In order to make it clear what can be behind it, it helps to briefly visualize the digestive process as a whole. “The gastrointestinal tract is about six meters long from the mouth to the anus,” explains the gastroenterologist Birgit Terjung, chief physician in the department for internal medicine at the GFO clinics in Bonn.
The food is transported through the esophagus into the stomach, where it is chopped up and mixed as a chyme. In the small intestine, the pulp is broken down into its components, the large intestine withdraws water and thickens it as a bowel movement. It is excreted through the anus.
It’s a long way food can travel, so it’s not surprising that problems can arise along the way.
An uncomfortable feeling
How often we go to the toilet varies from person to person, even in healthy people – one goes three times a day, the other three times a week. But if there are deviations from the time routines, it can cause an uneasy feeling.
“If a bowel movement occurs less frequently than usual, people feel constipated,” says Terjung. “You have the feeling of fullness, an incomplete defecation. You have to press hard, report hard or lumpy stools, or you even have to help manually.”
That worries. Some even worry about “internal poisoning”, reports the doctor. But don’t worry: “This myth lacks a scientific basis.”
Two forms of constipation
Doctors differentiate between two main forms of constipation: a so-called passage disorder and an emptying disorder of the rectum.
Too slow a bowel passage leads to a feeling of fullness, a bloated stomach and infrequent bowel movements. “This form can come from drugs and other illnesses,” says Terjung. A different diet – on vacation for example – can temporarily lead to this.
The gastroenterologist explains that the cause of an emptying disorder of the rectum can be cramping at the anus, a weak pelvic floor with a possible bulging of the anterior wall of the rectum into the vagina or a thickened bowel movement.
Chronic constipation is also called constipation and can occur at any age, explains Prof. Christian Pehl. He is guideline coordinator for chronic constipation of the German Society for Gastroenterology and Medical Director at the hospital in Vilsbiburg in Bavaria.
Older people are particularly affected, however. “The reasons are a lack of exercise, a low-fiber diet or too little drinking,” says Birgit Terjung. In addition, the transport time in the intestine often changes in the elderly, the stool is transported more slowly in the large intestine.
Parkinson’s, dementia, depression or diabetes mellitus can also have a negative effect on bowel movements, says Terjung. The same applies to antidepressants, Parkinson’s medication, psychotropic drugs and opiate pain relievers.
What are home remedies for?
Anyone struggling with constipation does not always have to seek medical advice straight away – in certain cases you can try home remedies first. “Prunes, dried fruit and sauerkraut juice can treat mild forms of chronic constipation well,” says Pehl. “But here too there are sometimes side effects such as stomach pain, gas and diarrhea.”
Dietary fiber can also be added to the diet. “Psyllium husk preparations in particular are ideal here because of their stool-regulating effect,” explains Pehl.
Blood in the stool
And when should you go to the doctor? “If constipation is new and persistent, especially from the age of 50, a doctor should be consulted,” advises Terjung. This also applies if there is severe gas, abdominal pain or blood in the stool.
“In addition to an ultrasound examination of the abdomen, a colonoscopy should be performed if necessary,” explains Terjung. For example, to rule out polyps or inflammation.
Often laxatives are prescribed. They should accelerate the transport of stool and make it easier to empty it. According to Pehl, there are various classes of substances with different mechanisms of action. Any medication should only be taken for as long as necessary.
Dietary fiber for prevention
Constipation can be prevented if you make sure you get enough fiber. “The recommendations here are 30 grams per day,” explains Pehl. More vegetarian meals will also help. And you should drink 1.5 to 2 liters a day.
Those affected would also do well to ensure that they get enough exercise. And: if you have to, you shouldn’t suppress this urge.
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