Constipation is a problem for many people and can sometimes reduce their quality of life considerably. You can read about whom it affects, the symptoms, as well as ways of diagnosing and treating it here.
Which symptoms occur?
Although the frequency of everyone’s bowel movements is obviously different, constipation is considered to be when there are less than three bowel movements a week. A differentiation is normally made between two types of constipation:
- Acute constipation (described as situative or temporary)
- Chronic constipation
Who is primarily affected by constipation?
Around every fourth adult in the Western world has to deal with the issue of constipation. An increasing number of women struggle with constipation, but it can also be an issue which afflicts and troubles parents of babies, small children and children. Pregnant women suffer particularly strongly from constipation.
Temporary (situative) constipation
is not an illness, but a symptom, a sign from the body that something is wrong. Medically-speaking, constipation is present when:
- There are less then three bowel movements a week
- They are accompanied by great effort and pressing
- Stools are hard and lumpy due to the long duration they have been in the bowels (see the Bristol stool form scale, type 1 and type 2)
- Symptoms located outside the bowels occur frequently
is a state which has been present for at least three months and shows at least two of the following key symptoms at least in every fourth bowel movement:
- Straining hard
- Stools are hard or lumpy (see the Bristol stool form scale, type 1 and type 2.
- Subjective feeling of incomplete evacuation of the bowels
- Subjective feeling of discomfort as if the bowels were plugged
- Trying to help evacuation along with your hand
- Less than three bowel movements a week
- Soft unshaped stools only when taking laxatives
- Irritable bowel syndrome has been excluded.
The difference here is in the speed of occurrence and the duration of the constipation:
acute constipation arises relatively quickly, i.e. within hours or a few days, whereas chronic constipation develops over a longer period – usually more than six months.
Constipation is accompanied by very hard stools, pain during bowel movements, incomplete evacuation and a feeling of the rectum being blocked. If blood is also present during bowel movements, and there are severe abdominal pains, fever or alternating constipation and diarrhoea, these are alarm signals to see a doctor as soon as possible.
In general it is sensible to see a doctor when you are constipated, particularly when it is not situational and temporary.
What can cause constipation?
There are a variety of possible causes of constipation. A general understanding of the physiology of the bowels is important here: this large muscular tube requires a certain volume of stools in order to get the necessary ‘signal’ to move the contents of the bowel forwards. If our food is lacking in fibre which swells up and the necessary liquid to go with it, the required stool volume is not present. If a person consumes too few liquids, the bowels take water from the stools, which leads to them becoming hard and difficult to move on – constipation is the result.
Alongside these causes of constipation (food lacking in fibre, reduced intake of liquids) there are a number of other triggers:
- Lack of exercise
- Psychological strains and stress
- Physical/organic causes (e.g. changes to the pelvic floor, piles, changes in the bowels, tears in the skin around the rectum (anal fissures), narrowing of the intestinal tract, etc.)
- Impairment of the metabolism and hormone imbalance (e.g. thyroid underactive, diabetes, pregnancy)
- Impairments due to medication: e.g. products to combat heartburn (antacids) containing calcium and aluminium), antidepressants, diuretics, medicines against high blood pressure (e.g. beta blockers), opiates (strong painkillers or the cough medicine codeine) etc.
- Reduced bowel motility due to neurological causes (e.g. multiple sclerosis, diabetes, Parkinson’s disease etc.)
- Electrolyte imbalance (e.g. a deficit of potassium, often also in the case of excessive use of laxatives)
How can constipation be diagnosed?
Every diagnosis begins with a thorough interview with a doctor about the patient’s medical history. The doctor will talk to you about several points.
- Existing organic bowel disorders
- Questions about other disorders such as neurological conditions (e.g. Parkinson’s disease, multiple sclerosis, diabetic nervous disorders (neuropathy) etc.)
- Questions about the family history (presence of illnesses in the family)
- Frequency of bowel movements, stool colour and form
- Eating and drinking habits
- Accompanying symptoms such as pain and flatulence
- Questions about medication which is taken and possible effects it could have on bowel movements
- Examination of the function of the thyroid gland
The interview is followed by a physical examination during which the doctor examines the rectum and palpates and listens to the abdomen. A stool sample can provide indications of digestive problems and settlement of the bowels by the wrong bacteria. In addition, the stools are examined for blood which is not visible (fecal occult blood).
In the laboratory, a blood count is analysed (thyroid gland hormones and electrolytes such as sodium, potassium and calcium). If these findings are normal, the patient is under 50 and no warning signs were established in the interview on their medical history (acute constipation, loss of weight, blood in the stools, tiredness), treatment of functional constipation can be commenced.
In the case of chronic constipation, the examination will be more detailed and the doctor may suggest an proctoscopy of the rectum and sigmoid colon, and a colonoscopy if there is suspicion of disease of the large intestine.
Other possible diagnostic measures:
- Ultrasound examination of the entire abdomen (sonography)
- Radiological examination of the bowels, now usually carried as a computer tomography (CT)
- Establishment of the colon transit time (the duration until food has passed through the bowels).
If an organic cause is found for the constipation, the underlying condition has to be treated first. If no clear cause can be found for the sluggishness of the bowels which would enable this to be treated, general measures should then be taken to resolve the constipation.
How can constipation be treated?
Treatment of constipation is often accompanied by a change of lifestyle:
Change of diet: foods rich in fibre such as wholemeal bread, dates, brown rice etc. make the stools swell up and support the proper function of the bowels. It is best to slowly increase the amount of fibre, as an increase in symptoms can be expected initially (wind, abdominal pains, feeling of fullness) until the bowels have adapted.
Change of drinking habits: a glass of water before every meal stimulates the bowels. It is particularly effective to drink a glass of cold water on an empty stomach in the morning.
More exercise: whether it is cycling, swimming, running or Nordic walking – exercise is one of the keys to success when the bowels need to be stimulated.
Make it into a routine - bowel movement training Don’t suppress a bowel movement! Get your bowels used to going to the toilet regularly again. Daily bowel movement training creates regularity in your everyday life.
Massaging the large intestine and complementary therapies: a clockwise abdominal massage along the large intestine stimulates the bowels – five minutes a day is sufficient. In addition, the following can be used: breathing exercises, yoga, shiatsu, traditional Chinese medicine (TCM), strengthening of the muscles of the abdomen and pelvic floor as well as loosening and stretching the muscles of the legs, the buttocks and the lower back and massaging the connective tissue (manual lymphatic drainage, foot reflex zone massage).
Probiotics: We require a large number of probiotic bacteria in our bowels, as they continue the process of breaking down food in our bodies and of making it available to the body. If our gut flora has been reduced and damaged (e.g. by medication (antibiotics), stress or unhealthy food), fermentation and putrefaction processes begin which can impair and slow down bowel function. In order to build up and regenerate a damaged gut flora, probiotics with highly active bacteria strains are recommendable. They protect the intestinal mucosa, promote metabolic processes and can increase the frequency of bowel movements.
Household remedies and natural aids for constipation
- Prunes, figs and other fruit (fresh or dried) as well as sauerkraut (or sauerkraut juice) can stimulate bowel activity. Papayas have a particularly positive effect on the symptoms of constipation. The digestion-regulating enzymes of the papaya, which are preserved if they are obtained with care, increase the mobility of the bowels and harmonise the digestion. Your pharmacy will be pleased to advise you on such products
- Dietary fibre as contained in linseed, Indian psyllium and bran soaks up water (from the bowels) and swells up, thus increasing the volume of chyme (the semi-fluid mass of partly-digested food), stretching the intestinal wall and stimulating the movement of the bowels. A sufficient intake of liquids is absolutely necessary here
- Coffee can also stimulate bowel movements
- Fast food, white flour, sweets, animal fats, non-herbal tea and cocoa should be avoided.
Medicinal therapy: if the measures mentioned above do not provide sufficient help, laxatives can be used temporarily under medical guidance (e.g. Glauber’s salt, Epsom salts, lactulose or senna leaves, the bark of the black alder, aloe, castor oil, bisacodyl and sodium picosulphate). However, care needs to be taken here with regard to the side effects if used for a longer period, such as heart rhythm disorders due to an excessive loss of potassium. A potassium deficit – often triggered by the misuse of laxatives – can intensify the symptoms of constipation. Prokinetics promote the movement of the bowels (bowel motility). In this way, the remains of food are excreted more quickly. However, please note their side effects.
If the measures mentioned above do not provide sufficient help, laxatives can be used temporarily under medical guidance (e.g. Glauber’s salt, Epsom salts, lactulose or senna leaves, the bark of the black alder, aloe, castor oil, bisacodyl and sodium picosulphate). However, care needs to be taken here with regard to the side effects if used for a longer period, such as heart rhythm disorders due to an excessive loss of potassium.