In the case of constipation, stool emptying is difficult, incomplete, or rare.
Who doesn’t know this: You have finally arrived at your holiday destination, but your intestines are lagging behind. It simply takes a few days to change, to adapt to the suddenly relaxed rhythm, an unfamiliar diet, warmth, or heat, and the lack of fluids during traveling.
But it doesn’t take long before everything has re-established itself. Travel constipation is a prime example of occasional constipation. By the way: even after travel diarrhea, there may be temporary constipation.
The situation is different for chronic constipation (technical term: primary or functional constipation; primary means that there is no other cause). As it is well known, the frequency of emptying of the bowel varies from person to person.
On average, the frequency is every 2nd day. But ideally, we want to go at least once a day.
So when is there constipation? And what’s behind it?
There are three main groups of constipation:
The experience that in the long run, only laxatives lead to the desired success can be part of the problem but does not belong to the definition of chronic constipation.
In primary (functional) constipation, doctors also distinguish two forms:
Here, other causes of a disease as well as medications are responsible for constipation.
Many people feel like they are clogged. A sluggish intestine affects more than a third of the population, women are significantly more affected than men, older people are more likely affected than younger people.
Statistical figures are slightly lower: according to this, around 15 percent of people have to contend with constipation.
The majority of people treat themselves with laxatives.
Over time, however, the intestine can react counterproductively and lose its responsiveness to the normal signals, such as a filling stimulus. There may be a lack of potassium, which increases constipation. This may lead to a vicious circle.
In case of persistent or new constipation, you should consult with a health care professional, especially at the age of 50. It could be a possible underlying disease. There are also situations, for example, neurological disorders, which require long term use of laxatives and/or emptying aids.
Laxatives are available in various preparations, such as tablets, dragees, drops, soluble powder, or suppositories. Common side effects include intestinal cramps and diarrhea. The latter may also indicate an overdose.
In the case of acute gastrointestinal inflammation, suspicion of intestinal obstruction and disturbances of the fluid and salt balance, do not take a laxative. Here is a quick overview:
Don’t use laxatives as a self-treatment or only for a very short time. There are better natural alternatives.
In case of persistent constipation see your Holistic Colon Hydrotherapist and Naturopath who might then refer you to the doctor.
Acute constipation is distinguished from habitual intestinal inertia. If the intestine suddenly strikes, this can be a warning sign. This is especially true if there are other complaints, such as blood in the stool, weight loss, and fatigue.
Alarming symptoms such as
Can signal an intestinal obstruction (see the section below: “Acute constipation – intestinal obstruction?”). This is more than constipation, it is an emergency that needs help in the hospital quickly. Call your doctor and if he is not reachable go to the emergency.
The intestine is on average eight meters long. This means a lot of digestive work. It consists of the small intestine and the large intestine. The latter consists of the appendix, the colon and the rectum.
The rectum includes the actual intestinal outlet with its sphincter construction (the ‘after’ or ‘anus’). The lining of the extremely fine canal has transitions from the outer skin to the inner intestinal skin.
While the inner sphincter cannot be arbitrarily influenced, the outer is subject to conscious control.
The passage of stool, for example, is usually caused by prolific pumping or peristaltic of the intestinal muscles.
The actual emptying is a complicated process that involves numerous nerve connections between the Anus at the end of the intestine, spinal cord, brain, and psyche.
A changed or disrupted interaction of the sensory and movement nerves as well as the muscles of the intestine are responsible for a blockage of the intestinal passage. The main components are:
Diseases or functional disorders of the body can affect these components individually or in combination. These are metabolic diseases such as diabetes mellitus, muscle diseases that can also affect the intestinal muscles, and diseases of the central nervous system (spinal cord, brain). Some diseases relevant here are hereditary.
Of course, bowel diseases and medication also play an important role as possible causes of constipation.
The defecation may be hampered by changes that lead to a dysfunction of the pelvic floor muscles. But other pathological developments also play a role here. See “Types and Causes of Constipation” below.
The fact that constipation leads to complete stool retention due to blocking feces (technical term: coprostasis) is rarely the case in otherwise healthy people.
Corresponding fears are usually unfounded here, as are fears of “poisoning” the body when not passing stool every day. Unless you have leaky gut.
Lack of fiber, insufficient drinking and lack of exercise are some of the causes of constipation. In these circumstances, chronic constipation appears to be more common, especially when fiber intake is very low.
But: fiber-rich food, fiber supplements, and adequate hydration, as well as regular physical exercise, can help regulate bowel activity. Efforts in this direction are therefore still recommended measures against constipation.
! Tip: If you eat fiber, you should start slowly. By the way, the recommended daily water drinking amount is generally around two liters.
For patients with heart or kidney disease, there are often individual recommendations from the doctor. More in the section “Self-help for constipation”.
Stress can also strain the gut
According to many, some circumstances in your daily life also run counterproductive to regulated bowel activity. The most common are long sitting time, postponing the bowel movement despite the urge to move due to tightly scheduled appointments, and stress.
People who are exposed to changing day-night rhythms complain more often about constipation: Whether they’re restless long-distance travelers jetting around the world or members of nursing services who often work night shifts – they and many other professional groups are forced to come to terms with their respective “predicament” “.
It is undoubtedly not a gut-friendly living situation.
Short-term bedriddenness, fever, unusual heat (without drinking more), or travel can lead to temporary constipation. But the problem that is at stake here is constipation that continues to impair well-being and is therefore pathological.
In the case of prolonged bedriddenness, it must be checked whether the underlying health problem and/or possibly also medication are the reason for troublesome intestinal inertia.
Good digestion requires sufficient fluids
A sluggish bowel can often be boosted by changing the diet.
According to the German Society for Nutrition DGE), adults should consume at least 30 grams of fiber per day with their normal diet and, if this is not medically opposed, drink at least two liters of liquid.
For example, the recommended fiber target is five servings (with 7 grams of fiber each) of fruits or vegetables, including legumes, if they are tolerated. Whole grain muesli and other whole-grain foods, dried fruits, and berries also count, of course.
Fiber, for example from whole grain cereals or legumes, can bind water very well. Together with the absorbed liquid, they increase the stool volume and weight. This accelerates the passage through the intestines.
Preparations containing fiber in the form of swelling agents (e.g. Psyllium Husk) can also increase the fiber content in the food and thus get the intestines going, provided the hydration is correct.
It is common knowledge that stimulants like caffeine can stimulate the intestine, while chocolate, or cocoa slow it down. Anything that has a constipating effect, for example, white bread, is of course taboo if you are prone to constipation.
! Tip: Slowly and slowly use fiber supplements to get the intestine used to the new diet. Too much fiber too quickly can constipate you!
The investigation begins with a conversation about the complaints. One of the most important questions is how long constipation has existed. The therapist is also interested in other possible abnormalities such as changing stool quality and frequency, e.g. diarrhea and constipation alternating, changes in the color of the stool, deposits with mucus and/or blood, pain during bowel movements and blood on the anus.
Sometimes it is helpful to keep a stool diary for a while.
The therapist also needs to know whether stomach pain, severe flatulence, or even an excess gas that no longer seems to be able to be resolved has actually occurred. Did the affected person have a fever, an infectious disease, did he or she lose or gain significant weight (ten percent or more)?
What about appetite? Are there other diseases or complaints, such as back pain or spinal problems, is there a disease of the gallbladder or other upper abdominal organs such as the liver or pancreas? Information about intestinal diseases in the family is also important.
In the case of constipation, the examination always includes careful palpation of the entire abdomen and the groin area and possibly a rectal digital palpation.
Depending on the needs laboratory analyzes, an ultrasound examination of the abdominal organs, and a referral to a specialist, colonoscopy (endoscopic colon examinations such as colonoscopy / ileocoloscopy, sigmoidoscopy, rectoscope) with tissue samples, might be needed.
Imaging procedures such as a computer (CT) and magnetic resonance or magnetic resonance imaging (MRI) may also be necessary. These can occasionally affect the upper digestive tract, i.e. the stomach, esophagus, and small intestine, or determinations of the transit time of the intestine.
Anorectal manometry, evacuation proctography a so-called
defecography, a balloon emulsion test, and an electromyographic examination (electromyography) can be used to check the functionality of the rectum and sphincter structure at the intestinal exit and the interaction with the pelvic floor.
It may be necessary to consult doctors in various specialties, from gastrointestinal medicine (gastroenterology), proctology (specialist in rectal diseases), or urology to gynecology to neurology.
A specialist area called neurogastroenterology is dedicated to the so-called motility disorders – i.e. disorders of the intestinal transport.
The propulsion of the intestine can be weakened across the entire colon. This form of constipation, which is sometimes very pronounced, is present in about a fifth of all those affected with constipation.
The exact diagnosis of the slowed passage through the intestine can possibly be made by determining the transit time of the intestinal contents in the colon with an X-ray dye substance.
Therapy: The usual strategies against constipation such as general measures (exercise, high-fiber diet, adequate hydration) are always at the beginning of the treatment. Some probiotics can also support the therapy. Sometimes these measures are not sufficiently effective.
About 75 percent of people with constipation are affected by this. The colon transit time is normal at around twelve to sixteen hours.
Based on experience, adjusted behavior (regular toilet visits, more physical exercise) and high-fiber nutrition help to get the bowel evacuation reflex going again. Additional swelling agents or an osmotic laxative may also be considered.
When these methods do not help, a medical examination is advised (see also note in the section: “Constipation: you are not alone”, further above). Above all, emptying disorders and persistent slow transit constipation should be excluded. The transit time determination helps here in part, but it can also be extended in the case of rectal (anorectal) disorders. Therefore, they should be eliminated first.
Sometimes irritable bowel syndrome is associated with normal transit constipation. The clinical picture exists in various forms, including a form that focuses on constipation.
The main symptom is either constipation or diarrhea, or both alternate. However, those affected often also suffer from flatulence, bowel noises, but above all from repeated, stabbing, or cramping abdominal pain. These do not depend directly on the bowel movement itself; rather, it typically brings relief.
The therapy depends on the prevailing complaints. Nutritional advice – for example on a fodmap diet – and relaxation procedures such as progressive muscle relaxation according to Jacobson are part of the treatment concept. Certain medications are also used.
Abscesses, hemorrhoids, prolapses, etc.: This can involve abscesses and fistulas, i.e. pathological connections between the rectum and skin, for example.
As well as narrowing of the anal canal, painful anal tears, anal eczema, and hemorrhoids, all can disrupt bowel movements.
A rectal or anal prolapse can significantly hamper bowel motions.
Parts of the intestine can sink into the pelvic area during emptying and press on the rectum, intestinal sacs fill with stool instead of releasing them. Larger intestinal polyps and rectal cancer are also possible obstacles to bowel movements, which by no means lists all of the rectal diseases. Polyps and cancerous growths are also examples of diseases that can occur in other parts of the intestine.
Since the anal region is extremely sensitive to pressure and pain, slight changes or irritations are sufficient to trigger cramps. To rule out the possibility of an organic obstacle, those affected should go to their primary health care professional sooner rather than later.
Dysfunction of the sphincter muscles at the Rectum
The muscular, bowl-shaped pelvic floor closes off the abdominal cavity. There are openings for the urethra and rectum, and also for the vagina in women. The anal sphincter is closely interwoven with this highly complicated construction. The pelvic floor is relaxed during bowel movements.
Pelvic floor dyssynergia: In this problem, bowel emptying is hampered by a disruption in the interaction of the muscles at the exit of the intestine. The abdominal pressing and thus the increase in pressure in the rectum triggers an excessive tension reflex and insufficient loosening in the sphincter apparatus.
The coordination disorder is also called Paradoxical puborectalis syndrome, because the arbitrarily increased pressure of the abdominal muscles is supposed to help shorten the anal canal, open the exit, and thus complete the bowel movement. Women are increasingly affected.
Biofeedback training for the pelvic floor may help to relieve tension. The exact diagnosis is always important.
Damage to certain nerve cells in the spinal cord or brain: This can also have adverse effects at the end of the intestine (see section “Nervous system and psyche”). In the context of some neurological diseases, for example, so-called motor neuron diseases, there is a spasm (spasticity) of the sphincter or disorders of the anorectal functions such as anismus. Here, paradoxical, involuntary contractions of the sphincters occur, which hinders targeted muscle actions at the intestinal exit for the purpose of emptying. Overall, the clinical pictures are rare.
Finally, there are also malformations on the pelvic floor. For example after several pregnancies and in old age. As a result, bowel movements and continence problems can occur.
Ultrasound examination of the thyroid gland
Thyroid & Co .: What does the thyroid have to do with the intestine? A whole lot. There is hardly a body process that is not influenced by thyroid hormones. Accordingly, a significant underactive thyroid (hypothyroidism) can be confused with a number of other diseases.
Many processes in the body, including intestinal activity, work at a snail’s pace when the thyroid hormone is deficient since the nerve fibers switch extremely slowly. The long line in the intestine can lead to significant constipation. Among other things, a very dry, cool, doughy, and flaky skin, strong sensitivity to cold, and lack of mental drive indicate the lack of the thyroid hormones.
Hyperfunction of the parathyroid glands (hyperparathyroidism): An increased calcium level in the blood (hypercalcemia) interferes with the signal transmission from the nerve to the muscle. This also applies to the intestinal muscles. In addition to constipation, those affected tend to be thirsty, have kidney stones, nausea, rapid fatigue, depression, confusion. At worst, there is a risk of coma. There are numerous causes of this hormone disorder.
Hypercalcemia may also be due to an overdose of vitamin D and other medicinally active substances or drugs, and in sarcoidosis or in bone diseases (including tumors or metastases). For kidney disease as a possible cause of constipation, see section “Mineral Metabolism” below.
Pregnancy: Constipation is particularly common in the last trimester. On the one hand, the intestine becomes increasingly sluggish due to the influence of rising hormone levels; on the other hand, its scope is becoming ever narrower due to the maturing embryo and the expanding uterus. More exercise, as well as possible, healthy, fiber-rich diet (start slowly as a newcomer) and sufficient fluids, are the first measures. In the second step, extra fiber such as flaxseed can be tried out.
In the case of hemorrhoids, good anal hygiene is important first. Nourishing fatty ointments with plant extracts such as witch hazel can also be beneficial. Consultation with the midwife, in the case of persistent constipation with the caring gynecologist, is advisable. He can recommend various means that are also suitable for pregnant women.
Hormonal fluctuations in the menstrual cycle: in the second half of the cycle many women suffer from constipation. Trying to counteract with natural strategies is always worthwhile. The blockage is usually released when the period begins.
Hormonal contraception: can also cause bloating and constipation, especially when you start taking them. If the problem persists, it can make sense to look for alternatives.
Sugar metabolism: Too high blood sugar levels (diabetes mellitus) attack many organs in the body, mostly the vascular system, but also nerves, such as in the stomach and intestines. This autonomic neuropathy can affect different areas of the vegetative system. This controls many organ functions autonomously without being subject to our will.
If the movement activity (motility) of the gastrointestinal tract is impaired, digestion problems arise, such as constipation. Impotence, drops in blood pressure, reduced sweating and impaired perception of hypoglycemia can also be attributed to autonomic diabetic neuropathy.
Mineral metabolism: With kidney failure (Renal insufficiency) there is increased calcium release from the bones into the blood as a result of over-acidification of the body and lack of vitamin D – the kidneys no longer form enough of the active vitamin. This means that the calcium level in the blood increases (hypercalcemia). For further mechanisms regarding the intestine see above under hyperfunction of the parathyroid glands (hypercalcemia).
Hypokalaemia means potassium deficiency. Here again, there are many triggers, not least the misuse of laxatives, taking diuretics, weak kidneys, overactive adrenal glands, excess licorice, and much more. In the worst case, constipation caused by potassium deficiency can lead to an intestinal paralysis (paralytic ileus).
The emptying of the bladder and the activity of the skeletal muscles can also be disturbed.
In the case of amyloidosis, insoluble protein substances are deposited in the intestinal wall. This hinders bowel activity. Amyloidosis can be hereditary or a consequence of other diseases, including blood disorders, plasmacytoma (also called Waldenstrom’s disease, which is one of the malignant lymphoma diseases).
In chronic inflammatory bowel diseases that primarily affect the intestine itself, amyloidosis can also develop as a late complication.
Collagenosis is a connective tissue disease such as scleroderma and dermatomyositis. Connective tissue is present almost everywhere in the body – from the vessels through nerves, eyes, joints, and skin to the heart and intestines.
The respective clinical pictures are correspondingly diverse. Constipation is a common symptom in scleroderma. As a result of a loss of the intestinal muscles, which is replaced by connective tissue, the intestine loses mobility.
Numerous medications can lead to constipation. Examples include agents that reduce or block the formation of gastric acid such as H 2 receptor antagonists (can also cause diarrhea) or proton pump blockers, furthermore gastric acid binders containing aluminum or calcium salt, colestyramine, codeine, cardiovascular drugs such as calcium channel blockers and water-propelling drugs, so-called diuretics.
Other options include sleeping pills and sedatives, antidepressants, medication for epilepsy, for Parkinson’s disease, for bladder weakness (urinary incontinence), and for cramp-like pain (spasmolytics, for example for colic pain).
Strong pain relievers such as morphine preparations often significantly dampen the intestines. Oxy-Power works wonder for this kind of constipation.
In order for the highly sensitive intestine to function properly, the undisturbed interplay between the intestine, nerves, and brain is required. Since there are also connections with psychological instances in the brain, it is actually quite conceivable that the “intestinal system” is susceptible to a variety of problems.
In fact, diseases at all levels mentioned here can also affect the intestine – small intestine and large intestine. This ranges from damage to peripheral nerves (see, for example, section “Sugar metabolism” above) to spinal cord diseases or injuries, such as paraplegia, to diseases of the central nervous system such as Parkinson’s disease, multiple sclerosis, stroke, dementia diseases or brain tumors.
Diseases on the psychological level such as eating disorders, like anorexia nervosa, are also worth mentioning here. Sometimes dangerous derailments of the salt balance and metabolism can occur due to improper use of dehydration tablets, laxatives, and malnutrition. Last but not least, this can have an adverse effect on the intestine.
Special disorders and damage to the intestinal nerves
Lack of nerve supply, for example, Hirschsprung disease: the congenital illness can occur in families, but can also occur spontaneously. Boys are affected three times as often as girls. Various genetic patterns are known.
If only a very small area of the intestine is affected, the diagnosis is sometimes made only in adulthood. However, it mostly appears in infancy and early childhood. It is characteristic that – mostly in the lower rectum section – there is a complete absence of nerve switching cells (ganglion cells). This derives the general term aganglionosis, which means something like the absence of ganglion cells.
In addition to Hirschsprung disease, there are other variants of intestinal ganglion disorders which overlap with slow transit constipation forms.
In the case of a more pronounced form, the affected section of the intestine is very narrow and the part in front of it is inflated by feces (megacolon). The sphincter also cannot loosen.
Symptoms: Severe constipation with abdominal distension, abdominal pain, and a tendency towards bowel obstruction can occur as early as infancy.
The diagnosis results in most cases from a tissue sample that contains not only the intestinal mucosa but also the underlying tissue (endoscopic biopsy). In adults anorectal manometry is upstream; if it shows a normal finding, it can usually be used to rule out Hirschsprung disease.
The treatment is mostly surgical.
Chronic intestinal pseudo-obstruction: This term describes the temporary blockages of the intestine, i.e. episodes with symptoms that are similar to the beginning of intestinal obstruction (see the section at the bottom). There are acute and recurring forms (chronic), as well as those with and without known causes.
For example, changes in the central movement elements of the intestinal wall – muscle cells, nerve cells, or pacemaker cells – can trigger this. This is often due to genetic causes, which appear as hereditary nerve diseases (such as so-called mitochondrial neuropathies) or hereditary muscular dystrophies.
Or there are secondary causes, which means that other diseases have an adverse effect on the intestine: for example, systemic diseases such as amyloidosis, autoimmune diseases such as collagenosis or metabolic diseases such as diabetes (see above).
The list of causes is long, including side effects of medication and radiation treatments, alcohol damage, infectious agents or substances that develop in tumors. It is primarily about the small intestine, sometimes the emptying of the stomach and / or bladder is also disturbed. Despite the broad background: as severe as the clinical picture is, it is rare overall.
The main symptoms are a bloated stomach, abdominal pain, nausea, vomiting, constipation, burning in the upper abdomen or behind the breastbone as with heartburn.
The diagnostic measures correspond to the acute picture, and, after the abdominal crisis has subsided, is aimed at recognizing the cause.
The therapy includes stage-specific special forms of nutrition, medications, the treatment of possible underlying diseases, and, if necessary, surgical measures.
Hereditary muscular dystrophies: There are numerous different types of these muscle diseases. The diseases are either congenital or occur in childhood, adolescence, or adulthood.
Symptoms: In the foreground are stunted, weakened muscles on the arms and legs. Muscle pain, gait disturbances, a hearing loss in the ears, drooping eyelids, heart muscle damage, impaired intellectual development are other possible symptoms. Muscular dystrophy in the intestine leads to constant constipation.
Chagas disease: Chagas disease, transmitted by bites from predatory bugs, is native to South America. Children are the most affected. The actual pathogens are parasites. They attack the heart and brain, as well as the ganglion cells of the intestine. Therapy is difficult, so the affected countries are on prevention. Currently, there is no vaccination.
Symptoms: Parasitosis leads to severe, sometimes dramatic constipation, which can also lead to an intestinal blockage.
As a result of intestinal inflammation (ulcerative colitis, Crohn’s disease, and other forms of inflammation), or diverticular disease, as well as a circulatory disorder, radiation therapy or surgery, scared constrictions (strictures) on the intestine can form and become an obstacle to bowel motions.
Blockages are also possible due to stones created in the intestine (enterolithiasis, which occur as a result of other intestinal problems but are rather rare) or by a foreign body.
Very rarely a gallstone that has broken through the wall of the gallbladder closes the intestine – usually the duodenum (upper small intestine).
A tumor or cancerous tumor can also narrow or block the intestine. Bowel loops can be pinched in the event of a hernia.
Bowel activity can also be disturbed in acute appendicitis. There are other possible causes. They can all lead to more or less acute constipation and eventually to intestinal obstruction (here: mechanical ileus). All of them are emergencies that require immediate diagnosis and treatment in a clinic.
Bowel palsy can also occur after bowel surgery (paralytic ileus) or, for example, with acute inflammation of the pancreas.
! Important: In the case of suspected intestinal obstruction, do not take laxatives or pain medication yourself!
Alarm symptoms: abdominal pain or severe pressure pain in the abdomen, sometimes violent bowel noises (but they may also be absent), nausea, persistent bloating, vomiting (possibly stool), stool blockage.
Depending on the cause, you have a wide variety of options.
We recommend (after ruling out serious issues first) to see a knowledgable well trained Holistic Colon Hydrotherapist who is trained to deal with constipation.
In the case of pelvic floor weakness or other rectal disorders, procedures such as biofeedback and special exercises, so-called pelvic floor training, have also proven their worth.
Nerve stimulation treatments and surgical therapies are options for certain, severe emptying disorders in the rectum if all other measures, including emptying aids such as suppositories, enemas, or irrigators, do not help sufficiently.
If a particular drug is thought to be responsible for constipation, talk to your doctor to stop it if possible. You shouldn’t do it on your own.
Cleaning out your colon with a Holistic colon Hydrotherapy session can help with constipation and many other health challenges.
Make a booking today.