Constipation

Constipation - symptoms and treatment

What is constipation?

Constipation is symptomatic, sluggish, hard, or infrequent bowel movements. 20% of the population experiences constipation, and 10% use laxatives. The problem is more prevalent among older individuals. Bowel habits are individual. Some people have bowel movements multiple times a day - others three or four times a week. There is no sharp distinction between what is normal and what is abnormal. It is estimated that only about 30% of us have completely regular bowel movements with a daily emptying at a fixed time. Even if several days pass between each emptying, it doesn't necessarily mean it's abnormal. The crucial factor is whether you experience discomfort or distress due to sluggish, hard, or infrequent bowel movements.

Why do people get constipation?

The defecation process depends on two factors: intestinal transit and a "cooperative" sphincter muscle.

Intestinal transit depends on the bowel's activity (peristalsis) as well as physical passage (whether there are knots or similar obstructions that block passage and thus cause constipation). The role of the sphincter muscle is just as important as bowel function. Pain in the rectum (for example, from fissures or painful hemorrhoids) can lead to spasms in the sphincter muscle and obstruction of passage.

A diet low in fiber, insufficient fluid intake, and too little physical activity stimulate the bowel insufficiently, and thus stool is not pushed towards the rectum.

Of course, there are several other causes of constipation, such as various types of medications, problems with metabolism, problems with the pelvic floor muscles, depression, and some neurological diseases.

A very long large intestine and/or a very slow bowel can be a cause of constipation.

What symptoms of constipation should you pay special attention to?

• Feeling dizzy, tired, or pale.
• Having lost weight.
• Bleeding from the bowel (either as red blood or as black stool).
• Alternating between diarrhea and constipation.
• Having had constipation for over a month.

How is constipation diagnosed?

If persistent problems occur, a colonoscopy is often performed. In some cases, the large intestine may also be examined with more specialized tests that can assess muscle and nerve function. The most important thing is to rule out other more serious diseases.

How is constipation treated?

The most important principles in the treatment of constipation are regular bowel habits, a coarse and fiber-rich diet, plenty of fluids, regular exercise, and possibly the use of laxatives that increase stool volume.

Good bowel habits

The most important treatment for constipation is to establish regular bowel habits. Go to the toilet when you feel the urge to defecate; do not hold back. If you have no rhythm in emptying, this needs to be established. Go to the toilet (regardless of when) at a specific time after a meal - for example, after breakfast. If you do this consistently day after day, your bowel will begin to cooperate, and the most important prerequisite for problem-free defecation will be met.

Coarse and fiber-rich diet

A coarse and fiber-rich diet ensures that more food reaches the large intestine as indigestible matter. These are waste products, and they constitute the majority of the stool. Plenty of waste products stimulate activity in the large intestine. More soft stool is formed, which is easily expelled.

Plenty of fluids

A contributing factor to constipation is that many people drink too little. An extra glass of water with several meals throughout the day can correct this deficit and have a beneficial effect on stool consistency. A lot of alcohol and coffee make stool drier and harder.

Physical activity

Exercise daily to reduce the risk of constipation. Physical activity stimulates the bowel to function.

Laxatives

Constipation can be treated with three different types of laxatives:

• Agents acting on intestinal content.
• Agents acting on bowel movements.
• Agents with local action in the rectum.

Agents acting on intestinal content work by retaining fluid in the intestine. This makes the intestinal content softer and increases its volume, stimulating bowel movements. These agents must be taken with plenty of fluid to be effective. They are the best choice if you need treatment for a longer period. The laxative effect for some of these agents is achieved after a few hours. For others, after 12-24 hours. However, several agents only reach maximum effect after 2-3 days.

Stimulant laxatives work by stimulating muscles and nerves in the intestinal wall, thereby intensifying bowel movements. At the same time, they retain fluid in the intestine, thus softening the intestinal content. This type of agent may be suitable for acute constipation. The laxative effect is achieved after 6-12 hours. Stimulant laxatives should not be used for prolonged periods, as they can be habit-forming for the bowel. In special cases, you may have an agreement with your doctor that long-term use is necessary for you. If you need to use a laxative for constipation, a so-called bulk-forming agent is recommended. These are agents that attract water into the intestine, leading to increased stool volume.

Agents with local action in the rectum are used if stool has accumulated in the rectum, or if the bowel needs to be emptied before a bowel examination or surgery. Agents with local action in the rectum work by softening the stool or by triggering the defecation reflex. The laxative effect is achieved after 5-20 minutes. These agents should not be used regularly, as they can disrupt the natural urge to defecate.

Prognosis?

Constipation is often a chronic condition, but almost always harmless. In most cases, constipation can be treated with a combination of lifestyle changes and laxatives. In a very few cases, other forms of treatment, such as pelvic floor rehabilitation or surgery, are required.

constipation

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