Not everyone needs to have to every day; therefore, those who are symptom-free with only a few bowel movements per week need not worry!
General measures
After waking up, but before getting up, an abdominal massage with the flat of the hand along the course of the colon in circular motions from the right lower quadrant of the abdomen, through the right upper and left upper to the left lower quadrant.
Attempting a bowel movement even in the absence of an urge to defecate for at least 5 minutes daily after breakfast at approximately the same time of day to condition the bowel and exploit the gastrocolic reflex.
For patients with a predominantly sedentary lifestyle, morning calisthenics and / or walking is recommended.
Furthermore, during defecation (bowel movement), a full forward flexion of the hips can facilitate rectal evacuation during pressing. To help with this, the standing area around the toilet bowl can be raised by 15 cm.
Suppression of the urge to defecate should be avoided.
Increase physical activity!
Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
Review of permanent medication due topossible effect on the existing disease.
Avoidance of psychosocial stress:
Psychological stresses
Conventional non-surgical therapy methods
Sacral nerve stimulation (synonym: sacral neuromodulation, SNS) may be considered for refractory (“not treatable by usual means”) slow transit constipation (lack of bowel motility causes bowel contents to move forward slowly; excretion may be delayed by up to two weeks as a result).
In the case of dyschezia (rectal constipation; the urge to defecate is felt, but the stool can not be excreted in the normal way), in addition to the basic measures, glycerol suppositories (glycerol zapfchen), suppositories that release CO2 in the rectum or small enemas can provide relief to the patient.
Fecal training can be used in cases of pelvic floor dyssynergia (dysfunction caused by neuromuscular disease)
Include high-fiber diets (soluble and insoluble fiber) in the diet plan:
The fiber content should be circa 35 g daily. Especially the insoluble fiber such as lignin, cellulose and some hemicelluloses, contained in cereals, vegetables, fruits, increase the stool volume by binding liquid. This accelerates the natural movement of the intestine and reduces the time spent in the intestine of the food pulp.
Soluble fiber such as pectin have a higher water binding capacity. Due to their gel-forming function, a lot of liquid is bound in the upper gastrointestinal tract. Although they increase stool volume only slightly, but significantly affect the stool consistency and gas pressure.
Especially wheat bran (10-30 g/day) increases stool weight due to its high water-binding capacity. Flaxseed is also recommended.
Important: Fiber does not help children with constipation, because the cause here is not in the diet, but is due to a corresponding predisposition. The findings were obtained from data on the stool behavior of children at the age of 5 weeks, six months, as well as in two-and-a-half-year-olds and four- to 10-year-olds. Means of choice are substances that soften the stool.
Raw foods should complement bread-only or grain-only meals.
Fresh sour milk products twice a day (counteract flatulence).
Care should be taken to drink enough fluids, as intake of less than 0.5 liters per day can increase constipation; fluid intake of 1.5(-2) liters throughout the day.
If there is a potassium deficiency (serum potassium < 3.5 mval/l), this can be remedied by potassium-rich foods (see “food lists”), potassium supplements.
Diet rich in:
Probiotic foods (if necessary, dietary supplements with probiotic cultures).
Selection of appropriate food based on the nutritional analysis
See also under “Therapy with micronutrients (vital substances)”.
For the function and motility of the intestine, sufficient exercise is of great importance. Thus, a sluggish bowel can be stimulated by increased physical activity – such as walking and gymnastics – and thus replace drug therapy in some patients.
If anismus (pelvic floor dyssynergy; the anal canal cannot open sufficiently and the rectum cannot empty itself) is present, biofeedback therapy can be tried. Biofeedback is a method from the field of behavioral therapy. It is a relaxation method in which the body’s own parameters are made visible and thus a voluntary change in those same parameters with the aim of relaxation should be carried out.
