Often constipation (constipation) proceeds without symptoms and only the awareness of real or imagined low defecation makes the patient resort to laxatives (laxatives). In some psychologically conspicuous patients, the fear of poisoning themselves internally – so-called horror autotoxicus – can lead to these patients expecting daily bowel movements and – if these fail to occur – feeling the need for treatment.
Complaints such as a feeling of fullness, general malaise, abdominal pressure, abdominal pain and flatulence are not infrequently attributed to constipation.
With prolonged residence in the intestinal lumen, increased reabsorption of water and electrolytes causes compaction of fecal masses, which can lead to fecal colith (fecal stones) and fecal impaction (fecal stasis).
Fecal impaction – which usually occurs in bedridden elderly patients with desiccosis – can cause paradoxical diarrhea (diarrhea). These liquid stools occur when an increased distension stimulus leads to increased secretion as it builds up in front of an obstruction – fecal impaction – and flushes out the then hardened stool masses. At times, these stool masses may not be flushed out as well, but the liquid stool may flow around the obstruction and thus appear as diarrhea.
If chronic constipation occurs for the first time in adulthood without a tangible cause, colon cancer must be ruled out.
Spastic constipation is often associated with symptoms of irritable bowel syndrome. In spastic constipation, there is crampy abdominal pain (abdominal pain) in addition to sheep feces-like stools. In rectal constipation (dyschezia; difficulty in defecating), the urge to defecate is absent as a result of a suppressed defecation reflex – for example, to avoid painful defecation (defecation) due to an anal fissure (painful tear in the skin or mucous membrane of the anus).
Bright red blood in the stool indicates lesions in the anal area – for example, an anal fissure or hemorrhoids.
In atonic constipation of the elderly, hypokalemia (potassium deficiency) is often found, which should be treated because it can stimulate bowel motor activity.
Habitual constipation (a functional disorder of the intestine) is characterized by increased motor activity with prolonged passage time and has usually existed for many years.
The following symptoms and complaints may occur along with constipation (constipation):
- Strong pressing
- Hard/clumpy stool
- Feeling of incomplete emptying
- Feeling of anorectal tightness / obstruction (“constriction”).
- Maneuver (support to allow defecation) or.
- Less than three bowel movements per week
Warning signs (red flags) for somatic (physical) causes of illness
- Anamnestic information:
- Family history of gastrointestinal (GI) tumors.
- First manifestation at age > 50 years
- Unexplained weight loss of more than 10%.
- Severe discomfort
- Short duration (< 12 weeks) or rapid progression (progression)
- Blood in the stool (hematochezia; tarry stools (melena)).
- Anemia (anemia)
- Chronic constipation and persistent abdominal swelling and empty rectum (rectum) in children – Hirschsprung’s disease (megacolon congenitum; flared colon due to congenital nerve damage) possible.
- Diarrhea (alternating with constipation: paradoxical diarrhea), mucus discharge, weight loss – colorectal carcinoma (colon cancer) probable.
- Lymph node enlargement
- Resilient resistance
- Nocturnal discomfort or waking up due topain or symptoms.
- Lack of response during probationary treatment.
