big money. It is true that he won several thousand rubles, but considering that he has been playing for several years, he spent more on the Internet.
Four months ago we had a baby. At first I thought my husband had matured. And he just became more executive than usual for a while. To today he was rather tired of both me and the child. Yes, he helps a lot. I only command "husband - that, husband - that." So that there is no very strong pressure, I give him the choice "you sit in the nannies or run to do things." When there is a lot to do, the husband grumbles. When the task is completed, he sits down in front of the TV or at the game. Expresses dissatisfaction with each new assignment. I feel offended - I generally sit for rare minutes. Or with a child, or housework. He also feeds me breakfast. At the same time, promises with the word "tomorrow" are extremely rarely fulfilled.
And how hard it is for me. It's hard to decide everything. Taking care of laundry, replacing old clothes with new ones, lunch and dinner, buying food, paying utility bills, doctors and vaccinations for the child, congratulating his parents on the holidays ... He can’t even buy his own pants. Set aside for "someday". So, for a month now I have been asking my husband to give me an hour to talk about the housing issue. To which I get the answer "Do not take out my brain, there is enough at work."
No strength, I'm already crying. And with health problems after childbirth. Not serious, but as soon as you solve one problem, another pops up. Yes, and there is no particular opportunity to solve them. Who to leave the baby with? Now such age that with grandmothers cries.
I tried several times to talk about what was written above with my husband, but he does not understand. The other day I was offended, they say, "I, in your opinion, do nothing" (but why don't I do that?). I went the other way - I gave him 3 areas of responsibility to begin with (paying a communal apartment, making sure that the cat has food and toilet filler, making sure that potatoes are at home). In response, "Aha-aha", but things are still there.
Another problem is that we used to be together everywhere. In the last months of pregnancy, I was unable to lead the same way of life, sometimes my husband went to friends without me. And now, when it is still very Small child, we can't go to parties and meetings. Husband wants. And he doesn't think that I'm tired and I need help. And that without him I can’t do everything, for example, I can’t bathe a child. I am not against periodic absences, I even understand their necessity. But he would have warned in advance, somewhere he would have agreed with his mother to help me in his absence with the same bathing. And he wouldn't come back in the middle of the night. But if he left, then he does not know the measures. He seems to be in a bad mood with us now.
The husband asks if he can go with friends. If I say no, he stays at home. But then in this case I become an enemy of backgammon. AT last days began to feel that her husband was ready to rebel. The opportunity to sit with friends at our house and a couple of times a month to chat with them outside the home does not suit him. Tonight, once again, I began to "take time off", although in the afternoon we talked about what I was against. Then I replied that it was not my mother to forbid him. He has his own head. He happily got up and left. And when I grumbled, I was surprised, "you let me go, why are you dissatisfied with that."
I'm so tired. And I don't know what to do anymore. I'm not so much tired physically (that doesn't bother me much), I'm tired mentally. Responsible for everything. I want to feel support from my husband so that he takes some of the responsibility. Well, at least he just showed that he cares. And he only shows dissatisfaction. I swear at him, I do something not the way he would like. And I don't do anything. And I don't hear it either. But where in the current situation to get the strength to do everything, everything, everything THAT is what? For the umpteenth time already recent months thought about divorce. But the baby and I won't survive on welfare. Officially paid a little more than the minimum wage, the rest - in an envelope. Benefit 3500 ... And to go to work with a 4-month-old baby is not an option. It's not a financial issue - I would have left. And the most offensive thing is that my husband is not bad, it's just that there is no understanding between us. And how to get through, I do not know. I tried to start conversations, but didn’t go far, I get an answer with the phrase “brain removal”. What to do?

Hello. I'll start from the very beginning. I got married five years ago. Now I am 32. Many people think that I became a wife very late, but somehow I was in no hurry to get married. I always wanted to build a career, and only then get married and have children. By the age of 27, I already had my own housing, a car. Then she got married. My husband is 2 years younger than me. He proposed to me after a year of living together. At that time, my salary was higher, but this did not bother me. A year after the wedding, we got into an accident, my car was badly damaged. We had to take out a loan to buy a new car. I took out a loan for myself. Soon my husband's father fell ill and a large amount of money was urgently needed for treatment, which we did not have at that time. Got a loan again. Now I already had two loans. After some time, the husband left work and opened his own business. There was no income and there is still no. The money he earns is barely enough to pay rent and taxes. The husband assures that these are only temporary difficulties. I started working from home after my main job. There is not enough time for household chores. At first, the husband did not say anything, then he began to be indignant at the fact that he did not have time to warm up dinner, did not wash the dishes, etc. He is used to the fact that we always have money. He is not even interested in how much is left until the repayment of loans, whether I have enough money for monthly payments, etc. Recent times began to ask for a child. I agreed, maybe this will impose on him at least some obligations. There were problems with conception. He started lashing out at me. I felt guilty that I couldn't have a baby. I had a check-up that showed that I was healthy. The doctor ordered her husband to be checked. It was with difficulty that I persuaded him. It turned out to be the reason. Except bad tests he has male problems, he has no desire to have sex. However, he believes that once or twice a month is enough to conceive a child. And still blames me. I've got a heart problem. yesterday my husband and I were talking about something and he said fleetingly that "cores" pretend more than get sick, so that they would be pitied and this also applies to me. I was shocked. I never asked anyone for help, I never complained about my illness, I always achieved everything with my own work, and here are such words from a loved one! But he also has good qualities, he is pleasant in communication, loves my parents and relatives, they have an excellent relationship. If he did not shift all the responsibility to me, but if he were the real head of the family, I would be very happy. Sometimes I want to be weak so that someone takes care of all the problems ... I tried to talk to him, but he doesn’t want to hear, he says that everything is in order with us. How can I be, tell me?

Received 2 advice - consultations from psychologists, to the question: The husband does not take responsibility for the head of the family

Hello Irina! let's see what's going on:

We had to take out a loan to buy a new car. I took out a loan for myself.

Soon my husband's father fell ill and a large amount of money was urgently needed for treatment, which we did not have at that time. Got a loan again. Now I already had two loans.

look, you yourself “brought up” your man in this way - you took everything upon yourself, showing that it was you who was the head of the family. Loans are drawn up for you - why? what is the reason? thus, you yourself relieved him of responsibility for payments, you yourself took everything upon yourself and drag it, he sees your behavior, sees how you treat yourself, you see that you take everything upon yourself - which means that it suits you! and it also applies to you! Initially, he was like that, he also chose such a passive role, and why should he be the head, why should he be strong - after all, there is YOU!

What prevented him from getting loans? if his salary was not enough for approval, then he would have had the motivation to look for a part-time job, otherwise you didn’t put everything on yourself!

After some time, the husband left his job and started his own business. There was no income and there is still no. The money he earns is barely enough to pay rent and taxes. The husband assures that these are only temporary difficulties. I started working from home after my main job.

and in this situation - you began to lack money, BUT they didn’t put it on him, but again on themselves, they also began to look for a part-time job after their work! And what consequences did he experience that your family's income fell? none - you save him from all the consequences - he can not take loans, not be responsible for them, leave work, do his job the way he wants, and you cover all the rear for him! if you don’t have enough money, if you don’t want to carry anything on yourself, then give up part-time work, then he will also feel that there will be no meat on the table, but only porridge and whether he can live like that! if you don’t want to be strong, stop covering all the rears, let him plunge into these problems, experience them for yourself, reissue one of the loans to him, or take some amount from him for one of the loans!

He is used to the fact that we always have money. He is not even interested in how much is left until the repayment of loans, whether I have enough money for monthly payments, etc.

see - he's used to it!!! You created it yourself! and now you demand that he take over! he's used to it, he's comfortable, so he doesn't see a problem! don't wait until he starts to respect you, start to respect yourself, take off what you don't want to carry, let him lack money, financial problems, don't try to provide everything for him! then he will also have motivation and you will see - what kind of a man he is - who will strive to provide for his family and take responsibility, or the one who will wait for a woman to do everything for him!

Recently, he began to ask for a child. I agreed, maybe this will impose on him at least some obligations.

but how will he take upon himself THAT he is used to taking off from himself? and why did you decide that this responsibility for the child will fall on him??? and not again on you?

It was with difficulty that I persuaded him. It turned out to be the reason. In addition to bad tests, he has male problems, he has no desire to have sex. However, he believes that once or twice a month is enough to conceive a child. And still blames me.

he cannot take responsibility for his health! and you are waiting to make a commitment to the family! it is easier for him to blame you, he is used to shifting responsibility !!

I've got a heart problem. yesterday my husband and I were talking about something and he said fleetingly that "cores" pretend more than get sick, so that they would be pitied and this also applies to me. I was shocked.

Of course, it is convenient for him to talk like that, because you show that you are ready to pull everything out of yourself, are ready to show disrespect to yourself, exhaust yourself, and he also treats you!

I never asked anyone for help, I never complained about my illness, I always achieved everything with my own work, and here are such words from a loved one!

This is how they showed that YOU DO NOT NEED ANYONE! that DO NOT NEED A MAN! that you can handle everything! think - why did this happen? why did you decide to be strong, why is it difficult for you to trust a man, why is it difficult to give responsibility?

But he also has good qualities, he is pleasant in communication, loves my parents and relatives, they have excellent relations.

but he lives with you, not with your family! What is important to you in addition to pleasant communication?

.I tried to talk to him, but he doesn't want to hear, he says that everything is fine with us. How can I be, tell me?

he won't hear! because it is necessary NOT to SPEAK, but to do! stop working part-time, reissue a loan for him or refinance - so that he takes on a loan, and you close those two and that the loans are on him, motivating this by the fact that you will be psychologically comfortable next to strong man who can take it on! stop providing him with a comfortable life, yes, both of you will face this, BUT until YOU TAKE OFF responsibility, no one will take it! and for him to take it, you need to stop dragging it on yourself and show him that you are not going to take everything back on yourself!

Shenderova Elena. Moscow. You can work by phone, skype, watsapp.

Good answer 2 bad answer 1

Irina, hello!

You have prepared everything for family life, and the husband was brought to everything ready. And in this moment you work two jobs. And the whole Finn component of your family, control of funds, anxiety for providing for the family, everything is on your shoulders. You both took responsibility for yourself, and you do not give it yourself. Husband and can not feel strong. You are the man in your relationship. Therefore, he does not see in you a weak woman who can get tired, who can have a sick heart. Such a model of behavior is very often characterized by the fact that "I really want to be weak, but how can I afford it, because everything will collapse"... And everything remains in its place. You have a syndrome of hyper-responsibility, you, apparently, from childhood, by your parents, but rather by your mother, have been delegated what you should. They had to constantly fulfill their duties, take care of others, that in life they should rely only on themselves and the like. And you aspired and strive to do everything in the best possible way, and to be needed by everyone except yourself. Perhaps now is the time to take care of yourself, and your heart is signaling to you, "love me." Of course, you will not behave differently in an instant, but there will be a reason to think. At the heart of all of the above, is your internal conflict, but will they love me if I become different .....

Karina Matveeva, psychoanalyst, psychologist.

Matveeva Karine Vilievna, psychologist in Moscow

Good answer 5 bad answer 1

Description:

Disorders of gastric motility include violations of the tone of the GMC muscular membrane stomach (including muscular sphincters), gastric peristalsis and evacuation of stomach contents.
- Violations of the tone of the muscular membrane of the stomach: excessive increase (hypertonicity), excessive decrease (hypotension) and atony - no muscle tone. Changes in muscle tone lead to violations of the peristole - the covering of food masses by the wall of the stomach and the formation of a portion of food for intragastric digestion, as well as its evacuation into the duodenum.
- Disorders of the activity of the muscular sphincters of the stomach in the form of a decrease (up to their atony; causes a long opening - "gaping" of the cardiac and / or pyloric sphincters) and increased tone and spasm of the sphincter muscles (resulting in cardiospasm and/or pylorospasm).
- Violations of the peristalsis of the stomach in the form of its acceleration (hyperkinesis) and slowing down (hypokinesis).
- Disorders of evacuation. Combined and / or separate disorders of the tone and peristalsis of the stomach wall lead either to an acceleration or a slowdown in the evacuation of food from the stomach.

Symptoms:

As a result of violations of gastric motility, the development of early satiety syndrome, heartburn, nausea, and.
- Syndrome of early (rapid) saturation. It is the result of a decrease in tone and motility of the antrum of the stomach. Eating a small amount of food causes a feeling of heaviness and fullness in the stomach. This creates a subjective feeling of satiety.
- - a burning sensation in the region of the lower part of the esophagus (the result of a decrease in the tone of the cardiac sphincter of the stomach, lower sphincter esophagus and reflux of acidic gastric contents into it).
- . With subthreshold excitation of the vomiting center, nausea develops - an unpleasant, painless subjective sensation that precedes vomiting.

Causes of occurrence:

Violations of the nervous regulation of the motor function of the stomach: increased influence vagus nerve stimulates its motor function, and activation of the effects of sympathetic nervous system suppresses it.
- Disorders humoral regulation stomach. For example, high concentration in the cavity of the stomach of hydrochloric acid, as well as secretin, cholecystokinin inhibit gastric motility. On the contrary, gastrin, motilin, reduced content of hydrochloric acid in the stomach stimulate motility.
- Pathological processes in the stomach (erosion, ulcers, scars, tumors can weaken or increase its motility, depending on their location or severity of the process).

Treatment:

For treatment appoint:

Medical therapy diseases accompanied by a weakening of the tone and peristalsis of various departments gastrointestinal tract(gastroesophageal reflux disease and reflux-like and dyskinetic variants of functional, hypomotor dyskinesia duodenum and biliary tract, hypomotor variant, etc.), includes the use of drugs that enhance motility digestive tract.
Medicines prescribed for this purpose (these drugs
called prokinetics), exert their effect either by stimulating cholinergic receptors (carbacholine, cholinesterase inhibitors), or by blocking dopamine receptors. Attempts to use the prokinetic properties of the antibiotic erythromycin, which have been made in recent years, are faced with a high frequency of its side effects due to the main (antibacterial) activity of the drug, and are still at the stage of experimental studies. Also, they have not yet gone beyond the scope of experimental work.
studies of the prokinetic activity of other groups of drugs: 5-HT3 receptor antagonists (tropisetron, ondansetron), somatostatin and its synthetic analogues (octreotide), cholecystokinin antagonists (asperlicin, loxiglumide), kappa receptor agonists (fedotocin), etc.
As for carbachol and cholinesterase inhibitors, due to systemic their cholinergic effect (increased saliva production, increased secretion of hydrochloric acid, bronchospasm), these drugs are also relatively rarely used in modern clinical practice.

The only drug from the group of dopamine receptor blockers long time remained metoclopramide. Experience with its use has shown, however, that the prokinetic properties of metoclopramide are combined with its central side effect(development of extrapyramidal reactions) and a hyperprolactinemic effect leading to the occurrence of and, as well.
Domperidone is also a dopamine receptor blocker, however, unlike metoclopramide, it does not cross the blood-brain barrier and thus does not cause central side effects.

The pharmacodynamic action of domperidone is associated with its blocking effect on peripheral dopamine receptors localized in the wall of the stomach and duodenum.

   Domperidone increases the tone of the lower esophageal sphincter, enhances the contractility of the stomach, improves the coordination of contractions of the antrum of the stomach and duodenum, prevents the occurrence of duodenogastric reflux.

   Domperidone is currently one of the main drugs for the treatment functional dyspepsia. Its effectiveness in this disease has been confirmed by data from large multicenter studies conducted in Germany, Japan and other countries. In addition, the drug can be used to treat patients with reflux esophagitis, patients with secondary gastroparesis that occurs against the background, systemic, and also after stomach surgery. Domperidone is prescribed at a dose of 10 mg 3-4 times a day before meals. Side effects during its use (usually general weakness) are rare, and extrapyramidal disorders and endocrine effects are only in isolated cases.

   Cisapride, which is now widely used as a prokinetic drug, differs significantly from others in its mechanism of action. medicines, stimulating the motor function of the gastrointestinal tract.

   The exact mechanisms of action of cisapride remained unclear for a long time, although their implementation through the cholinergic system was assumed. In recent years, it has been shown that cisapride promotes the release of acetylcholine by activating a recently discovered new type of serotonin receptors (5-HT4 receptors) localized in the neural plexuses of the muscular membrane of the esophagus, stomach, and intestines.

   Cisapride has a pronounced stimulating effect on the motility of the esophagus, increasing, and to a greater extent than metoclopramide, tone
lower esophageal sphincter and significantly reducing total number episodes of gastroesophageal reflux and their total duration. In addition, cisapride also potentiates propulsive motility of the esophagus,
thus improving esophageal clearance.

   Cisapride enhances contractile activity stomach and duodenum, improves evacuation from the stomach, reduces duodenogastric bile reflux and normalizes antroduodenal coordination. Cisapride stimulates contractile function gallbladder, and, increasing the motility of the small and large intestine, accelerates the passage of intestinal contents.

   Cisapride is currently one of the main drugs,
used in the treatment of patients with gastroesophageal reflux
disease. In the initial and moderate stages of reflux esophagitis, ukzaprid can be prescribed as monotherapy, and with severe forms mucosal lesions - in combination with antisecretory drugs (H2 blockers or proton pump blockers). AT
Currently, experience has been accumulated for the long-term maintenance of cisapride to prevent recurrence of the disease.

Multicenter and meta-analytic studies have confirmed good results the use of cisapride in the treatment of patients with functional
dyspepsia. In addition, the drug was effective in the treatment
patients with idiopathic, diabetic and post-vagotomy gastroparesis, patients with dyspeptic disorders, duodenogastric reflux and sphincter of Oddi dysfunction after cholecystectomy.

   Cisapride gives a good clinical effect in the treatment of patients with irritable bowel syndrome, which occurs with a picture of persistent constipation, resistant to therapy with other drugs, as well as patients with
intestinal pseudo-obstruction syndrome (developing, in particular, against the background of systemic scleroderma, etc.).

   Cisapride is prescribed at a dose of 5-10 mg 3-4 times a day before meals. The drug is generally well tolerated by patients. The most frequent side effect is, occurring in 3 - 11% of patients, usually not requiring discontinuation of treatment.
If patients have signs of increased motility of certain parts of the digestive tract, drugs with an antispasmodic mechanism of action are prescribed. Traditionally in our country, myotropic antispasmodics are used for this purpose: papaverine, no-shpa, halidor. Abroad, in similar situations, preference is given to butylscopolamine, an anticholinergic drug with antispasmodic activity exceeding that of myotropic antispasmodics. Butylscopolamine is used for various options esophagospasm,
hypermotor forms of dyskinesia of the duodenum and biliary tract, irritable bowel syndrome occurring with a clinical picture intestinal colic. The drug is prescribed in a dose of 10-20 mg 3-4 times a day. Side effects characteristic of all anticholinergic drugs (tachycardia, decreased blood pressure, accommodation disorders), are expressed in the treatment
butylscopolamine to a much lesser extent than with atropine therapy, and occur mainly with its parenteral use.

   With manifestations of esophagospasm, a certain clinical effect can be given by the use of nitrates (for example, nitrosorbide) and blockers calcium channels(nifedipine), which have a moderate antispasmodic effect on the walls of the esophagus and the tone of the lower esophageal sphincter.

   In hypermotor variants of irritable bowel syndrome, the so-called functional diarrhea, which, unlike organic (for example, infectious) diarrhea, occurs mainly in the morning, is associated with psycho-emotional factors and is not accompanied by

pathological changes in the analysis of feces, the drug of choice is loperamide. By binding to opiate receptors in the colon, loperamide inhibits the release of acetylcholine and prostaglandins in the colon wall.
intestines and reduces its peristaltic activity. The dose of loperamide is selected individually and is (depending on the consistency of the stool) from 1 to 6 capsules of 2 mg per day.

   Thus, as the data of numerous studies show, motility disorders of various parts of the digestive tract are an important pathogenetic factor in many gastroenterological diseases and often determine them clinical picture. Timely detection of motor disorders of the gastrointestinal tract using special methods instrumental diagnostics and the use of adequate drugs that normalize gastrointestinal motility can significantly improve the results of treatment of such patients.