Constipation

What is constipation?

Everyone has to deal with constipation at some point in their lives. Often a wrong diet and lack of exercise are behind it. But certain diseases can also be responsible. Most of the time, constipation disappears within a short period of time due to lifestyle changes or treatment, however, this is not always the case. In some people, digestive problems persist for more than three months. Constipation can significantly reduce everyday life and quality of life. This is especially true when constipation is chronic.

Constipation is not a disease in itself, but a symptom that something is wrong in the body. And: it describes a subjective feeling of not being able to eliminate stool frequently enough, in sufficient quantity, with the right consistency, and only with discomfort.

Constipation – from when?

Not everyone who cannot go to the toilet from time to time immediately suffers from constipation. The frequency of bowel movements varies greatly from individual to individual and depends on a wide variety of factors, including your lifestyle.

We roughly apply the following rule: Constipation is when a person has fewer than three bowel movements per week. All other stool frequencies – from three times a day to three times a week – are considered normal.

However, the frequency of bowel movements alone is not conclusive enough. Because some have regular bowel movements, but quite “trouble” with them. A blockage could also be present if

• the stool is very hard – sufferers often have to push hard,
• the emptying is irregular and incomplete,
• defecation is laborious and painful, some even have to use their fingers to help.

We speak of chronic constipation only when you have been struggling with such problems with bowel movements for more than three months.

Constipation in babies and young children

Slightly different rules apply to constipation in babies and young children:

• If you are fully breastfeeding your baby, failure to have a bowel movement for three to four days is not yet considered unusual. We estimate a stool frequency of five times per day to once every five days as normal.
• In young children, the following signs indicate constipation: Bowel movements are very infrequent (once a week), and they are also hard and dry.

Constipation – frequency and age

In Western countries such as Switzerland, about 15 percent of the adult population suffers from constipation. Overall, digestion falters significantly more often in women than in men. For example, many women experience constipation during pregnancy, breastfeeding or menopause. The cause lies in the hormonal changes during these phases of life. The female hormones progesterone and progestin are at work here.

Constipation becomes more common with age, especially in men. The reasons are usually lack of exercise, but also the intake of medication, which can cause constipation as a side effect.

Constipation: causes and risk factors

There are many different causes that can make the bowels sluggish and trigger constipation. Possible risk factors for constipation may include:

• Incorrect diet: Too little consumption of fiber (whole grains, fruits, vegetables, legumes, seeds), too little fluid intake (recommended is at least 1.5 to 2 liters per day). However, not everyone who eats an unhealthy diet necessarily has constipation – and vice versa: those who eat a very healthy diet are not necessarily immune to constipation. So presumably some people are more prone to constipation than others.
• Lack of exercise: Many people sit too much in their daily lives – at their desk at work or in front of the TV or PC at home. This also makes the intestines sluggish. Exercise, on the other hand, stimulates bowel activity.
• Changed rhythm of life: e.g. stress at work, school, training or at home, but also travel can make bowel activity sluggish.
• Unhealthy bowel habits: Some people hold back their stool, for example because they are sitting in a meeting, the way to the toilet is long or there is no hygienic toilet nearby.
• Pregnancy, breastfeeding, menopause, menstruation: Hormonal changes can result in constipation.
• Some medications may cause constipation as a side effect. Examples are painkillers (e.g., opiates), iron and lithium preparations, drugs for high blood pressure, diuretics, neuroleptics (for psychoses), or antidepressants.
• Abuse of laxatives: These medicines can cause constipation if used for a long time by themselves.
• Diseases: Cancer, thyroid disease, depression, neurological disease (e.g., Parkinson’s disease, multiple sclerosis), or muscle disease (e.g., muscular dystrophy, myasthenia gravis).

Causes of constipation: Intestinal dysfunction

Intestinal dysfunction can also be responsible for constipation. These can be described as follows:

• Slowed colon movements: The colon does not work fast enough and takes much longer to move stool toward the bowel outlet. The small intestine keeps supplying more and more products of digestion, which then collect and accumulate in the large intestine. The intestinal contents remain there longer and more fluid is extracted from them – so the consistency of the stool eventually becomes firm and hard.
• Emptying disorders: Although the colon works as it should, the rectum is blocked. Affected persons cannot empty their stool or can do so only with great difficulty. Doctors are often unable to find an organic cause for the bowel dysfunction; instead, the problems are purely functional in nature. Therefore, they also speak of functional constipation.

Intestinal diseases as a cause of constipation

• Certain intestinal diseases can also be linked to constipation. These include irritable bowel syndrome (IBS or irritable bowel syndrome for short).
• Inflamed protrusions (diverticula) in the intestine – diverticulitis is the name given to this clinical picture.
• Chronic inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis
• Less common: Intestinal polyps, intestinal adhesions, intestinal cancer

Painful anal fissures, anal abscesses or hemorrhoids usually also have an aggravating effect on bowel movements.

Symptoms: Constipation causes difficult bowel movements

Constipation is not a disease in its own right, but a symptom. It can be associated with many other unpleasant symptoms. Characteristics of constipation are:

• Hard bowel movements, which often require heavy pressing and are therefore often painful.
• Stool frequency is less than three times per week.
• Feeling of fullness, feeling of being “bloated”
• Abdominal pain
• Bloating
• Feeling of incomplete emptying
• Feeling that the rectum is blocked

Even though constipation can be very unpleasant and affect everyday life and quality of life – constipation is usually not dangerous to health. Nor do toxic substances form if the stool remains in the intestine for a longer period of time. If you experience other symptoms in addition to constipation, you should always consult a doctor immediately and have them clarified. These include:

• Blood in the stool (this is always a case for a visit to the doctor)
• Unexplained weight loss
• Nausea, vomiting, abdominal cramps, colic – these may be signs of intestinal obstruction. Immediate action is needed here.

Diagnosis of constipation – this is how we proceed

Always consult your doctor if you have problems with bowel movements for a long time. Even if digestive problems are a taboo subject – for us they are a normal part of everyday life. At the beginning there is a conversation about your medical history, the anamnesis. These and other questions already help us to make an initial assessment:

• How often do you have bowel movements – per day, per week?
• How long have you been suffering from digestive problems?
• Do these improve again in between?
• Do you have any known diseases?
• Are you taking any medications? If yes: which ones and since when?
• Do you have a lot of stress in your everyday life?
• What about your lifestyle? Eating habits, exercise, sports activities?

This is usually followed by a physical examination: the doctor palpates the abdomen and feels for any abnormalities with his or her hands.f. Using a stethoscope, she or he can listen for bowel sounds. Palpation of the rectum with a finger (digital rectal examination, DRU) can detect changes that may be the cause of the constipation.

Sometimes a blood test is also informative (conclusions about existing diseases) or a blood-in-stool test (it detects hidden blood in the stool). If these examinations do not yield conclusive results, an ultrasound examination (sonography), X-ray or colonoscopy sometimes follow.

Bowel function disorders – Diagnosis

Disorders of bowel function can be detected by the following tests:

• Hinton test: On each of six days, you take a capsule containing certain substances (markers) that are later (on day seven) visible on the X-ray. We can use the Hinton test to determine how long the stool remains in the intestine and where the blockage forms, i.e. in the colon or rectum. A sluggish colon is probably responsible if the retention time exceeds 60 hours. If this is between 30 and 40 hours, the constipation is probably due to a voiding disorder – the rectum is blocked.
• Anorectal manometry: This procedure allows the pressure in the rectum to be measured and the strength of the sphincter muscle to be determined. The method works by using a small probe with an inflatable balloon at the tip, which is placed in the rectum. Anorectal manometry shows how well the sphincter and rectum function and work together.

Constipation: prevention, early detection, prognosis

You cannot prevent constipation 100 percent. Almost everyone deals with constipation at some point in their lives. However, there are some measures you can take to reduce the risk of constipation. Some general tips:

• Eat enough fiber, which is beneficial for digestion. Good sources of dietary fiber are whole-grain products (e.g., rice, pasta, bread, cereals), fruit (including dried fruit), vegetables, seeds (e.g., flaxseed, psyllium), nuts, and legumes (e.g., lentils, peas, beans).
• Make sure you drink enough fluids: 1.5 to 2 liters per day are recommended, on warm days even more. Choose low-calorie beverages such as water, unsweetened teas or fruit juice spritzers.
• Move a lot in everyday life and do sports. Take more frequent rigorous walks (e.g. after meals). Endurance sports such as swimming, cycling, Nordic walking or hiking are also good. Dancing is also healthy.

Course and prognosis in constipation

The course and prognosis for constipation depend on the underlying cause. In most people, intestinal sluggishness disappears within a few days on its own or through appropriate measures (high-fiber diet, drinking plenty of fluids, adequate exercise). However, if existing illnesses or taking medications are to blame for constipation, it’s not so simple. We must adequately treat the underlying disease or – in the case of medications – reduce the dose or choose a different preparation. Sometimes constipation can even become chronic – then the digestive problems last longer than three months. This is extremely unpleasant and can seriously affect the enjoyment of life.

Constipation: treatment depends on the trigger

The treatment of constipation always depends on the underlying cause. If, for example, your lifestyle is involved, there are things you can do yourself to give your bowels “legs” again. Some tips:

• Change diet
• Dietary fiber supplements
• Avoid stress
• Laxative for constipation