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Constipation – Causes, Symptoms and Therapy

This text complies with the specifications of medical literature, medical guidelines and current studies and has been reviewed by medical doctors and physicians.

K59 ICD codes are internationally valid codes for medical diagnoses. They are found e.g. in medical reports or on incapacity certificates.

Unhealthy diet and stress reinforce the irritable bowel. (Image: underdogstudios / fotolia)

Carrier Intestinal Disturbed intestinal activity with abdominal pain and distended abdomen
Gut sluggishness is a common phenomenon. Those affected suffer from abdominal pain, bloating, nausea and even depression. Especially in the western industrialized countries, a sluggish bowel is widespread due to lack of exercise and unhealthy diet. Other (organic) causes are also possible.

The intestine

Our gut is a very complex entity. It consists of small intestine and large intestine and winds in up to eight meters long loops through the interior of our body. In the large intestine sit the cecum, the colon and the rectum; the rectum, in turn, divides into the rectum and the intestinal outlet, where the sphincter muscles sit, so the anus or anus; This anus is one of the most sensitive zones of the body, because here the outer skin meets the inner intestinal mucosa.

The intestine is the most important part of the digestive tract. It is divided into the two sections of small and large intestine and can be up to eight meters long in adults. (Image: ALDECAstudio / fotolia.com)

We can not deliberately influence the inner sphincter, but we control the outer one ourselves. Constipation means that deflation at the end of the bowel does not work. This evacuation, which we take for granted, is a complicated process that we still can not fully comprehend. Various neural pathways from the end of the intestine to the spinal cord and to the brain are involved; and also mental moods are involved.

If the faeces accumulate during transport, this is due to a disturbed coordination of sensory and movement nerves in the intestine. This includes the nervous system in the intestine itself, the muscles of the intestinal wall and pacemaker cells in the intestines.

When the intestine goes on strike – case studies

Hendrik (name changed) began his engineering studies in Hannover; He had little money and therefore gladly accepted the offer of a fraternity to live for DM 180.00 in their house of liaison.

The older residents treated newcomers like him like servants, and he felt like a military recruit who the sergeant harassed. Liberations promised alcohol excesses on the weekend, but even with those Hendrik could not keep up and vomited as the first in the toilet bowl.

Added to this was a problem that he did not reveal to anyone. His intestine squeezed, and his stomach ached, but when he sat down on the toilet and pressed, the feces accumulated in the rectum.

After two weeks, he drove home to his parents, who live in a village in the Lüneburg Heath. He slept and his mother cooked him. After dinner, he sat on the toilet, his sphincters relaxed, and finally his intestine emptied.

Constipation, commonly known as constipation, complicates the bowel movement – the excrement is not completely excreted or too rare. It is still a taboo subject and a complaint we all know. That was another reason why Hendrik found it difficult to talk about his problem.

Many people are familiar with the problem: In familiar surroundings, there are no problems with bowel movements – but in unfamiliar situations, the intestine suddenly strikes. (Image: nito / fotolia.com)

Melanie (name changed) has a similar problem. She works as a department head of a municipal authority. In her apartment and right next to her work place her gut works smoothly, but away from home, whether at conferences, concerts or in the restaurant, her gut closes the doors – and nothing escapes to the outside.

Once again Melanie was in the situation that the pressure on the anus was hard to bear, it was on a uniparty, and she asked her best friend if he could stand guard in the ladies’ room. He was astonished, but her request was followed. And, she hardly believed it, her sphincters relaxed.

Psyche, brain and intestinal nerves played together for Hendrik and Melanie. In both, the intestine went on strike in unfamiliar situations, which they also found unpleasant. In both, however, the sphincters relaxed when they thought they were safe.

Evolutionary self-protection

Not every constipation, however, is as clearly psychologically conditioned as the two. Reactions of our gut are first a psycho-biological heritage of our evolution; Exterminating feces was a risky situation for early humans: those who squat down, pressed their anus muscles, and put their hands on their hips, were defenseless and thus easy prey for saber-toothed tigers, lions, or hostile humans.

To be on the safe side and to keep members of the own group on guard was therefore a necessity. It can only be speculated, but it is logical that the gut responded to potentially dangerous situations – for example, by constipation.

However, the intestine inside the body does not decide itself. Whether a situation could be risky determines our sensory perception. The sensory organs conduct this mood to the brain, and the brain passes on the information to the nerves in the gut. He keeps the feces back until he gets the message: Everything’s alright.

Whether a situation is really dangerous as the saber-toothed tiger on the watch or our fear just classifies them as risky, is equally valid for the physical reaction.

Travel congestion

Unproblematic is the travel constipation: We are on the Caribbean beach or visit the Coliseum, it squeezes in the gut, but nothing comes. The body needs some time to adapt to the new climate, to digest the unfamiliar food, and in hot countries we often take too little liquid. Sometimes we have alternating diarrhea and constipation. After a few days, however, our intestinal balance normalizes.

When traveling, it often takes a few days for the digestive system to get used to the new conditions. (Image: 9nong / fotolia.com)

Intestinal inactivity in the foreign, as in Melanie, can also have psychological causes. Some people are afraid to go to the toilet in a strange environment, and the body translates this by cramping the intestinal tract.

Not dangerous is the occasional constipation. It has various causes, there is a widespread lack of fluid, and on the other hand help hot soups or dried fruit.

Chronic constipation

However, a persistently sluggish gut is a serious problem. Usually we empty it at least three times a week. However, if we have problems with disposing of the feces over a period of at least a quarter of a year, there is probably a chronic constipation.

Signs of chronic constipation:

  • We have to press extremely hard to empty ourselves and even help with our hands.
  • The feces are hard and make lumps.
  • The intestinal outlet feels blocked and hurts from the inside.
  • We notice that a larger amount remains in the intestine.
  • At least every fourth emptying these complaints occur.

Constipation is also present if we empty ourselves daily, but these problems occur.

based diseases

Basic diseases can interfere with the interaction of the nerves during bowel movements. These include especially metabolic diseases such as diabetes mellitus, which damage the nerves, muscle diseases that affect the intestinal muscles or disorders of the central nervous system.

Bowel diseases usually affect emptying. Likewise, anatomical changes in the gut can hinder elimination.

way of life

Life and work influence the intestinal balance. If we move too little, postpone defecation, and especially if we have stress, it can cause constipation. However, these triggers are not causes of disturbed intestinal activity, but merely promote it.

An unregulated sleep, so changing day-night rhythms, affect the intestinal functions as well. Among those affected are nurses as well as managers, journalists and professional travelers.

However, specific factors are added to these people: professional travelers are more at risk of travel congestion, and those who frequently attend conferences and lectures sometimes postpone their bowel movements, and the same applies to journalists on reportage. Here, a doctor should decide individually which problem exists.

Irregular sleep and wake periods, e.g. by working in shifts, favoring digestive problems. (Image: Kaesler Media / fotolia.com)

Acute constipation

An acute constipation, however, occurs suddenly, without the symptoms are present for a long time. Often it is associated with other ailments, namely, nausea, fever, bloated abdomen, and abdominal pain. There may be an intestinal obstruction, and then an emergency doctor should be alerted immediately.

An intestinal inflammation, a disruption of the blood circulation, surgery or radiation therapy can cause scarring in the intestine – and obstruct the bowel movement. Gallstones sometimes close the intestine, usually the upper small intestine. Tumors in the abdomen and pelvis also lead to narrowing, and a hernia sometimes pinches the bowel.

irritable bowel

Irritable bowel syndrome is often associated with constipation. Mostly affected are young people; Constipation and diarrhea alternate. The sufferers suffer from bloating, stomach pressure, flatulence and massive abdominal pain associated with cramps.

The diagnosis is difficult. Allergies to food cause similar symptoms, as well as intestinal inflammation, protuberances of the intestinal wall (diverticula) and a narrowing of the intestine. To cure irritable bowel syndrome, proper nutrition is as important as relaxation exercises.

In irritable bowel syndrome, the digestive organ strikes, without the doctor recognizing a physical cause. Nevertheless, the disease is not only psychologically conditioned; The affected have rather an unusually sensitive intestine, the intestinal nervous system of those affected reacts with pain on air in the intestine, which accumulates quite normal again and again.

Mental states, such as fear, anger or inner restlessness promote the irritable bowel, trigger it or at least strengthen it.

As with other forms of constipation, a bad diet is just as little the cause as cigarettes or alcohol – but a healthy diet helps to heal.

Unhealthy diet and stress reinforce the irritable bowel. (Image: underdogstudios / fotolia)

Other causes of constipation

1) nerves and psyche. In the intestine system, network of nerves and psyche, mediated through the brain, work together. Diseases of the nerves and the brain can affect the intestine as well as psychological problems. Spinal cord injuries, such as paraplegia, also affect the bowel, such as central nervous system disorders, multiple sclerosis, stroke or Parkinson’s disease.

2) Eating disorders such as anorexia and bulimia directly affect the digestive system. The metabolism is disturbed, and the salt balance gets out of balance, also misuse eating-disturbed laxatives and mess up the intestinal transport.

3) Hormones affect the intestine. Hypothyroidism makes it work slower, the thyroid hormones no longer supply the organism properly, and therefore the nerves turn too late; Constipation is the result, plus an increased sensitivity to cold.

4) Pregnant women often have problems with bowel movements. Your intestine works delayed, due to the high hormone release, in addition, the uterus and the embryo press on the digestive system and thus narrow it.

5) Cause can be the pill, so prevention with hormones – at least until the body has adjusted to the altered hormone balance. However, if the problem persists, the person should change the pill or consider other contraceptives.

6) High blood sugar has an effect on the intestine, because too high a level, ie varieties of diabetes, damages the nerves of the involuntary nervous system. This leads to constipation and impotence.

7) The kidneys fail, the body acidifies and the body lacks vitamin D. The result: calcium from the bones gets into the blood at too high a dose.

8) Potassium deficiency promotes constipation. Kidney weakness is considered a natural trigger, but also the excessive consumption of laxatives and drainage deprives the body of potassium, and it affects not only the intestine, but also the bladder; Urinating is as difficult as draining the feces.

The cause of the digestive problems can be a lack of potassium. In order to provide the body with the mineral sufficient, should regularly, for example, Legumes and dried fruit are eaten. (Image: samael334 / fotolia.com)

9) Far more serious, however, is amyloidosis. This so-called systemic disease, which is the result of chronic inflammation in the body and damages the entire organism, causes protein to accumulate in the wall of the intestine, which it can not dissolve. Although amyloidosis is hereditary, it only develops as a result of chronic inflammation in the body, as for example in rheumatism, some diseases of the lymph and the blood.

10) Drugs influence the intestine as a side effect. Common suspects are, in particular, agents such as gastric acid inhibitors or codeine and other opioids. Also beta-blockers for the heart and circulation and water-drenching remedies affect the defecation, in the form of constipation or diarrhea.

Remedies for epilepsy and Parkinson’s, against cramps, against bladder weakness and against insomnia affect the digestive system as well as morphine: Heroin users usually suffer from constipation.

11) Abscesses, scars and fistulas in the anus block the intestinal outlet. Also, injuries, such as cracks in the skin on the anus, which connects the outer skin and the intestine, not only make the bowel movement painful, but also complicate it, especially when the wound swells.

12) An intestinal prolapse on the rectum and its opposite, invagination of the rectum causes the feces to collect in intestinal protuberances in the body instead of excreting it over the anus.

13) Intestinal and after cancer can narrow the bowel outlet so that a normal excrement is impossible.

14) A disturbed sphincter also blocks the bowel movement. The sphincter at the anus coordinates a complex system between the pelvic floor, urethra and rectum. If the rectum or pelvic floor is tight, constipation means: Although the pressure in the rectum increases, the sphincter muscles do not relax, we squeeze and squeeze involuntarily, but the more we squeeze, the more the anus closes.

15) Anatomical malformations in the pelvis also lead to constipation. These are sometimes innate, but the pelvis also lowers after pregnancies and with age.

16) Severe constipation sometimes occurs in young women. The indication for this problem is a delayed transport of the stool through the intestine, which can be detected with a gut biopsy.

Here intestinal nerves, intestinal muscles and pacemaker cells are equally affected.

Weakened nerves

Not a few sufferers are genetically stressed, namely by the Hirschsprung disease. The organism then does not supply the nerves in the intestine with enough impulses, and in the lower rectum the nerve shedding cells are completely absent.

In severe cases, the intestine is too tight in these areas, and the sphincter muscle does not relax. Those affected suffer as infants from extreme abdominal pain or even from bowel obstruction. A sample of the intestinal mucosa is part of the diagnosis.

The disease must be eliminated by surgery.

If the bowel is blocked, in some cases, only a surgical intervention helps. (Image: s4svisuals / fotolia.com)

The blocked intestine

Often the intestine is blocked without a closure. Physicians then speak of a chronic intestinal pseudo-obstruction. Simply put, the person has symptoms that indicate a developing intestinal obstruction; the cause is different.

Bloating stomach, abdominal pain, vomiting, a kind of heartburn in the chest are constipated. Muscles and nerves of the intestine fail.

Numerous disorders can underlie this pseudo-intestinal obstruction, for example diseases of the muscles. The muscles hurt, and they are stunted. The eyelids can not lift, the heart beats irregularly, and the brain develops slowly. Since the intestinal muscles are weakened, those affected suffer from chronic constipation.

diagnosis

The doctor asks about the symptoms, especially how long they are already occurring. Then he asks if constipation and diarrhea alternate, if the excrement changes color, is mixed with blood or mucus. It also clarifies whether the patient suffers from abdominal pain or flatulence, whether the droppings fall difficult, hurts or even leads to bleeding. Sometimes he advises the person concerned to keep a toilet diary.

Weight loss, fever and infections are also important indicators of basic diseases. In addition, other symptoms sometimes play a role: back pain, diseases of the liver, gallbladder and pancreas.

The doctor scans the abdomen and groin as well as the anus. In the anus, he introduces his finger and thus detects whether the rectum is changing. Laboratory analyzes are added, the abdomen is ultrasonically analyzed, a colonoscopy, tissue sampling, computer and MRI follow.

Often different specialists work together: the gastrointestinal specialist is then just as in demand as the urologist, the gynecologist and the neurologist. If the transport routes of the intestine are disturbed, even a special discipline comes into force: Neurogastroenterology.

therapy

To cure constipation, there are very different methods, depending on the nature of the disease. In basic diseases such as multiple sclerosis, tumors or anorexia, the root is always the disease, constipation only a consequence of it, and curing the symptoms brings little in the long term.

Chronic constipation can be relieved with both medication and surgery. Blockages caused by an abscess, scars or cancer are best combated by the surgeon scalpel. Enema helps the intestine to empty itself.

In psychic triggers, so in cases such as Hendrik and Melanie, a psychologist or psychotherapist should be involved.

laxative

Those who suffer from a sluggish bowel quickly think of laxatives to treat them. This may be useful for a certain period of time, but in the long term the digestive organ reacts counterproductively: it responds less to the filling stimuli, and in the long run it increases constipation.

Laxative so

  • do not constantly take
  • dose low
  • wait at least three days after evacuation for the next dose
  • do not take before attempting to switch to a diet-friendly diet

Fiber brings back into the gut. Image: PhotoSG – fotolia

Intestinal friendly diet

The cause of constipation are not missing fiber and too few drinks. But fiber and sufficient water relieve a chronic constipation.

Rich in fiber, extra fiber and plenty of water or herbal tea help the intestines. Up to two liters of water per day are generally recommended, moreover, liquid has no effect on the body.

Self-help with constipation

If there is no serious illness, effective home remedies for constipation help. Dried plums relieve the blockages, especially with plenty of water. Other vegetables and fruits also provide fiber, as well as legumes, cereals, dried and fresh bromine, Johannis, raspberries and blueberries. Flax seeds with a lot of fluid accelerate the intestinal transport; If you do not have a sluggish bowel you should enjoy it in moderation.

All foods that clog up should be avoided. Stay away from: white bread, French fries, chips, long-drawn black tea, meat and white flour products.

If the self-help is unsuccessful, the intestine continues to congest despite the improvement in lifestyle, sufficient sleep, friendly nutrition and a lot of exercise, we ask a doctor. Perhaps an irritable bowel, a bowel inflammation or even cancer in the intestines and anus triggers the discomfort. (Dr. Utz Anhalt, nr)

  • Schilddruesenzentrum Cologne: Thyroid subfunction, (call 05.09.2019), Schilddruesenzentrum-koeln
  • Stephanie M. Moleski: Irritable Bowel Syndrome (IBS), MSD Manual, (Obtained 05.09.2019), MSD
  • V. Andresen et al .: S2k Guideline Chronic Constipation: Definition, Pathophysiology, Diagnosis and Therapy, German Society for Neuro-Gastroenterology and Motility (DGNM), German Society for Digestive and Metabolic Diseases (DGVS), (Call 05.09.2019), AWMF
  • P. Layer et al .: S3 Guideline Irritable Bowel Syndrome: Definition, Pathophysiology, Diagnosis and Therapy, German Society for Digestive and Metabolic Diseases (DGVS), German Society for Neurogastroenterology and Motility (DGNM), (Call 05.09.2019), AWMF
  • Irmtraut Koop: Gastroenterology compact, Thieme Verlag, 3rd edition, 2013
  • Deborah M. Consolini: Constipation in Children, MSD Manual, (Obtained 05.09.2019), MSD

Important NOTE:
This article contains only general information and should not be used for self-diagnosis or treatment. He can not substitute a visit at the doctor.

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