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Constipation: causes, home remedies, medication

by Josephine Andrews
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constipation

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

quick overview

  • Description: When constipated, sufferers (adults) have fewer than three bowel movements per week. The stool is hard and can only be removed by pressing hard.
  • Frequency: In Europe, about 17 to 24 percent of the population suffer 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., lack of fiber, frequently suppressed bowel movements), constipation due to medication, nerve disorders (e.g., diabetes), hormone disorders (e.g., 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, fillers and swelling agents (such as flaxseed), rest when eating, chew well, drink enough, avoid stress, regular relaxation, do not suppress bowel movements, a glass of water on an empty stomach in the morning, abdominal massage in the morning
  • Medical treatment: medication for constipation (laxatives, agents to stimulate intestinal peristalsis = prokinetics), if necessary, treatment of underlying diseases that cause constipation (underactive thyroid, diabetes, etc.).

When do you speak of constipation?

How often the bowel is emptied varies significantly from person to person. Some people have bowel movements every day, and others just need to do their “big business” every few days. According to experts, as far as the frequency of bowel movements is concerned, anything between three times a day and three times a week is considered normal.

Doctors generally speak of constipation when someone

  • has bowel movements fewer than three times a week
  • must press hard while doing this, and
  • the stool is hard and lumpy due to the longer time it remains in the intestine.

In practice, however, this definition is often unclear – sometimes, people who do not meet the medical criteria for constipation also consider themselves “constipated.” An example: If someone has a bowel movement three times a week, but the stool is tough and can only be passed with heavy straining and pain, the person concerned can also have the subjective impression of constipation.

Temporary constipation is not uncommon: Most people have a sluggish bowel from time to time, for example, because they move too little, drink too little, and eat a low-fiber diet. A lifestyle change usually gets the intestines going again quickly.

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

  • strong pressing
  • lumpy or hard stools
  • the subjective feeling of incomplete defecation
  • the subjective feeling of blockage or blockage (obstruction) in the rectum
  • Assisting in defecation with the hand
  • less than three bowel movements per week

Home remedies for constipation

You can easily resolve or even prevent constipation with the proper diet and lifestyle. The following tips will help prevent constipation:

  • High-fiber diet: Eat lots of fruits, vegetables, and whole grains.
  • eat in peace
  • Chew thoroughly: Digestion begins in the mouth. Chew each bite well.
  • Drink enough: Experts recommend a daily intake of two liters (e.g., water, mineral water, tea).
  • Move: Constipation in old age, in particular, seems to be associated with a lack of exercise.
  • Give in to the urge to defecate: Do not hold back your bowel movements because you are about to make a call.
  • Resting bowel movement: Take enough time to go to the toilet.
  • Regular bowel movements: For example, always go to the toilet in the morning after breakfast and remain seated for ten minutes, even if nothing happens. Often the body gradually gets used to it and, at some point, uses the time to empty the bowels.
  • Relaxation: When the body is under stress, bowel movements are slowed. Suitable relaxation methods are, for example, progressive muscle relaxation and autogenic training.

If you still suffer from constipation despite these tips, the following home remedies can help you.

Natural laxatives

Can home remedies help with constipation? Yes, they can, but it usually takes patience. In contrast to medication for constipation, home remedies typically 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 get the digestion going. These natural laxatives include:

Flaxseed for constipation

Flax seeds increase the volume of the intestinal contents. In the case of constipation, this makes it easier and faster to empty the stool. Adults take one to two tablespoons or 10 to 20 grams of whole or lightly crushed flaxseed twice daily between meals. Sufficient fluid intake is essential: You should take each portion of flaxseed with at least 150 milliliters of water.

The daily dose for adults is 45 grams of flaxseed. It is slightly lower for children: they 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) of the seeds two to three times a day take – again with sufficient liquid.

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

A teaspoon of flaxseed is about four grams.

Flea seeds against constipation

On the one hand, the mucilage in the psyllium husk can swell up in the intestines and thus increase the volume of the stool. This makes bowel movements easier. On the other hand, they bind free water and toxins in the intestine. Flea seeds help to relieve constipation.

If you want to use the home remedy for laxation, 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 10 to 20 grams of psyllium husks (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 help against nausea and constipation. To do this, peel a black radish, grate it 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

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

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

Probiotic Foods

Probiotics are living microorganisms in natural yogurt, kefir, buttermilk, sauerkraut, beetroot, and lactic acid drinks made from organic whole grains. They support healthy intestinal activity and the immune system. Home remedies are mainly used for gastrointestinal complaints and can shorten the duration of the symptoms.

You can read more about this in the article Probiotics.

Abdominal massage, embrocation, and warmth

Abdominal massage or rubbing can often help relieve constipation immediately.

abdominal massage

A gentle abdominal massage can stimulate natural bowel movement, relieve tension and relieve gastrointestinal problems such as constipation. To do this, use both hands to rub your stomach in a clockwise direction with gentle pressure for several minutes. Start at the right lower abdomen and stroke in an arc to the left lower abdomen. This will follow the course of the large intestine.

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

See the Abdominal Massage post for more information.

belly rub

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

To do this, add approx. 10 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, then gently rub it onto your stomach clockwise for a few minutes. Don’t work with too much pressure! Then let it rest, well covered, for about 30 minutes. It can be repeated several times a day as needed.

Essential oils can cause life-threatening glottal spasms with respiratory failure in infants and small children. Therefore, only use essential oils in small children after consulting a doctor and only in small doses!

Belly pad with chamomile

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

Place a rolled-up inner towel in a second towel and roll up to form a wrap. Soak it in hot tea with the ends hanging out and wring it out. Place the inner cloth around your stomach without any creases. Wrap a dry cloth around and remove after 20 to 30 minutes. Then rest for half an hour. Use maximum twice a day.

Warm grain pillow

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

Mustard flour foot bath

A mustard foot bath stimulates blood circulation, has an expectorant effect, and relieves pain. Here’s how:

Fill a foot bath or a large bucket with no more than 38 degrees water. The water should be high enough to come up to your calves. Then stir in 10 to 30 grams of black mustard flour. Put your feet in, and place a large towel over your knees (to protect your face from rising fumes).

After about two to ten minutes, a burning sensation sets 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.

Home remedies have their limits. If the symptoms persist over an extended period, do not get better, or even worsen, you should always consult a doctor.

Location of the small and large intestine:

Location of small and large intestine

Medication for constipation

You should only use laxatives to prevent constipation if a lifestyle change (e.g., more exercise, stress reduction), roughage intake, and other home remedies have not had 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, and castor oil), and others require a prescription (such as prucalopride):

  • Osmotically active laxatives bind water in the intestine, which keeps the stool moist and slippery. Examples include Glauber’s salt, Epsom salt, lactulose, sorbitol, and macrogol.
  • “Water-driving” (hydragogic) laxatives ensure more water flows into the intestine’s interior. These include bisacodyl, sodium picosulfate, and anthraquinones (e.g., in senna leaves and buckthorn bark ).
  • Stool softening agents mix with the food particles in the intestine and act as a lubricant (e.g., paraffin oil).
  • Gas-forming laxatives (sodium hydrogen carbonate) release gas (carbon dioxide) in the intestines, which increases the volume of the stool and increases the pressure on the intestinal wall – this stimulates the further transport of the stool and the defecation reflex.
  • Prokinetics promote intestinal movement (intestinal motility). In this way, the leftovers are transported more quickly in the direction of the exit (anus) (prucalopride).

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

Consult a doctor or pharmacist for advice on which laxative is best for you. Use this strictly as your doctor or pharmacist has recommended or as it says on the package leaflet. Because if misused (dose too high and/or taken too long), laxatives can have serious side effects such as loss of fluids and salt.

constipation in pregnancy

The above home remedies and tips often help against frequent constipation during pregnancy. If not, pregnant women can use certain laxatives in consultation with the doctor. For example, lactulose, sorbitol, bisacodyl, macrogol, and sodium picosulfate are suitable. Also, enemas/mini enemas are allowed.

These laxatives can be used not only for constipation during pregnancy but also for constipation during breastfeeding.

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, but no cocoa!) and eat a fiber-rich diet (fruit, vegetables, whole grain products).
  • You can give small children pear puree and wholemeal porridge to stimulate digestion.
  • Soaked dried fruit, sauerkraut, and flaxseed with plenty of liquid also help against constipation.
  • Constipating foods (e.g., white bread, cakes, fast food) should be avoided.
  • Only give the child milk in moderation, but daily mildly acidified milk products (e.g., buttermilk, kefir, yogurt, whey).
  • Use olive oil for cooking instead of butter, margarine, or sunflower oil.
  • Make sure the child does not eat too many sweets.
  • The child should move a lot.
  • To stimulate the further transport of the chyme in the intestine, you can gently massage the child’s stomach in a clockwise direction with the palm of your hand. Alternatively, you can put a hot water bottle on the child’s stomach or make a warm wrap for the stomach.
  • Babies and small children with constipation must pay particular attention to caring for their buttocks and anus.

If necessary, the doctor can recommend certain laxatives for your child to relieve constipation, such as lactulose or 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 supplements for constipation, such as senna leaves, buckthorn bark, or rhubarb root.

Constipation: accompanying symptoms

Constipation is often accompanied by bloating and discomfort. Flatulence, pressure in the abdomen, and abdominal pain can also occur. Some sufferers also report headaches, tiredness, exhaustion, and loss of appetite.

Constipation: causes and possible diseases

Constipation is not a disease but a symptom – a sign that something is wrong in the body. This cause is usually relatively harmless (insufficient exercise, low-fiber diet, etc.), but sometimes there is a (serious) illness behind it.

The main forms or causes of constipation are:

Temporary or situational constipation

Many people have constipation in certain situations, for example, during a feverish illness, when working shifts, or being bedridden—eating unfamiliarly while traveling can also temporarily trigger constipation.

Chronic habitual constipation

Dysfunction of the intestine causes chronic habitual constipation. The causes are not clarified. 

Possible triggers are:

  • Insufficient fluid intake.
  • A low-fiber diet.
  • Lack of exercise.
  • Frequent suppression of the urge to have a bowel movement (e.g., due to lack of time).

However, lack of fluids, fiber, and exercise do not necessarily lead to constipation. Constipation can also occur with a high-fiber diet, sufficient fluid intake, and many activities.

irritable bowel syndrome

People with irritable bowel syndrome alternate between constipation and diarrhea (diarrhea). The reasons for this are not yet known. However, experts have created various hypotheses. For example, disturbed intestinal movement (intestinal peristalsis), increased intestinal mucosa permeability, increased immune activity in the intestinal mucosa, and a disturbing serotonin balance is suspected. A disturbed intestinal flora, stress, and gastrointestinal infections could also 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 cause sluggish intestine. Anticholinergics (e.g., for irritable bladder and incontinenceParkinson’s disease, asthma), opiates (strong painkillers or the cough medicine codeine), and high blood pressure medication are also possible triggers of constipation.

Electrolyte disorders (disorders of the salt balance)

Sometimes a lack of potassium (hypokalemia) is to blame for constipation. This can develop, for example, 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 diseases

Various bowel diseases can lead to problems and pain with bowel movements. These include, for example, bowel protrusions ( diverticula ), inflamed bowel protrusions ( diverticulitis ), bowel polyps, anal fissures and abscesses, painful hemorrhoids, the chronic inflammatory bowel disease Crohn’s disease, the rectum slipping out of the anus (rectal prolapse) and bowel cancer.

nerve disorders

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

hormonal imbalances

Constipation can also result from hormonal imbalances, such as those that occur with an underactive thyroid gland (hypothyroidism), diabetes, an overactive parathyroid gland (hyperthyroidism), or during pregnancy.

pregnancy

Constipation in pregnancy is a common phenomenon. It is due to several factors. These include, for example, increased hormone levels (such as progesterone ) in pregnant women. These ensure the child’s supply but restrict intestinal activity.

In addition, the intestines come under increasing pressure due to 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 & Toddlers

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

  • Poor diet: As with adults, a lack of fiber, fluids, and exercise is often to blame for problems and pain with bowel movements in children. In addition, eating too much “constipating” foods, such as white bread, cake, chocolate, and other sweets, can also cause constipation.
  • Switching from breast milk to solid food: Babies often become constipated when the diet switches from breast milk to porridge meals or solid food.
  • Changes in the regular daily routine: If the usual daily rhythm is disturbed (e.g., when traveling, being bedridden, or in stressful situations), children can easily develop digestive problems.
  • Sore buttocks: A sore buttock causes pain during bowel movements, which is why children often hold back the stool. The longer the stool stays in the intestine, the drier and more complex it becomes, which makes emptying even more painful and causes new tears in the skin or mucous membrane. Many children then really “smother” the urge to defecate. Chronic constipation (lasting more than two months) can develop over time.
  • Antibiotics: Constipation in children can also be caused by antibiotic treatment.
  • “Learning constipation”: Some children have difficulty weaning from the diaper: they don’t always make it to the toilet on time and are then ashamed of the mishap. A “learning constipation” can be the result.
  • Lactose intolerance: Sometimes, chronic constipation is caused by an intolerance to lactose.
  • Congenital farm malformation: Hirschsprung’s disease is a congenital malformation of the rectum. Mild forms of the disease often only become noticeable in children of preschool age with chronic constipation. People only have a bowel movement every five to seven days, sometimes only with the help of enemas or other measures.

diseases with this symptom

Find out more about the diseases in which the symptom can occur here:

Constipation: when to see a doctor

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

  • Accompanying symptoms such as blood in the stool and/or weight loss
  • acute constipation

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

Constipation: what does the doctor do?

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

  • How often do you have bowel movements?
  • What color and consistency is the stool?
  • Do you feel pain when you have a bowel movement?
  • How long have you had problems and pain with bowel movements?
  • Do you have any other complaints (e.g., back pain, nausea)?
  • Do you take any medication? If yes, which?
  • Do you have any underlying disease (diabetes, hypothyroidism, irritable bowel syndrome, diverticulosis, Parkinson’s disease, etc.)?

The doctor can often determine the cause of constipation simply from the information provided by the patient (e.g., lack of fluids, stress, shift work).

Physical examination

In addition, the doctor can use various tests and examinations to find out whether a specific disease may be the reason for the hard bowel movements. He will, therefore, next perform a physical examination. Especially in the case of chronic constipation, he will also examine the anus of the patient and check the basic tension of the anal sphincter with his finger.

Further investigations

Depending on the need, further examinations follow to clarify the suspicion of certain underlying diseases as the constipation trigger. These include, for example:

  • Blood test: The blood test can, for example, give indications of diabetes, hypothyroidism (hypothyroidism), or electrolyte imbalances.
  • Colonoscopy: This examination is particularly informative if there is a suspicion of bowel protrusions (diverticula), inflamed bowel protrusions (diverticulitis), bowel polyps, bowel cancer, and irritable bowel syndrome.
  • Ultrasound: An ultrasound examination of the abdomen is helpful if diverticulosis, diverticulitis, or Crohn’s disease is suspected. An ultrasound of the thyroid gland can clarify suspected hypothyroidism.
  • Stool examination: If there is blood in the stool, Crohn’s disease or diverticulitis, for example, can be behind it. Colon polyps and colon cancer are also possible causes.

In the case of persistent chronic constipation, further examinations and tests may be necessary. For example, the colonic transit time can be measured to check whether the large intestine transports food particles at a normal rate. The measurement can be made using 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 middle section of the large intestine – the large intestine (colon). From this, the colonic transit time can be calculated. A colonic transit time of more than 72 hours is considered pathological.

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

Important investigations

These examinations help to find out the causes of the symptoms:

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