Constipation: causes, symptoms and effective treatment strategies

Constipation, or as it is medically known obstipation, one of the most common digestive complaints that can significantly affect quality of life. Many people consider it a temporary discomfort, but a persistent condition can be a sign of more serious health problems.

From Endomedix Gastroenterology Centre experts are committed to accurate diagnosis and personalised treatment to help restore normal bowel function.

What is constipation?

According to the medical definition (Rome IV criteria), chronic constipation is defined as constipation that has lasted for at least 3 months in the last 6 months and has two or more of the following:

Infrequent emptying: Less than three times a week.
Effort: Over 25% of discharges require considerable effort.
Hard stools: Berry or bumpy texture (Bristol scale 1-2 type).
Incomplete emptying: The feeling is that the bowel has not been completely emptied.
Manual assistance: The need to use a finger to assist emptying.

Types of constipation

We distinguish three main groups based on the root cause:

Slow transit time: The passage of intestinal contents through the large intestine is slowed down due to the weak peristalsis.
Outlet type (pelvic floor dissynergia): The muscles of the rectum and the pelvic floor do not tune up, the muscles do not relax when emptying.
Normal transit time: The most common form, where transit time is normal but symptoms persist (often part of IBS-C).

Most common causes and risk factors

Category	Examples
Lifestyle	Low-fibre diet, low fluid intake, sedentary lifestyle, stimulus suppression.
Medicines	Opioid painkillers, certain antihypertensives, iron supplements, antacids.
Diseases	Hypothyroidism, diabetes, Parkinson's disease, colon cancer, haemorrhoids.
Status	Pregnancy, old age.

Warning signs - When to seek medical advice immediately?

Some symptoms may require a thorough investigation (e.g. colonoscopy), as they may also indicate cancer:

Blood in the stool or on paper.
Sudden changes in bowel movements (especially after the age of 50).
Unintended, significant weight loss.
Severe, persistent abdominal pain or anaemia.

Treatment strategies

1. Lifestyle changes (The first step)

Grate coating: 25-30 grams of fibre a day (oatmeal, vegetables, plantain seed husks).
Liquid: At least 2-2.5 litres of water a day.
Move: Walking for 30 minutes a day stimulates bowel movements.

2. Medication

Ozmotic laxatives: They attract water into the gut (e.g. macrogol, lactulose). They are safer in the long term.
Stimulant laxatives: They are only recommended in the short term because they can cause habituation.
Prescription medicines: In severe cases, secretagogues or prokinetics (e.g. prucalopride).

3. Biofeedback therapy

A special method for treating outlet-type constipation, where the patient learns the correct coordination of the pelvic floor muscles.