Constipation: Causes, Therapy

Brief overview

Treatment: medications for constipation (laxatives, agents to stimulate intestinal peristalsis), treatment of underlying diseases if necessary.
Causes: For example, lack of exercise, lack of fiber, suppressed bowel movements, medications, bowel diseases, hormonal disorders.
When to see a doctor?If digestive problems and hard bowel movements occur more frequently. If accompanying symptoms are severe, such as abdominal pain and nausea, see a doctor immediately.
Diagnosis: Medical history, physical examination, further diagnostics (blood tests, ultrasound, stool tests, etc.).
Prevention:Among other things, through a high-fiber diet, thorough chewing, drinking enough and exercise.

What is constipation?

How often the bowel empties varies greatly from person to person. Some people have a bowel movement every day, others only do their “big business” every few days. According to experts, anything between three times a day and three times a week is considered normal as far as the frequency of bowel movements is concerned.

Doctors generally refer to constipation as when someone has

has bowel movements less than three times a week,
they have to push hard, and
the stool is hard and lumpy due to the longer time it remains in the intestine.

Temporary constipation is not uncommon: most people have a sluggish bowel from time to time, for example because they exercise too little, drink too little and eat a diet low in fiber. A change in lifestyle usually gets the bowels moving again quickly.

Chronic constipation, on the other hand, is usually more difficult to eliminate and is often associated with a high level of suffering. Those affected then suffer from constipation constantly or at least for a long time. Experts speak of chronic constipation when the following three criteria have been present for at least three months:

1. at least two of the following complaints are present:

the stool is hard or lumpy in more than 25 percent of bowel movements
more than 25 percent of bowel movements are accompanied by heavy straining
subjective feeling of incomplete bowel movements in more than 25 percent of bowel movements
Subjective feeling of blockage or obstruction in the rectum in more than 25 percent of bowel movements.
assistance with defecation (e.g., by hand) in more than 25 percent of defecations
less than three spontaneous bowel movements per week

2. soft bowel movements rarely occur without the use of laxatives

3. criteria for an irritable bowel syndrome are not fulfilled

Concomitant symptoms of constipation

Constipation is often accompanied by a feeling of fullness and discomfort. Bloating, a feeling of pressure in the abdomen and abdominal pain may also occur. Some sufferers also report headaches, fatigue, lassitude and loss of appetite.

Constipation: Treatment

There are a number of medicines that are suitable for the treatment of constipation. Sufferers may also resort to home remedies or homeopathy for constipation.

Medicines for constipation

It is advisable to use laxatives (laxatives) to treat constipation only after lifestyle changes (for example, more exercise, stress reduction), a high-fiber diet, and the use of other home remedies have not shown any effect even after a month.

There are various types of laxatives, some of which are available over-the-counter (such as Glauber’s salt, lactulose, castor oil) and some of which require a prescription (such as Prucalopride):

Osmotic laxatives bind water in the intestine, keeping stool moist and slippery. Examples include Glauber’s salt, Epsom salts, lactulose, sorbitol, and macrogol.
“Water-pushing” (hydragogic) laxatives cause increased water to enter the bowel. These include bisacodyl, sodium picosulfate, and anthraquinones (e.g., in senna leaves, alder bark).
Gas-forming laxatives (sodium bicarbonate) release gas (carbon dioxide) in the intestine, increasing stool volume and increasing pressure on the intestinal wall – this stimulates the onward transport of stool and the defecation reflex.
Prokinetics promote intestinal movement (intestinal motility). In this way, food waste is transported more quickly towards the exit (anus) (Prucalopride).

Many laxatives are taken by mouth, for example in the form of tablets, drops or as a syrup. Others can be administered directly into the intestine via the anus, either in the form of suppositories or as enemas/minicliters. With the latter, a small amount of liquid is injected into the intestine, for example a saline or sugar solution. The effect against constipation sets in very quickly with this small enema.

Consult a doctor or pharmacist for advice on which laxative is best for you. Use it exactly as recommended by the doctor or pharmacist or as stated in the package insert. This is because laxatives can have serious side effects, such as fluid and salt loss, if used improperly (too high a dose and/or taken for too long).

Surgery for constipation

Home remedies against constipation

With the right diet and lifestyle, constipation in the intestines can be easily solved or even prevented. The following tips will help against constipation:

eat a high-fiber diet: eat plenty of fruits, vegetables and whole grains.
eat in peace
chew thoroughly: Digestion starts in the mouth, so chew every bite sufficiently.
drink enough: experts recommend a daily drinking quantity of 1.5 to two liters (e.g. water, mineral water, tea).
exercise: constipation in old age in particular seems to be linked to lack of exercise.
Yield to the urge to defecate: Do not suppress bowel movements, for example because you were about to make a phone call.
Have a bowel movement at your leisure: Take enough time to go to the toilet.
Regular bowel movements: For example, always go to the toilet in the morning after breakfast and remain seated for ten minutes, even if nothing happens. Often the body gradually gets used to this and then eventually uses the time for bowel emptying.
Relaxation: If the body is under stress, it throttles bowel activity. Suitable relaxation methods include progressive muscle relaxation and autogenic training.

If you suffer from constipation despite the above tips, the following natural laxatives may help:

Natural laxatives

Some foods have a natural laxative effect. They can be taken if you are constipated and are thought to kick-start your digestion. These natural laxatives include:

Flaxseed for constipation: flaxseed increases the volume of intestinal contents. In constipation that facilitate and accelerate defecation. For this purpose, adults with constipation take one to two tablespoons or 10 to 20 grams of whole or lightly crushed flaxseed two to three times a day between meals.

It is very important to drink sufficient fluids: It is advisable to take each portion of flaxseed with at least 150 milliliters of water.

The daily dose for adults is 45 grams of flaxseed. For children it is somewhat lower: They can take two to three times daily in each case two to four grams (1 to 3 years), three to six grams (4 to 9 years) and/or six to ten grams (10 to 15 years) of the seeds – again with sufficient liquid.

For more information, see the article Flax.

One teaspoon of flaxseed is equivalent to about four grams.

If you want to use the home remedy for laxative, take one teaspoon of psyllium with 200 milliliters of water or clear broth. Then quickly drink two glasses of water.

The daily dose for adults is 20 to 40 grams of psyllium or 10 to 20 grams of psyllium husks (in each case divided into three individual doses).

More information can be found in the article Psyllium.

Radish juice: Black radish contains pungent mustard oils and bitter substances. These are said to inhibit bacteria, viruses and fungi as well as loosen mucus in the upper respiratory tract and also help with nausea and constipation. To do this, peel and grate a black radish and squeeze it with a juicer. Take one to two tablespoons of the juice several times a day.

For more information, see the article Black radish.

Liquid on an empty stomach: Drink a glass of water or fruit juice on an empty stomach after getting up. This often triggers the bowel movement reflex. Alternatively, it is possible to try it with a morning glass of warm water mixed with the juice of half a lemon. For coffee drinkers, even the morning cup of coffee may trigger the stool reflex.

A teaspoon of lactose or some salt dissolved in water may soften the stool and thus help against constipation.

Probiotic foods

They are said to support healthy intestinal activity and the immune system. As home remedies, they are mainly used for gastrointestinal complaints and are supposed to shorten the duration of the complaints.

Abdominal massage, rubbing and heat

An abdominal massage or rub is said to help relieve constipation immediately.

Abdominal massage: A gentle abdominal massage is said to stimulate the natural movement of the bowels, relieve tension and relieve gastrointestinal discomfort such as constipation. To do this, spend several minutes stroking the abdomen with both hands and gentle pressure in a clockwise direction. Start at the lower right abdomen and stroke in an arc to the lower left abdomen. This way you follow the course of the large intestine.

Gentle abdominal massage is also good as a home remedy for babies and older children with constipation.

For more information, see the article Abdominal massage.

Abdominal rub: The use of essential oils may enhance the effect of abdominal massage. Use diluted fennel, lemon balm, chamomile or caraway oil for this purpose. This is said to have a warming effect, relieve cramps and pain, calm and stimulate digestion.

Essential oils may cause a life-threatening glottis spasm with respiratory arrest in infants and young children. Therefore, use essential oils on small children only after consulting a doctor and only in a low dosage!

Abdominal compress with chamomile

A moist-hot abdominal compress with chamomile relieves pain, relieves cramps and has a relaxing effect. To do this, pour half a liter of boiling water over one to two tablespoons of chamomile flowers. Let steep covered for a maximum of five minutes, then strain the plant parts.

Place a rolled-up inner cloth in a second cloth, roll the whole thing up into a poultice. Let it soak in the hot tea with the ends hanging out and wring it out. Place the inner cloth around the abdomen without wrinkles. Wrap a dry cloth around it and remove it after 20 to 30 minutes. Then rest for half an hour. Use a maximum of twice a day.

Warm grain pillow

A warm grain pillow (for example, cherry pit pillow) gives off heat for a long time. It relaxes, relieves pain and promotes blood circulation. Therefore, the heat may have a beneficial effect on constipation. Heat the pillow on the heater or in the microwave, depending on the manufacturer’s instructions, and apply to the abdomen. Leave on as long as the heat is comfortable.

Mustard flour foot bath

Fill a foot bath or a large bucket with water at a maximum temperature of 38 degrees. Fill the bucket so high that the water goes up to the calves. Then stir in ten to 30 grams of black mustard flour. Put your feet in, place a large towel over your knees (to protect your face from rising vapors).

After about two to ten minutes, a burning sensation starts on the skin. Then leave the feet in the water for another five to ten minutes. Then remove, rinse thoroughly and rub with olive oil. Then cover and rest in bed for 30 to 60 minutes.

Read more about the effect and application of mustard flour in the article Mustard.

Home remedies have their limits. If the symptoms persist for a long time, do not improve or even get worse, you should always consult a doctor.

Constipation during pregnancy

The above home remedies and tips may also help against frequent constipation in pregnancy. If not, pregnant women have the option to use certain laxatives in consultation with the doctor. Suitable are, for example, lactulose and macrogol.

These laxatives can be used not only for constipation during pregnancy, but also for constipation during breastfeeding.

What helps against constipation in children?

Drink enough (e.g. mineral water, unsweetened tea, but no cocoa!) and maintain a high-fiber diet (fruits, vegetables, whole grains).
Small children can be given pear puree and whole grain porridge to stimulate digestion.
Soaked dried fruit, sauerkraut and flaxseed taken with plenty of liquid also help against intestinal sluggishness.
Stuffing foods (e.g. white bread, cakes, fast food) should be avoided.
Give the child milk only in moderation, but daily mildly acidified dairy products (e.g. buttermilk, kefir, yogurt, whey).
Use olive oil instead of butter, margarine or sunflower oil for cooking.
Make sure the child does not snack on too many sweets.
Encourage the child to get enough exercise.
To stimulate the onward transport of the food pulp in the intestine, it is possible to gently massage the child’s stomach with the flat of the hand in a clockwise direction. Alternatively, place a hot water bottle on the child’s abdomen or make a warm poultice for the abdomen.
For infants and young children with constipation, special care should be taken with the buttocks and anus.

If necessary, the doctor will recommend certain laxatives for your child to relieve constipation, such as lactulose or macrogol. In case of acute constipation, it can be relieved with a mini enema from the pharmacy, which softens the stool in the rectum.

Constipation: causes and risk factors

Constipation is not a disease, but a symptom – a sign that something is wrong in the body. But what causes constipation? In most cases, the cause is relatively harmless (too little exercise, low-fiber diet, etc.), but sometimes there is a (serious) disease behind it.

Forms of or causes for constipation include:

Temporary or situational constipation

Many people experience constipation in certain situations, for example during a febrile illness, shift work or bed confinement. Unfamiliar food while traveling may also trigger transient constipation.

Chronic habitual constipation

Chronic habitual constipation is due to a functional disorder of the bowel. The causes are not clearly understood. Possible triggers include insufficient fluid intake, low-fiber diet, lack of exercise, and frequent suppression of the bowel movement stimulus (for example, due to time constraints).

However, lack of fluids, fiber and exercise do not necessarily lead to constipation. Intestinal sluggishness also occurs with a high-fiber diet, adequate fluid intake and plenty of exercise.

Irritable bowel syndrome

However, experts have generated various hypotheses. For example, a disturbed intestinal movement (intestinal peristalsis), increased permeability of the intestinal mucosa, increased immune activity in the intestinal mucosa and a disturbed serotonin balance are suspected.

Disturbed intestinal flora, stress and gastrointestinal infections may also contribute to the development of IBS.

Medications

Certain medications can also be counted among the possible risk factors for constipation. For example, iron supplements, heartburn medications containing calcium and aluminum, and antidepressants may make the intestines sluggish and lead to constipation.

Anticholinergics (for example, for irritable bladder and incontinence, Parkinson’s disease, asthma), opiates (strong painkillers or the cough suppressant codeine), and hypertension medications are also possible triggers of constipation.

Disturbances of the salt balance (electrolyte disturbances).

Sometimes potassium deficiency (hypokalemia) is to blame for constipation. Such a deficiency develops, for example, if one takes laxatives too often. In addition, other disorders of salt balance, such as an excess of calcium (hypercalcemia), may also be the cause of digestive problems.

Organic intestinal diseases

Several bowel diseases potentially cause problems and pain during bowel movements. These include, for example:

inflamed intestinal protrusions (diverticulitis),
intestinal polyps,
tears in the anal mucosa (anal fissures),
encapsulated, purulent inflammations in the anal area (anal abscesses),
painful hemorrhoids,
the chronic inflammatory bowel disease Crohn’s disease,
slipping of the rectum out of the anus (rectal prolapse), as well as
Colorectal cancer.

Nerve disorders

In some cases, constipation is caused by nerve disorders. These are due, for example, to diabetes mellitus, Parkinson’s disease or multiple sclerosis.

Hormone disorders

Constipation may also be the result of hormonal disorders, such as those associated with hypothyroidism, diabetes, hyperthyroidism, or pregnancy.

Pregnancy

Constipation in pregnancy is a common symptom in many women. It is caused by several factors. These include, for example, the increased hormone levels (such as progesterone) in pregnant women. These ensure the supply of the baby, but throttle the bowel activity.

In addition, the intestines come under increasing pressure due to the growth of the uterus and the unborn child. The fact that women are less physically active during pregnancy also contributes to intestinal sluggishness.

Causes of constipation in babies and young children

Incorrect diet: As with adults, a lack of fiber, fluids and exercise is often to blame in children when there are problems and pain with bowel movements. In addition, too much “constipating” foods such as white bread, cakes, chocolate and other sweets may also cause bowel sluggishness.

Switching from breast milk to solid foods: Constipation in babies often occurs when the diet is switched from breast milk to porridge or complementary foods.

Changes in the normal daily routine: If the usual daily rhythm is disturbed (e.g. during travel, when bedridden, in stressful situations), children may experience slight digestive problems.

Wonder butt: A sore butt causes pain during bowel movements, which is why children often hold back their stool. The longer the stool remains in the bowel, the drier and harder it becomes, which then makes defecation even more painful and causes new skin or mucous membrane tears. Many children then “deny” themselves the urge to defecate all the more. Over time, chronic constipation (constipation that lasts longer than two months) may develop.

Antibiotics: Constipation in children may also be caused by treatment with antibiotics.

Lactose intolerance: Sometimes lactose intolerance causes chronic constipation.

Congenital bowel malformation: Hirschsprung’s disease is a congenital malformation of the rectum. Mild forms of the condition often first become apparent in preschool-aged children with chronic constipation. Those affected only have a bowel movement every five to seven days, and even then sometimes only with the help of enemas or other measures.

Constipation: When to see a doctor?

Occasional constipation can often be eliminated without medical help (with more exercise, a high-fiber diet, drinking plenty of fluids, abdominal massage, stress reduction, home remedies, et cetera). However, if you experience digestive problems and hard stools more often, or if constipation persists for more than four days despite preventive and general measures, a visit to the doctor is advisable.

The same applies, for example, if constipation persists for more than two days despite laxatives.

Immediately go to the doctor in case of:

accompanying symptoms such as blood in the stool and/or weight loss
acute constipation

When does it become dangerous? Acute constipation with severe abdominal pain, distended abdomen, fever, nausea and vomiting may be due to a life-threatening intestinal obstruction. Notify the emergency doctor immediately!

Constipation: examinations and diagnosis

How often do you have a bowel movement?
What is the color and consistency of the stool?
Does defecation cause you pain?
How long have you had problems and pain with bowel movements?
Do you have any other symptoms (e.g., back pain, nausea)?
Are you taking any medications? If yes, which ones?
Do you have any known underlying medical conditions (diabetes, hypothyroidism, irritable bowel syndrome, diverticulosis, Parkinson’s disease, etc.)?

From the patient’s information alone, the physician often deduces the cause of the constipation (for example, lack of fluids, stress, shift work).

Physical examination

In addition, the doctor uses various tests and examinations to find out whether a particular disease may be the reason for the hard stools. He therefore next performs a physical examination. Especially in the case of chronic constipation, he also examines the patient’s anus and checks the basic tension of the anal sphincter with his finger.

Further examinations

Depending on the need, further examinations follow in order to clarify the suspicion of certain underlying diseases as triggers of the constipation. For example, if constipation is accompanied by sudden pain on the left side of the lower abdomen and fever, this indicates a possible inflamed intestinal diverticulum (diverticulitis).

Blood test: Blood analysis provides indications of diabetes, hypothyroidism or electrolyte disorders, for example.
Colonoscopy: This examination is particularly informative in cases of suspected intestinal protrusions (diverticula), diverticulitis, intestinal polyps, intestinal cancer and irritable bowel syndrome.
Ultrasound: An ultrasound examination of the abdomen is useful if diverticulosis, diverticulitis or Crohn’s disease are suspected. An ultrasound of the thyroid gland provides clarity if hypothyroidism is suspected.
Stool examination: Blood in the stool may indicate Crohn’s disease or diverticulitis. Intestinal polyps and intestinal cancer are also possible causes.

In the case of persistent chronic constipation, further examinations and tests may be necessary. For example, the doctor measures the colon transit time to check whether the colon is transporting food residues at a normal rate. The measurement is made with the aid of an X-ray examination as part of the Hinton test:

Another examination method is the determination of pressure in the rectum (anorectal manometry). Here, the doctor checks the functionality of the sphincter muscles at the anus. This is also helpful in clarifying chronic constipation.

Frequently asked questions

You can find answers to the most frequently asked questions about this topic in our article Frequently asked questions about constipation.