If a patient has fewer than three bowel movements per week, they are said to be constipated. In these cases, the stool is usually hard and emptying is difficult and sometimes painful. Around 20 to 30 percent of the population in industrialized countries suffers from constipation; women are affected much more often than men.
In most cases, constipation is harmless, but it can also be a symptom of another, even serious, illness. Constipation can have a variety of causes. The most common are functional disorders, where the function of the intestine is changed. The most common cause of functional disorders is a combination of too little fluid intake, too little fiber in the diet and too little physical exercise. Another common cause is the so-called irritable bowel syndrome. Intestinal diseases such as colon or rectal cancer are less common. The malignant tumor leads to a mechanical obstruction (closure) of the intestine, so that the passage of stool is hindered. Often, so-called paradoxical diarrhea occurs alternately due to the liquefaction and fermentation processes of the stool. Metabolic diseases such as hypothyroidism or medications can also cause constipation. Long-term use of laxatives often leads to constipation due to the intestinal habituation process. Temporary constipation can also occur during pregnancy or due to a change in diet while on vacation.
Since the stool is usually very hard when constipated, there is often pain during bowel movements. Fear of the possible pain can lead to suppression of the urge to defecate, which in turn leads to worsening of constipation. A feeling of insufficient defecation or a bloated stomach also occurs.
The diagnosis is made by asking the doctor about the symptoms and lifestyle habits. Information about stool frequency, stool texture (color, consistency), pain during bowel movements and duration of constipation is important. Blood tests, an ultrasound scan of the abdomen or a colonoscopy are then used to rule out serious illnesses as a possible cause of the constipation.
Many of the laxatives sold in Germany are irritating to the intestines or contain substances that irritate the intestines. What is little known is that these substances themselves promote constipation. During normal bowel movements, only a small section of the large intestine is emptied. It takes a long time until this section is filled again until the next natural bowel movement. However, a laxative empties the entire large intestine or even parts of the small intestine. Therefore, it takes longer than usual until the next natural bowel reflex occurs. Out of impatience, many of those affected resort to laxatives again, which initially brings the desired result. However, due to the frequent, unnatural emptying of the intestines, the body loses a lot of water and, above all, the mineral potassium. If there is a lack of potassium in the body, the intestines become sluggish and become blocked again. This creates a vicious circle.
Treatment for constipation depends on the causes. A diet rich in fiber, sufficient fluid intake of at least two liters daily and regular exercise are the basis of treatment. In principle, drug therapy should never be carried out without consulting a doctor so that a serious illness can be ruled out as a possible cause of constipation. If laxatives are necessary, long-term use should be avoided because of the “getting used to” process. Prolonged constipation promotes the appearance of hemorrhoids, anal fissures and diverticula. In principle, however, constipation can usually be eliminated through physical exercise, an appropriate diet and sufficient fluid intake.
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