constipation

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Constipation (medical: constipation) can severely impair the quality of life of those affected: Defecation is difficult and painful - the faeces are usually hard and can only be excreted in small portions by pressing hard. The cause of constipation is usually harmless (e.g. stress, shift work). Sometimes, however, there are also diseases such as diabetes behind it. Read everything you need to know about the symptom of constipation here.

Brief overview

Description: When constipated, those affected (adults) have bowel movements less than three times a week. The stool is hard and can only be put down by pressing hard.
Frequency: Around 17 to 24 percent of the population in Europe is constipated - women more often than men. In addition, the frequency increases with age.
Forms or causes: situational constipation (when bedridden, stressed, etc.), chronic habitual constipation (e.g. with a lack of fiber, frequently suppressed bowel movements), constipation due to medication, nerve disorders (e.g. with diabetes), hormonal disorders (e.g. with hypothyroidism), electrolyte disorders or intestinal diseases (Irritable bowel syndrome, colon cancer, etc.), constipation during pregnancy
Tips and home remedies: plenty of exercise, high-fiber diet, bulking agents and bulking agents (such as flaxseed), rest when eating, chew well, drink enough, avoid stress, regular relaxation, do not suppress bowel movements, a glass of water in the morning on an empty stomach, morning abdominal massage
Medical treatment: medication against constipation (laxatives, agents to stimulate intestinal peristalsis = prokinetics), possibly treatment of underlying diseases as the cause of constipation (hypothyroidism, diabetes, etc.).

When do we speak of constipation?

How often the bowel is emptied varies greatly from person to person. Some people have daily bowel movements, others only have to do their "big business" every few days. As for the frequency of bowel evacuation, experts say anything between three times a day and three times a week is considered normal.

Doctors generally speak of constipation when someone

has bowel movements less than three times a week,
must press hard and
the stool is hard and lumpy due to the length of time it remains in the intestine.

In practice, however, this definition is often not that clear - sometimes people consider themselves "constipated" who do not meet the medical criteria of constipation. For example, if someone has a bowel movement three times a week, but the stool is very hard and can only be settled with strong pressure and pain, the person concerned may also have the subjective impression of constipation.

Temporary constipation is not uncommon: Most people occasionally have a sluggish bowel, for example because they don't move enough, drink too little and eat a low-fiber diet. A change in lifestyle usually gets the bowel going again quickly.

Chronic constipation, on the other hand, is usually more difficult to resolve and is often associated with high levels of suffering. Experts speak of chronic constipation if there has been a subjectively unsatisfactory defecation for at least three months and this is accompanied by two of the following main symptoms in more than 25 percent of cases:

strong pressing
lumpy or hard stool
subjective feeling of incomplete emptying of the bowel
subjective feeling of blockage or occlusion (obstruction) in the rectum
Help with defecation by hand
less than three bowel movements a week

Home remedies for constipation

With the right diet and lifestyle, you can easily solve or even prevent constipation. The following tips will help with constipation:

High fiber diet: Eat lots of fruits, vegetables, and whole grains.
Eat in peace
Chewing thoroughly: digestion begins in the mouth, chew every bite sufficiently.
Drink enough: Experts recommend drinking two liters a day (e.g. water, mineral water, tea).
Exercise: Constipation in old age, in particular, seems to be related to a sedentary lifestyle.
Giving in to the urge to defecate: Do not suppress the bowel movement, for example because you were about to make a call.
Stool at rest: Allow enough time to go to the toilet.
Regular bowel movements: For example, always go to the bathroom in the morning after breakfast and stay seated for ten minutes, even if nothing happens. Often the body gradually gets used to it and then uses the time to defecate.
Relaxation: When the body is under stress, it slows down bowel movements. Suitable relaxation methods are, for example, progressive muscle relaxation and autogenic training.

If you are constipated despite these tips, the following home remedies may help.

Natural laxatives

Can Home Remedies Really Help With Constipation? Yes, they can, but it usually takes patience. Because in contrast to drugs for constipation, home remedies usually do not work immediately, but only after a few days.

Some foods have a natural laxative effect. They can be taken in case of constipation and stimulate digestion. These natural laxatives include:

Flaxseed for constipation

Flax seeds increase the volume of the intestinal contents. In the case of constipation, this facilitates and accelerates defecation. For this purpose, adults consume one to two tablespoons or ten to 20 grams of whole or lightly crushed flaxseed between meals two to three times a day. It is important to ensure sufficient fluid intake: You should take each flaxseed portion with at least 150 milliliters of water.

The daily dose for adults is 45 grams of flaxseed. It is slightly lower in children: you can add 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) of the seeds two to three times a day take yourself - again with sufficient liquid.

Further information can be found in the medicinal plant text flax.

One teaspoon of flaxseed is roughly four grams.

Psyllium for constipation

On the one hand, the mucilage in the husk of flea seeds can swell in the intestine and thus increase the volume of the stool. That makes bowel movements easier. On the other hand, they bind free water and toxins in the intestine. In this way, fleas help relieve constipation.

If you want to use the home remedy for purging, take a 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 ten to 20 grams of psyllium husks (each divided into three individual doses).

You can find more information in the article Flea seeds.

Radish juice

Black radish contains hot mustard oils and bitter substances. These can inhibit bacteria, viruses and fungi, loosen mucus in the upper respiratory tract and also help against nausea and constipation. To do this, peel and grate a black radish and squeeze it with a juicer. Take one to two tablespoons of the juice several times a day.

You can find more information in the article Black Radish.

Liquid on an empty stomach

After getting up, drink a glass of water or fruit juice on an empty stomach. This often triggers the bowel reflex. Alternatively, you can also try it with a morning glass of warm water mixed with the juice of half a lemon. For coffee drinkers, the morning cup of coffee can also trigger the stool reflex.

A teaspoon of lactose or a little salt dissolved in the water can soften the stool and help relieve constipation.

Probiotic foods

Probiotics are living microorganisms that occur in natural yoghurt, kefir, buttermilk, sauerkraut, beetroot and lactic acid drinks made from organic whole grain cereals. They support healthy bowel function and the immune system. As home remedies, they are mainly used for gastrointestinal complaints and can shorten the duration of the complaints.

You can read more about this in the article Probiotics.

Abdominal massage, rubbing and warmth

Abdominal massage or rub can often help clear a blockage right away.

Abdominal massage

A gentle stomach massage can stimulate the natural bowel movement, relieve tension and relieve gastrointestinal complaints such as constipation. To do this, stroke the stomach with both hands and gently pressure in a clockwise direction for several minutes. Start at the right lower abdomen and stroke in an arched manner to the left lower abdomen. In this way, you follow the course of the large intestine.

The gentle abdominal massage is also suitable as a home remedy for babies and older children with constipation.

You can find more information in the article Abdominal Massage.

Abdominal rubbing

The use of essential oils can increase the effect of the abdominal massage. Use diluted fennel, lemon balm, chamomile or caraway oil for this. This warms, relieves cramps and pain, calms and stimulates digestion.

To do this, add about ten to 15 drops of one of the essential oils mentioned in 50 milliliters of fatty oil (e.g. cold-pressed olive oil or almond oil). Warm some of this mixture on your palms and then gently rub it into your stomach in a clockwise direction for a few minutes. Don't work with too much pressure. Then rest well covered for about 30 minutes. Can be repeated several times a day as needed.

Essential oils can cause life-threatening glottic cramps in infants and young children with respiratory arrest. Use essential oils in small children only after consulting a doctor and only in a small dose!

Belly pad with chamomile

A hot, humid belly pad with chamomile has a pain-relieving, antispasmodic and relaxing effect. To do this, pour half a liter of boiling water over one to two tablespoons of chamomile flowers. Leave covered for a maximum of five minutes, then strain off the parts of the plant.

Place a rolled-up inner cloth in a second cloth, roll the whole thing up to make a wrap. Let this soak through the hot tea with the ends hanging out and wring it out. Place the inner cloth around the stomach without creases. Wrap a dry cloth around and remove after 20 to 30 minutes. Then rest for half an hour. Use a maximum of twice a day.

Warm grain pillow

A warm grain pillow (e.g. cherry stone pillow) gives off warmth for a long time. It has a relaxing and pain relieving effect and promotes blood circulation. This can also be beneficial in the case of constipation. Depending on the manufacturer's instructions, heat the pillow on the heater or in the microwave and place it on the stomach. Let it work as long as the warmth is comfortable.

Mustard flour foot bath

A mustard meal foot bath stimulates blood circulation, has an expectorant effect and relieves pain. Fill a foot bath or a large bucket with water at a maximum of 38 degrees. The water should be high enough to go up to your calves. Then stir in ten to 30 grams of black mustard flour. Put your feet in, place a large towel over your knees (to protect against rising steam).

After about two to ten minutes, a burning sensation will set in on the skin. Then leave your feet in the water for another five to ten minutes. Then remove, rinse thoroughly and rub with olive oil. Then rest, covered, in bed for 30 to 60 minutes.

You can read more about the effects and uses of mustard flour in the medicinal plant text mustard.

Location of the small and large intestines:

Drugs for constipation

You should only use laxatives against constipation if a lifestyle change (e.g. more exercise, stress reduction), the intake of fiber and the use of other home remedies have not shown any effect even after a month. There are different types of laxatives, some of which are over the counter (such as Glauber's salt, lactulose, castor oil) and some require a prescription (such as prucalopride):

Osmotic laxatives bind water in the intestine, which means that the stool remains moist and slippery. Examples are Glauber's salt, Epsom salt, lactulose, sorbitol and macrogol.
"Hydrating" (hydragogenic) laxatives ensure that more water flows into the inside of the intestine. These include bisacodyl, sodium picosulfate and anthraquinones (e.g. in senna leaves, buckthorn bark).
Stool softeners mix with the leftover food in the intestine and act as a lubricant (e.g. paraffin oil).
Gas-forming laxatives (sodium hydrogen carbonate) release gas (carbon dioxide) in the intestine, which increases the volume of the stool and increases the pressure on the intestinal wall - this stimulates the transport of the stool and the bowel reflex.
Prokinetics promote bowel movement (bowel motility). In this way, the leftovers are transported more quickly towards the exit (anus) (prucalopride).

Many laxatives are taken by mouth, for example in the form of tablets, drops or syrups. Others are administered directly into the intestine through the anus, either in the form of suppositories or as an enema / mini-enema. The latter is used to inject a small amount of liquid into the intestine, for example a salt or sugar solution. The laxative effect sets in very quickly thanks to this small enema.

Seek advice from a doctor or pharmacist about which laxative is best for you. Use this exactly as the doctor or pharmacist has recommended or as it is in the package insert. Because if used improperly (too high a dose and / or too long intake) laxatives can have serious side effects such as fluid and salt loss.

Constipation in Pregnancy

The home remedies and tips mentioned above often also help against the frequent constipation during pregnancy. If not, pregnant women can also use certain laxatives in consultation with their doctor. For example, lactulose, sorbitol, bisacodyl, macrogol and sodium picosulfate are suitable. Enema / mini-enema are also allowed. These laxatives can be used not only for constipation during pregnancy, but also for constipation while breastfeeding.

Treatment of constipation in children

For the prevention and treatment of constipation in children, the following recommendations apply:

The child should drink a lot (e.g. mineral water, unsweetened tea - no cocoa!) And receive a diet rich in fiber (fruit, vegetables, whole grain products).
You can give young children pear puree and whole grain porridge to stimulate digestion.
Soaked dried fruit, sauerkraut and linseed with plenty of fluids also help against constipation.
Constipating foods (e.g. bananas, white bread, cakes, fast food) should be avoided.
Give the child milk only in moderation, but daily mildly acidified milk products (e.g. buttermilk, kefir, yoghurt, whey).
Use olive oil instead of butter, margarine, or sunflower oil for cooking.
Make sure the child doesn't eat too many sweets.
The child should move around a lot.
To stimulate the further transport of the food in the intestine, you can gently massage the child's stomach in a clockwise direction with the flat of your hand. Alternatively, you can put a hot water bottle on the child's stomach or make a warm wrap for the child's stomach.
In infants and toddlers with constipation, particular care should be taken to care for the buttocks and anus.

If necessary, the doctor may recommend certain constipation laxatives for your child, such as lactulose or macrogol. In acute cases, the child can also be given a mini-list from the pharmacy, which softens the stool in the rectum.

Never give children herbal supplements for constipation such as senna leaves, buckthorn bark or rhubarb root.

Constipation: accompanying symptoms

Constipation is often accompanied by a feeling of fullness and malaise. Flatulence, a feeling of pressure in the abdomen and abdominal pain can also occur. Some people also report headaches, tiredness, exhaustion and loss of appetite.

Constipation: causes and possible diseases

Constipation isn't a disease, it's a symptom - a sign that something is wrong in the body. Usually this cause is relatively harmless (too little exercise, low-fiber diet, etc.), but sometimes there is also a (serious) illness behind it.

The main forms or causes of constipation are:

Temporary or situational constipation

Many people are constipated in certain situations, for example during a febrile illness, while working shifts or being bedridden. Unfamiliar food while traveling can also temporarily trigger constipation.

Chronic habitual constipation

Chronic habitual constipation is based on a dysfunction of the intestine. The causes are not clearly clarified. Possible triggers include insufficient fluid intake, a low-fiber diet, lack of exercise and frequent suppression of the urge to defecate (e.g. due to lack of time). However, a lack of fluids, fiber and exercise does not necessarily lead to constipation. Intestinal sluggishness can also occur with a fiber-rich diet, adequate fluid intake and a lot of exercise.

Irritable bowel syndrome

People with irritable bowel syndrome alternate between constipation and diarrhea. The reasons for this are not yet known. However, experts have created various hypotheses. For example, impaired intestinal movement (intestinal peristalsis), increased permeability of the intestinal mucosa, increased immune activity in the intestinal mucosa and a disturbed serotonin balance are suspected. A disturbed intestinal flora, stress and gastrointestinal infections could all contribute to the development of irritable bowel syndrome.

Medication

Sometimes constipation is caused by medication. For example, iron supplements, calcium- and aluminum-containing preparations for heartburn and antidepressants can make the intestine sluggish. Anticholinergics (e.g. for irritable bladder and incontinence, Parkinson's disease, asthma), opiates (strong pain relievers or the cough suppressant codeine) and high blood pressure drugs are also possible triggers of constipation.

Electrolyte disorders (disorders of the salt balance)

Sometimes a lack of potassium (hypokalaemia) is the cause of constipation.This can develop if you take laxatives too often. In addition, other disturbances in the salt balance, such as an excess of calcium (hypercalcemia), can also be the reason for digestive problems.

Organic bowel disease

Various bowel diseases can cause problems and pain during bowel movements. These include, for example, intestinal protuberances (diverticula), inflamed bowel protuberances (diverticulitis), intestinal polyps, anal fissures and abscesses, painful hemorrhoids, chronic inflammatory bowel disease, Crohn's disease, the rectum slipping out of the anus (rectal prolapse) and colon cancer.

Nerve disorders

In some cases, constipation is caused by nerve disorders. These can be due to diabetes (diabetes mellitus), Parkinson's or multiple sclerosis.

Hormonal imbalances

Constipation can also be the result of hormonal imbalances, such as those caused by an underactive thyroid (hypothyroidism), diabetes, overactive parathyroid gland (hyperthyroidism) or during pregnancy.

pregnancy

Constipation in pregnancy is a common phenomenon. It is caused by several factors. These include, for example, the increased hormone levels (such as progesterone) in pregnant women. These ensure that the child is supplied with food, but restrict bowel activity. In addition, the intestines come under increasing pressure from the growth of the uterus and the unborn child. The fact that women are less physically active during pregnancy also contributes to constipation.

Constipation in Babies & Young Children

Doctors generally speak of constipation in children when a child has hard, dry and usually painful bowel movements at most once a week. The main causes of constipation in children include:

Improper diet: As with adults, a lack of fiber, fluids and exercise is often to blame for children who have problems and pain during bowel movements. In addition, too much bananas, 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 switched from breast milk to mealtimes or complementary foods.
Changes to the normal daily routine: If the usual daily rhythm gets mixed up (e.g. when traveling, when bedridden, in stressful situations), digestive problems can easily arise in children.
Sore bottom: A sore bottom causes pain when defecating, which is why children often hold back the stool. The longer the feces stay in the intestine, the drier and harder it becomes, which makes emptying even more painful and causes new skin and mucous membrane tears. Many children then even more "hold back" the urge to defecate. Chronic constipation (constipation that lasts more than two months) can develop over time.
Antibiotics: Constipation in children can also be due to antibiotic treatment.
"Learning constipation": Some children find it difficult to wean from the diaper: They do not always make it to the toilet in time and are then ashamed of the mishap. A "learning blockage" can be the result.
Lactose intolerance: Sometimes chronic constipation is caused by lactose intolerance.
Hirschsprung's disease: Mild forms of this hereditary bowel disease can cause chronic constipation in preschool children. People only have bowel movements every five to seven days, and sometimes only with enemas or other measures.

Constipation: when to see a doctor?

Occasional constipation can often be cleared without medical help (more exercise, a high-fiber diet, plenty of drinking, abdominal massage, stress relief, home remedies, etc.). However, if digestive problems and hard bowel movements occur frequently, a visit to a doctor is advisable. You should see a doctor immediately if:

Concomitant symptoms such as blood in your stool and / or weight loss
acute constipation

In the case of acute constipation with severe abdominal pain, bloated stomach, fever, nausea and vomiting, a life-threatening intestinal obstruction can be behind it. Call the emergency doctor immediately!

Constipation: what does the doctor do?

In order to get to the bottom of the constipation (constipation), the doctor will first talk to the patient in detail in order to collect their medical history (anamnesis): He has the symptoms described in detail, asks about lifestyle habits (including eating habits), any current illnesses and the use of medication. Frequent questions in this anamnesis interview are for example:

How often do you have a bowel movement?
What color and consistency is the chair?
Is it painful to have a bowel movement?
How long have you had problems and pain when defecating?
Do you have any other complaints (e.g. back pain, nausea, etc.)?
Are you taking any medication? If yes, which?
Do you have any known underlying illness (diabetes, hypothyroidism, irritable bowel syndrome, diverticulosis, Parkinson's, etc.)?

The doctor can often deduce the cause of the constipation from the patient's information alone (e.g. lack of fluids, stress, shift work). In addition, the doctor can use various tests and examinations to find out whether a certain illness is possibly the reason for the hard bowel movements. He will therefore next do a physical exam. Especially in the case of chronic constipation, he will also examine the patient's anus and check the basic tension of the anal sphincter with his finger.

If necessary, further examinations will follow to clarify the suspicion of certain underlying diseases as the cause of the constipation. These include, for example:

Blood tests: They can provide information about diabetes, underactive thyroid (hypothyroidism) or electrolyte disorders, for example.
Colonoscopy (colonoscopy): especially if there is suspicion of colon bulges (diverticula), inflamed colon bulges (diverticulitis), colon polyps, colon cancer and irritable bowel syndrome
Ultrasound examination of the abdomen (for example if diverticulosis, diverticulitis or Crohn's disease is suspected) or the thyroid gland (if hypothyroidism is suspected)
Stool examination: Blood in the stool can occur with Crohn's disease, diverticulitis, colon polyps, and colon cancer, among others

If chronic constipation is persistent, further examinations and tests may be necessary. For example, the colon transit time can be measured to check whether the large intestine is moving food particles onward at normal speed. The measurement can be made with the help of an X-ray examination as part of the Hinton test: The patient must take gelatin capsules with radiopaque markers (once or spread over several days). After five to seven days, x-rays are used to check how many radiopaque markers are in the colon. The colon transit time can be calculated from this. A colon transit time of more than 72 hours is considered to be pathological.

Another examination method is to determine the pressure in the rectum (anorectal manometry). The functionality of the sphincter muscles at the anus is checked. This can also help clarify chronic constipation.

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