Constipation, or obstipation, is an extremely common digestive complaint that can significantly affect quality of life. Many people regard it as an unpleasant but temporary condition, but persistent or recurrent constipation can be a sign of more serious health problems and can lead to complications. It is important to understand what is behind it, how to recognise its symptoms and what treatment options are available to relieve symptoms and restore normal bowel function.
This article provides comprehensive guidance on constipation. We provide a detailed medical definition of constipation, the most common symptoms and the warning signs that you should seek medical advice. We cover possible causes, diagnostic methods and effective treatment strategies, from lifestyle changes to drug therapy. Our aim is to provide you with reliable and understandable information to help you identify the problem and take the right steps to improve your health. Visit Endomedix Gastroenterology Centre experts are committed to accurate diagnosis and personalised treatment.
What exactly is constipation?
In common parlance, constipation is simply identified with infrequent bowel movements, but the medical definition is more complex. Constipation is a symptom complex that includes not only a reduction in the frequency of bowel movements, but also difficulty in defecating and a feeling of incomplete evacuation.
According to the internationally accepted Rome IV criteria, a diagnosis of chronic constipation can be made if two or more of the following symptoms have been present for at least three months in the last six months:
- Infrequent defecation: Less than three bowel movements per week.
- Effort: More than 25% of defecations require considerable effort.
- Hard, berry stools: The stool consistency is type 1 or 2 on the Bristol stool scale (hard, discrete berries or bumpy sausage shape) in more than 25% of the voids.
- A feeling of incomplete emptying: The feeling that the bowel has not been completely emptied after a bowel movement in more than 25% of defecations.
- The need for manual assistance: Manual manoeuvres (e.g. fingertip assistance, pelvic floor support) are required to facilitate defecation in more than 25% of voids.
- A sense of blockage: A feeling of blockage or obstruction in the rectum or anus in more than 25% of defecations.
It is important to note that loose, watery stools (diarrhoea) cannot be present without the use of laxatives and the symptoms cannot be explained by irritable bowel syndrome (IBS).
Types of constipation
Chronic constipation can basically be divided into three main types based on the triggering mechanism:
- Slow-transit constipation: In this case, the passage of intestinal contents through the colon is slowed down. Intestinal movements (peristalsis) are more frequent, leading to thickening of the stool and infrequent bowel movements.
- Outlet type constipation (Outlet obstruction / Dyssynergic defecation): Here the problem lies in the dysfunction of the muscles around the rectum and anus (pelvic floor muscles). The patient is straining, but the muscles are uncoordinated and do not relax properly, which prevents the stool from passing. This phenomenon is called pelvic floor dyssynergia.
- Constipation with normal transit time: This is the most common form. Although colonic transit time is normal, patients still experience symptoms of constipation (e.g. abdominal pain, bloating, straining). It often overlaps with the constipation type of irritable bowel syndrome (IBS-C).
Possible causes and risk factors for constipation
Constipation can be caused by many factors, from simple lifestyle habits to more serious illnesses.
Lifestyle factors
- Low-fibre diet: Lack of adequate dietary fibre (vegetables, fruits, whole grains) is the most common cause. Fibre increases the weight and water content of stools, making them pass more easily through the intestinal tract.
- Insufficient fluid intake: Dehydration leads to hard, dry stools, which make it difficult to defecate.
- A sedentary lifestyle: Regular exercise stimulates intestinal peristalsis. Physical inactivity can contribute to intestinal flora.
- Suppression of the defecation stimulus: Ignoring the defecation stimulus (e.g. due to lack of time or being in a strange place) can lead to a decrease in rectal sensitivity and the development of constipation.
Drug side effects
Many medicines can cause constipation as a side effect. These include:
- Painkillers: In particular, opioid derivatives (e.g. codeine, morphine, tramadol).
- Antidepressants: Mainly tricyclic antidepressants.
- Antihypertensives: Certain calcium channel blockers.
- Savle binders: Preparations containing aluminium and calcium.
- Copper products: Tablets used to treat anaemia.
- Antihistamines, antipsychotics, anti-Parkinson's drugs.
Diseases and conditions
- Digestive diseases: Irritable Bowel Syndrome (IBS), diverticulosis (bowel wall prolapse), colon cancer, inflammatory bowel disease (IBD) with narrowing.
- Metabolic and hormonal disorders: Hypothyroidism, diabetes mellitus, high calcium levels (hypercalcaemia).
- Neurological diseases: Parkinson's disease, multiple sclerosis, spinal cord injury, stroke.
- Anorectal problems: Hemorrhoids (painful retention), anal fissure, rectal prolapse.
- Pregnancy: It is a common complaint due to hormonal changes and increasing uterine pressure.
- Old age: The natural slowing down of bowel function, reduced physical activity and more frequent use of medicines increase the risk.
Diagnosis of constipation at Endomedix Centres
In the case of constipation with persistent or worrying symptoms, it is essential to see a specialist. At Endomedix Gastroenterology Centre doctors start the diagnostic process by taking a detailed medical history and performing a physical examination.
Medical history and physical examination
The doctor will ask questions about the nature of your symptoms, bowel movements, diet, medication and previous illnesses. The physical examination may include palpation of the abdomen to rule out abnormalities and a digital (finger) examination of the rectum to check for any abnormalities in the rectum (e.g. tumours, strictures) or dysfunction of the pelvic floor muscles.
Warning signs
Some symptoms require immediate and thorough investigation, as they may indicate a more serious disease, such as a colon tumour:
- Blood in the stool or on the toilet paper.
- Sudden changes in bowel movements, especially after the age of 50.
- Unintentional weight loss.
- Severe, persistent abdominal pain.
- Anaemia.
- A family history of colon cancer.
Special diagnostic tests
If the baseline tests are inconclusive or the treatment is ineffective, further tests may be needed:
- Laboratory tests: Blood count (to rule out anaemia), thyroid function, blood glucose, calcium levels.
- Colonoscopy (colonoscopy): The most important test to rule out organ causes (e.g. tumour, polyp, inflammation, stricture). Endomedix Gastroenterology Centre offers modern, painless colonoscopy under general anaesthesia.
- Measurement of colonic transit time: The patient swallows capsules of X-ray tracers, and then at set intervals abdominal X-rays are taken to show the progress of the capsules through the intestinal tract.
- Anorectal manometry: A thin pressure-sensing catheter is passed into the rectum to measure sphincter pressure and rectal sensitivity. It helps diagnose outlet-type constipation.
- Defekography: A contrast-enhanced X-ray or MRI scan that depicts the process of defecation and detects anatomical abnormalities (e.g. rectal hernia) or a lack of coordination of the pelvic floor muscles.
- Balloon Expulsion Test: A small water-filled balloon is placed in the rectum and the time taken for the patient to empty it is measured. This test is also used to detect outlet obstruction.
Treatment options for constipation
Treatment of constipation is always individualised and depends on the underlying cause. Lifestyle changes form the basis of therapy, which can be supplemented by medication if necessary.
Lifestyle and dietary therapy
This is the first and most important step in any treatment.
- Increasing the input of fibre: The recommended daily fibre intake is 25-30 grams. This can be achieved by eating foods rich in soluble fibre (e.g. oatmeal, barley, apples, citrus fruits, carrots) and foods containing insoluble fibre (e.g. wholemeal bakery products, bran, nuts, cauliflower, green beans). Fibre intake should be increased gradually to avoid bloating and gas formation. Supplements containing psyllium (plantain seed husks) or methylcellulose can also help.
- Drink plenty of fluids: It is recommended to drink at least 2-2.5 litres of fluid (preferably water) per day. Adequate hydration is essential for the fibre to work.
- Regular physical activity: Just 30 minutes of walking a day can significantly improve bowel movements.
- Establish a stooling routine: Try to make time for a calm bowel movement at the same time every day (e.g. after breakfast). Do not ignore the impulse to defecate!
Laxatives (laxatives)
If lifestyle changes do not work, laxatives may be needed on the advice of a doctor. It is important that these are not used on a long-term basis without medical supervision as they can lead to habituation and further deterioration of bowel function.
- Laxatives to increase volume: Psyllium husk and methylcellulose swell in the intestine and increase the bulk of the stool. They should always be taken with plenty of fluid.
- Ozmotic laxatives: They contain substances (e.g. lactulose, macrogol/polyethylene glycol, magnesium salts) that attract water to the intestine, thus diluting and softening the stool. Macrogol-containing preparations are generally effective and well tolerated.
- Stimulant (stimulant) laxatives: They stimulate bowel movements by stimulating the nerves in the intestinal wall (e.g. senna, bisacodil). They should only be used occasionally for short periods because they can cause cramps and habituation.
- Stool softeners: Docusate salts help water to pass into the faeces, but their effectiveness is limited.
Prescription medicines
In cases of chronic, severe constipation, if the above methods are ineffective, a specialist gastroenterologist may prescribe special prescription medicines:
- Secretion enhancing agents: These include lubiprostone, linaclotide and plekanatide. These drugs stimulate the cells in the intestinal wall to increase the secretion of fluid and chloride in the intestine, which softens the stool and speeds up transit.
- Serotonin (5-HT4) receptor agonists: Prucalopride stimulates the movement of the large intestine, and is particularly effective in constipation with slow transit times.
Biofeedback therapy
For outlet-type constipation (pelvic floor dyssynergia), biofeedback therapy is the most effective treatment. From Endomedix Gastroenterology Centre specialised professionals will help the patient learn how to correctly coordinate the abdominal and pelvic floor muscles for successful defecation. During the therapy, you will receive visual or audio feedback on your muscle function using sensors.
The next step for your health
Constipation is a treatable condition, but persistent symptoms require attention and specialist intervention. Rather than self-diagnosis and reckless, long-term use of over-the-counter laxatives, the first step is to identify the cause of the problem. Don't let constipation ruin your quality of life or hide a serious illness!
If you are suffering from any of the symptoms described above, or are concerned about a change in your bowel movements, please contact your Endomedix Gastroenterology Centre your experienced specialists. Our centres offer state-of-the-art diagnostic tools and personalised treatment options to find the best solution for you and help you regain the health of your digestive system.
