Constipation: symptoms, causes and treatment

Constipation refers to a disruption of the body’s ability to pass stools normally. Constipation occurs when you have fewer than three bowel movements a week and where these are accompanied by other complaints. In cases of severe constipation, manual assistance is required to empty the bowels more than 25% of the time.

Constipation usually has various symptoms and associated complaints:

• Hard, dry stools: Constipation causes hard, dry, lumpy stools. These are more difficult to pass, which requires straining. This means constipation is often associated with pain.
• Feeling that you still need to go: Constipation often gives people a sense that their bowels haven’t emptied properly, and they may feel like their intestines are blocked.
• Abdominal discomfort: Acute constipation often causes abdominal pain, flatulence, a feeling of fullness and nausea.
• Back pain: In some cases, constipation also results in back pain.
• Haemorrhoids and anal fissures: Straining too hard to empty the bowels can lead to painful haemorrhoids and anal fissures (splits in the mucous membrane of the anus).
• General symptoms: Constipation can sometimes cause more general symptoms such as tiredness, loss of appetite and feeling unwell.
• Constipation alternating with diarrhoea: Sometimes, constipation may be followed by diarrhoea and abdominal pain. Diarrhoea caused by constipation usually occurs when hard stools accumulate in the intestine and only runny stools can pass through.

Exactly which symptoms develop and how severe they are varies from person to person. If the complaints persist for more than three months, this is considered to be chronic constipation (or obstipation in severe cases). People with chronic constipation are usually unable to pass soft stools without taking laxatives.

There are many factors that can contribute to constipation. The most frequent causes are:

• Diet and lifestyle: People who don’t get enough vegetables, wholegrain products and other high-fibre foods and who don’t drink enough fluids are more prone to constipation. A lack of exercise is another contributing factor.
• Medication: Numerous drugs have the side effect of slowing digestion. These include opioids, antidepressants, Parkinson’s medication, remedies for nausea and vomiting, and supplements containing iron, calcium or aluminium. It is also not uncommon to experience constipation after taking antibiotics, which damage the intestinal flora and inhibit bowel movements.
• Hormonal changes: Pregnancy and menopause can also be causes of constipation in some women.
• Diseases: Various illnesses can cause constipation. They include metabolic disorders such as diabetes and hypothyroidism (underactive thyroid), neurological illnesses such as Parkinson’s and multiple sclerosis, and bowel conditions such as Crohn’s disease.
• Operations: Constipation often occurs after surgery. Reasons include anaesthesia, bed rest, dehydration and taking painkillers that inhibit normal bowel movements.
• Stress: For some people, mental strain such as stress can have an impact on intestinal activity. In these cases, food remains in the intestine until stools harden and bowel movements become more difficult. Some patients may also subconsciously suppress bowel movements due to stress or time pressures.
• Travel: Different food, a break from your daily routine, a change of climate or a lack of movement all lead to constipation for many travellers. Stress before departure or while travelling can also be a factor.
• Long-term use of laxatives: Taking certain laxatives over a long period of time can lead to constipation. These include laxatives that bind water in the intestine and draw water into the bowels. The misuse of laxatives, for example to lose weight, can also impair digestion.
• Food intolerances: Fructose and lactose intolerance often lead to constipation.

In many cases, several factors combine to trigger or promote constipation.

There are various things you can do to relieve constipation. Which remedy is best for you depends on the cause of the constipation and the severity of your symptoms. In many cases, slight constipation can be relieved by making changes to your diet and drinking plenty of fluids, getting regular exercise, massaging your stomach or applying a hot-water bottle to the abdomen. Below you will find an overview of the best measures and natural remedies for constipation.

Using nutrition to fight constipation

Nutrition plays an important role in relieving constipation. Find out here which foods can help with constipation:

• Linseeds and psyllium husks: These seeds swell up in the intestine, increasing stool volume and stimulating bowel movements. One to two tablespoons a day are recommended. Make sure you drink plenty of fluids so you don’t make your constipation even worse.
• Sauerkraut and yoghurt: Lacto-fermented foods contain probiotic bacteria which supports the microbiome in the gut and thus regulates digestion.
• Apple cider vinegar for constipation: The pectin and fibre in apple cider vinegar help stimulate bowel movements. Mix one to two tablespoons of raw apple cider vinegar in a glass of water and drink it before meals.
• Digestive teas: Fennel, aniseed, caraway and peppermint tea can all help with constipation. Chamomile, senna and rhubarb root tea also have a laxative effect and stimulate digestion.
• Prune and apple juice: Thanks to their fructose and high levels of fibre, these juices have a laxative effect that can help relieve constipation. Drink a glass in the morning on an empty stomach.
• Water: Drinking a glass of water at room temperature in the morning on an empty stomach stimulates the metabolism and supports digestion.
• Oats for constipation: Oats are rich in fibre, which increases stool volume, binds water and softens stools. This stimulates bowel movements and counteracts constipation.

Many people suffering from constipation ask themselves: “What foods should I avoid?” In general, it’s best to avoid any foods that might worsen your symptoms if you’re already constipated. These include products made with white flour, white rice, fatty foods, chocolate, cabbage varieties that could cause bloating and unripe bananas. Ripe bananas, on the other hand, can help with constipation.

Home remedies for constipation: how can I get rapid relief?

In the case of acute constipation, home remedies are often the best way to restore bowel movements quickly. Castor oil is one proven remedy. It stimulates bowel movements, softens the contents of the intestines and often works within a few hours. You should talk to a professional about how to take castor oil as well as the dosage. The same applies to Epsom salt, which draws water into the bowel, increases stool volume and has a laxative effect. Other natural laxative foods known to relieve constipation include dried fruits such as prunes, figs and apricots.

Medication for treating constipation

If you’re suffering from constipation, various medications and remedies can help speed up your bowel movements and make it easier to pass stools. Their effects vary:

• Osmotic laxatives: Active substances such as lactulose, lactitol and polyethylene glycol draw water into the intestine, increasing stool volume and stimulating bowel movements. Magnesium also helps with constipation, as it has a similar osmotic effect. These laxatives are available as tablets, powders or oral solutions.
• Saline laxatives: Magnesium and sodium salts such as Epsom salt and Glauber’s salt draw water and minerals into the intestine and soften stools. Saline laxatives are available over the counter in pharmacies.
• Stimulating laxatives: These are specifically designed to provoke bowel movements in the event of constipation. They include bisacodyl, sodium picosulphate and sennosides and are available as tablets, drops or suppositories.

For severe pain, medication for constipation and flatulence with an additional anti-foaming agent can help. The most suitable remedy depends on the cause and severity of the constipation. Speak to your doctor or ask a pharmacist for advice. Be careful not to take laxatives for too long to avoid developing a tolerance.

In cases of acute constipation that occurs suddenly and is associated with severe complaints, you should seek medical advice after two to three days if your symptoms persist. This is particularly important if your constipation is accompanied by other symptoms such as severe abdominal pain, fever or blood in your stools. A medical examination is also recommended if your constipation lasts for more than a week and cannot be resolved with the help of home remedies.

If constipation and diarrhoea occur at the same time, this may indicate irritable bowel syndrome, inflammatory bowel disease or, in rare cases, an intestinal obstruction. You should consult a doctor as soon as possible if this is the case. A medical assessment is also recommended in cases of chronic constipation that have lasted several weeks or months to identify the cause of the constipation and start an appropriate course of treatment.

You should also speak to your doctor if you become constipated after taking a new type of medication or in connection with an allergy.

Eating a balanced diet with plenty of fibre, drinking lots of fluids and getting regular exercise are all great ways to help prevent constipation. If you are constipated, natural home remedies and over-the-counter medication from pharmacies will usually alleviate any acute complaints. However, you should talk to your doctor if your symptoms persist or if you experience any other complaints.