Constipation can severely affect a person's quality of life: It is difficult and painful to defecate - the stool is usually hard and can only be passed in small portions by pressing hard. The cause of constipation is usually harmless (e.g. stress, shift work). But sometimes it can be caused by a medical condition, such as diabetes.
Constipation: A brief overview
Description: Constipation occurs when an adult has a bowel movement less than three times a week. The stool is hard and can only be passed by pressing hard.
Frequency: In Europe, about 17 to 24 percent of the population suffers from constipation - women more often than men. The incidence generally increases with age.
Forms or Causes: Situational constipation (e.g. bedridden, stress), chronic habitual constipation (e.g. fiber deficiency, frequently suppressed bowel movements), constipation due to medication, nervous disorders (e.g. diabetes), hormonal disorders (e.g. hypothyroidism), electrolyte disorders or intestinal diseases (irritable bowel syndrome, SIBO, colon cancer, etc.), constipation during pregnancy.
Tips and home remedies: Get plenty of exercise, eat a diet high in fiber, use bulking and swelling agents (such as flaxseed), eat slowly, chew well, drink plenty of fluids, avoid stress, relax regularly, do not suppress bowel movements, drink a glass of water on an empty stomach in the morning, massage your abdomen in the morning.
Medical treatment: Medication against constipation (laxatives, agents that stimulate intestinal peristalsis = prokinetics), if necessary treatment of underlying diseases as a cause of constipation (hypothyroidism, diabetes, etc.).
When do we talk about constipation?
The frequency of bowel movements varies greatly from person to person. Some people have a bowel movement every day, while others only have to do the "big one" every few days. Experts say that anything between three times a day and three times a week is considered normal.
Doctors generally talk about constipation when someone has a bowel movement less than three times a week, has to push hard, and the stool is hard and lumpy because it spends more time in the bowel.
In practice, however, this definition is often not so clear-cut - sometimes people consider themselves "constipated" who do not meet the medical criteria for constipation. For example: If a person has a bowel movement three times a week, but the stool is very hard and can only be passed by pressing hard and with pain, that person may also have the subjective impression of being constipated.
Temporary constipation is not uncommon: Most people have sluggish bowels from time to time, for example because they do not exercise enough, drink too much, or eat a diet low in fiber. A change in lifestyle usually gets the bowel moving again quickly.
Chronic constipation, on the other hand, is usually more difficult to resolve and is often associated with a high level of suffering. Experts speak of chronic constipation when subjectively unsatisfactory bowel movements have been present for at least three months and are accompanied by two of the following key symptoms in more than 25 percent of cases
lumpy or hard stools
Subjective sensation of incomplete bowel movement
Subjective sensation of blockage or obstruction (constipation) in the rectum.
Assistance with bowel movements by hand
Fewer than three bowel movements per week
What to do? Home remedies for constipation
With the right diet and lifestyle, you can easily resolve or even prevent constipation. The following tips can help with constipation:
Eat a high-fiber diet: Eat plenty of fruits, vegetables, and whole grains.
Eat in peace
Chew thoroughly: Digestion begins in the mouth, so chew each bite thoroughly.
Drink enough: Experts recommend two liters of fluids per day (e.g. water, mineral water, tea).
Exercise: Constipation, especially in old age, seems to be linked to a lack of exercise.
Resist the urge to defecate: Do not suppress a bowel movement because you are about to make a phone call.
Defecate at rest: Give yourself enough time to go to the bathroom.
Regular bowel movements: For example, go to the bathroom every morning after breakfast and sit for ten minutes, even if nothing happens. Often the body will gradually get used to this and will eventually use this time for bowel movements.
Relaxation: When the body is under stress, it reduces bowel activity. Relaxation techniques include progressive muscle relaxation and autogenic training.
If you are still experiencing constipation despite these tips, the following home remedies may help.
Can home remedies really help with constipation? Yes, they can, but it usually takes patience. This is because, unlike medications for constipation, home remedies usually take a few days to work.
Some foods are naturally laxative. They can be taken to help relieve constipation and stimulate digestion. These natural laxatives include
Flax seeds for constipation
Flax seeds increase the volume of intestinal contents. In the case of constipation, this makes it easier and quicker to pass stools. Adults should 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 stay hydrated: each serving of flaxseed should be taken with at least 150 milliliters of water.
The daily dose for adults is 45 grams of flaxseed. Children can take two to four grams (1 to 3 years), three to six grams (4 to 9 years), or six to ten grams (10 to 15 years) two to three times a day, again with plenty of liquid.
Psyllium for Constipation
The mucilage in the psyllium husk can swell in the intestines, increasing the volume of stool. This makes bowel movements easier. It also binds free water and toxins in the intestine. This is how psyllium helps relieve constipation.
To use the home remedy for laxation, 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 (each divided into three separate doses).
Black radish contains pungent mustard oils and bitter compounds. These can inhibit bacteria, viruses, and fungi, loosen mucus in the upper respiratory tract, and help with nausea and constipation. Peel and grate a black radish and squeeze it through a juicer. Drink one to two tablespoons of juice several times a day.
Fluid on an empty stomach
Drink a glass of water or fruit juice on an empty stomach when you get up. This often triggers the bowel movement reflex. Alternatively, try a morning glass of warm water mixed with the juice of half a lemon. For coffee drinkers, a morning cup of coffee can trigger the evacuation reflex.
A teaspoon of lactose or some salt dissolved in water can soften the stool and help with constipation.
Probiotics are live microorganisms found in natural yogurt, kefir, buttermilk, sauerkraut, beets, and organic whole-grain lactic acid drinks. They support healthy bowel function and the immune system. As a home remedy, they are used especially for gastrointestinal disorders and can shorten the duration of symptoms.
Stomach massage, rubbing and heat
An abdominal massage or rub can often help relieve constipation right away.
Gentle abdominal massage can stimulate the natural movement of the intestines, relieve tension, and ease gastrointestinal problems such as constipation. For several minutes, use both hands and gentle pressure to stroke the abdomen in a clockwise direction. Begin at the lower right abdomen and move in an arc to the lower left abdomen. Follow the course of the colon. Gentle abdominal massage is also a good home remedy for babies and older children with constipation.
The use of essential oils can enhance the effects of belly rubs. Use diluted fennel, lemon balm, chamomile, or caraway oil. This warms, relieves cramps and pain, soothes, and stimulates digestion.
Add about 10 to 15 drops of one of these essential oils to 50 milliliters of fatty oil (such as extra virgin olive oil or almond oil). Warm some of this mixture in the palms of your hands and gently rub it on your abdomen in a clockwise direction for a few minutes. Do not apply too much pressure! Then cover well and rest for about 30 minutes. Can be repeated several times a day as needed.
Essential oils can cause life-threatening glottal spasm with respiratory arrest in infants and young children. Therefore, use essential oils on infants only after consulting a doctor and only in small doses!
Belly rest with chamomile
A hot and humid abdominal compress with chamomile has an analgesic, antispasmodic and relaxing effect. Pour half a liter of boiling water over one to two tablespoons of chamomile flowers. Leave to steep covered for no more than five minutes, then strain the infusion.
Place a rolled-up inner cloth in a second cloth, and roll the whole thing into a wrap. Soak it with the hanging ends in the hot tea and wring it out. Wrap 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. Do not use more than twice a day.
Warm cereal pillow
A warm cereal pillow (e.g. cherry pit pillow) gives off heat for a long time. It has a relaxing, pain-relieving effect and increases blood circulation. It can also be beneficial for constipation. Heat the pillow on the stove or in the microwave according to the manufacturer's instructions and apply to the abdomen. Leave on as long as the heat is comfortable.
Mustard Flour Foot Bath
A mustard flour foot bath stimulates circulation, has an expectorant effect, and relieves pain. Here is how it works:
Fill a foot bath or large bucket with water that is no warmer than 38 degrees. The water should be high enough to reach your calves. Then stir in 10 to 30 grams of black mustard powder. Place your feet in the water and place a large towel over your knees (to protect your face from rising fumes).
After about two to ten minutes, you will feel a burning sensation on your skin. Leave your feet in the water for another five to ten minutes. Remove, rinse thoroughly and rub with olive oil. Cover up and rest in bed for 30 to 60 minutes.
Home remedies have their limitations. If the symptoms persist for a long time, do not improve or even get worse, you should always consult a doctor.
Medication for constipation
Laxatives (purgatives) should only be used for constipation if lifestyle changes (e.g., more exercise, stress reduction), fiber supplements, and other home remedies have not worked after a month.
There are several types of laxatives, some of which are available over the counter (such as Glauber's salt, castor oil) and some of which require a prescription (such as prucalopride):
Osmotic laxatives bind water in the bowel, which keeps the stool moist and slippery. Examples include Glauber's salt, Epsom salts, sorbitol, and macrogol.
Water-pushing (hydragogic) laxatives increase the flow of water into the bowel. These include bisacodyl, sodium picosulfate, and anthraquinones (e.g., senna leaves, alder bark).
Stool softeners mix with food particles in the intestine and act as lubricants.
Gas-forming laxatives (sodium bicarbonate) release gas (carbon dioxide) in the intestine, increasing stool volume and pressure on the intestinal wall - this stimulates further stool transport and the evacuation reflex.
Prokinetics promote bowel movement (motility). In this way, waste is transported more quickly to the exit (anus) (prucalopride).
Many laxatives are taken by mouth, such as tablets, drops, or syrups. Others are administered directly into the bowel through the anus, either as suppositories or as an enema/miniclactic. With the latter, a small amount of liquid, such as a saline or sugar solution, is injected into the bowel. The laxative effect of this small enema is very rapid.
Talk to your doctor or pharmacist about which laxative is best for you. Use it exactly as advised by your doctor or pharmacist, or as directed on 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).
Constipation during pregnancy
The above home remedies and tips often help with frequent constipation during pregnancy. If not, pregnant women can use certain laxatives after consulting a doctor. These include sorbitol, bisacodyl, macrogol, and sodium picosulfate. Enemas/mini-enemas are also allowed.
These laxatives can be used not only for constipation during pregnancy, but also for constipation during breastfeeding.
Constipation in children
The following recommendations apply to the prevention and treatment of constipation in children:
The child should drink plenty of fluids (e.g. mineral water, unsweetened tea, but no cocoa!) and eat a diet rich in fiber (fruits, vegetables, whole grains).
Pear puree and whole grain oatmeal can be given to toddlers to stimulate digestion.
Soaked dried fruit, sauerkraut, and flaxseed, taken with plenty of fluids, also help with constipation.
Stuffing foods (e.g., white bread, cake, fast food) should be avoided.Give milk in moderation, but give mildly acidified dairy products (e.g. buttermilk, kefir, yogurt, whey) every day.
Use olive oil for cooking instead of butter, margarine, or sunflower oil.
Make sure the child does not snack on too many sweets.
The child should move around a lot.
To stimulate the passage of food in the intestines, you can gently massage the baby's abdomen in a clockwise direction with the flat of your hand. Alternatively, you can place a hot water bottle on your baby's tummy or make a warm tummy compress.
Infants and toddlers with constipation should pay special attention to the buttocks and anus.
If necessary, your child's doctor may recommend certain laxatives for constipation, such as macrogol. In acute cases, the child can also be given a mini enema from the pharmacy, which softens the stool in the rectum.
Never give children herbal preparations for constipation, such as senna leaves, sloth bark, or rhubarb root.
Constipation: Associated symptoms
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 people also report headaches, fatigue, exhaustion, and loss of appetite.
Constipation: causes and illnesses
Constipation is not a disease, but a symptom - a sign that something is wrong in the body. Most of the time, the cause is relatively harmless (not enough exercise, a low-fiber diet, etc.), but sometimes there is a (serious) disease behind it.
The main forms or causes of constipation are
Transient or situational constipation
Many people experience constipation in certain situations, such as during a febrile illness, shift work, or bed rest. Unaccustomed foods while traveling can also cause temporary constipation.
Chronic habitual constipation
Chronic habitual constipation is due to a functional disorder of the bowel.
The causes are not well understood.
Possible triggers include inadequate fluid intake, a low-fiber diet, lack of exercise, and frequent suppression of the stimulus to defecate (e.g., due to time constraints).
However, a lack of fluids, fiber, and exercise does not necessarily lead to constipation. Constipation can occur with a high-fiber diet, adequate fluid intake, and exercise.
Irritable bowel syndrome
People with irritable bowel syndrome experience bouts of constipation and diarrhea. The causes are not yet known. However, experts have come up with several hypotheses. These include impaired bowel movement (peristalsis), increased permeability of the bowel mucosa, increased immune activity in the bowel mucosa, and a disrupted serotonin balance. Disturbed intestinal flora, stress and gastrointestinal infections may also contribute to the development of IBS.
Sometimes constipation is caused by medications. For example, iron supplements, calcium and aluminum supplements for heartburn, and antidepressants can cause constipation. Anticholinergics (e.g., for irritable bladder and incontinence, Parkinson's disease, asthma), opiates (strong painkillers or the cough medicine codeine), and medicines for high blood pressure can also cause constipation.
Electrolyte disorders (salt imbalance)
Sometimes constipation is caused by a lack of potassium (hypokalemia). This can happen, for example, if you take laxatives too often. Other salt imbalances, such as excess calcium (hypercalcemia), can also cause digestive problems.
Organic bowel diseases
Several bowel disorders can cause problems and pain during bowel movements. These include diverticula, inflamed diverticula (diverticulitis), intestinal polyps, anal fissures and abscesses, painful hemorrhoids, Crohn's disease, rectal prolapse, and colon cancer.
In some cases, constipation is caused by nerve problems. These can include diabetes mellitus, Parkinson's disease, or multiple sclerosis.
Constipation can also be caused by hormonal imbalances, such as hypothyroidism, diabetes, hyperthyroidism, or pregnancy.
Constipation during pregnancy is very common. It is caused by several factors. These include the increased levels of hormones (such as progesterone) in pregnant women. These provide nourishment for the baby, but slow down bowel activity.
In addition, the growth of the uterus and the unborn child puts increased pressure on the intestines. The fact that women are less physically active during pregnancy also contributes to bowel sluggishness.
Constipation in infants & toddlers
Doctors generally consider a child to have constipation when he or she has a hard, dry, and usually painful bowel movement less than once a week. The main causes of constipation in children include
As with adults, a lack of fiber, fluids, and exercise is often to blame for children's problems and painful bowel movements. In addition, too many "constipating" foods such as white bread, cakes, chocolate, and other sweets can cause constipation.
Switching from breast milk to solid foods Constipation in babies often occurs when the diet is changed from breast milk to cereal or formula.
Changes in daily routine
When the usual daily routine is disrupted (e.g., travel, bedridden, stressful situations), infants can easily develop digestive problems.
Sore buttocks cause pain during bowel movements, so children often hold back stool. The longer the stool stays in the bowel, the drier and harder it becomes, making bowel movements even more painful and causing new skin or lining tears. Many children then "deny" the urge to have a bowel movement. Over time, chronic constipation (constipation that lasts more than two months) may develop.
Constipation in children may also be caused by treatment with antibiotics.
Some children have a hard time weaning from diapers: They don't always make it to the toilet on time and feel embarrassed about the mishap. Learning constipation" can be the result.
Sometimes chronic constipation is caused by lactose intolerance.
Congenital Hirschsprung's disease
Hirschsprung's disease is a congenital malformation of the rectum. Mild forms of the disease often first appear in preschool children with chronic constipation. These children have a bowel movement only 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 resolved without medical help (with more exercise, a high-fiber diet, drinking plenty of fluids, abdominal massage, stress reduction, home remedies, etc.). However, if digestive problems and hard stools become more frequent, a visit to the doctor is recommended. You should go to the doctor immediately in case of Associated symptoms such as blood in the stool and/or weight loss
Acute constipation with severe abdominal pain, bloating, fever, nausea, and vomiting may be due to a life-threatening bowel obstruction. Call an emergency physician immediately!
Constipation: What does the doctor do?
To get to the bottom of constipation, the doctor will first talk to the patient in detail to get a medical history: He or she will ask about your lifestyle (including your diet), any current illnesses, and any medications you are taking. Common questions in this history taking are, for example
How often do you have a bowel movement?
What is the color and consistency of your stools?
Does bowel movement cause pain?
How long have you had problems and pain with bowel movements?
Do you have any other complaints (e.g., back pain, nausea)?
Are you taking any medication? If so, 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 doctor can often deduce the cause of constipation (e.g., dehydration, stress, shift work).
In addition, the doctor can use various tests and examinations to find out if a particular condition may be causing the hard stools. The next step is a physical examination. Especially in the case of chronic constipation, the doctor will also examine the patient's anus and check the basic tension of the anal sphincter with his finger.
Depending on your needs, other tests may be done to rule out certain underlying conditions that may be causing your constipation. These may include
Blood test: A blood test may indicate diabetes, hypothyroidism, or electrolyte imbalances.
Colonoscopy: This test is especially helpful in cases of suspected diverticula, diverticulitis, polyps, colon cancer, and irritable bowel syndrome.
Ultrasound: An ultrasound of the abdomen may be useful when diverticulosis, diverticulitis, or Crohn's disease is suspected. An ultrasound of the thyroid gland may be helpful if hypothyroidism is suspected.
Stool examination: Blood in the stool may be caused by Crohn's disease or diverticulitis. Intestinal polyps and colon cancer are also possible causes.
If you have persistent chronic constipation, you may need more tests. For example, colonic transit time can be measured to determine whether the colon is moving food waste at a normal rate.
This can be done with an x-ray as part of the Hinton test:
The patient must take gelatin capsules containing radiopaque markers (once or over several days). After five to seven days, X-rays are taken to check how many radiopaque markers are in the middle section of the large intestine - the colon. From this, the colon transit time can be calculated. A colonic transit time of more than 72 hours is considered abnormal.
Another method is to measure the pressure in the rectum (anorectal manometry). This tests the function of the sphincter muscles at the anus. This can also be helpful in diagnosing chronic constipation.
These tests will help determine the cause of your symptoms: