Constipation (constipation)

constipation

Constipation is when the stool is emptied less often than usual or when it is more difficult to defecate. Usually additional symptoms such as flatulence or abdominal pain occur. Occasional constipation is common and in most cases goes away by itself. In the case of recurring or chronic constipation, it makes sense to initiate treatment and, if necessary, to clarify the cause.

Chronic constipation, in particular, can seriously affect the quality of life of those affected. It can occur at all ages; the frequency increases with age.

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• What are the symptoms?
• What are the causes of constipation?
• How is the diagnosis made?
• How is constipation treated?
• How to prevent constipation
• Whom can I ask?
• How are the costs going to be covered?

What are the symptoms?

A blockage is characterized by various characteristics, for example:

• the bowel is emptied less often than usual,
• the amount of stool excreted is less than usual,
• stool elimination is only possible with difficulty (e.g. by pressing hard),
• the stool is hard and dry, possibly lumpy,
• the person concerned has the feeling that the bowel is not emptied completely,
• the person concerned has the feeling of a blockage in the intestines.

This can also lead to abdominal pain, bloating, nausea and gas. A decrease in intestinal noises or a palpable accumulation of stool in the intestine via the abdominal wall is possible.

Note In any case, a doctor should be consulted if pain or bleeding occurs during bowel movements, if there is weight loss, tiredness and exhaustion, or if symptoms increase rapidly.

A guideline for diagnosing constipation is less than three bowel movements per week. If the symptoms have existed for more than three months, it is called chronic constipation.

What are the causes of constipation?

The reasons can often be found in lifestyle, with an unfavorable diet (e.g. insufficient intake of fiber) in combination with too little exercise playing a major role. Constipation can also have organic causes and be related to a disease. Many drugs also have a negative effect on digestion. It is not uncommon for constipation to be caused by a combination of several factors.

Possible causes of constipation can be:

• low-fiber diet,
• inadequate hydration,
• Sedentary lifestyle or being bedridden
• Ignoring or suppressing the natural urge to defecate (e.g. in everyday work),
• Reflective stool behavior due to painful bowel movements, e.g. with anal fissures, freshly thrombosed hemorrhoids
• Medicines such as iron supplements, antidepressants, hormonal contraceptives (progestins), high blood pressure medication,
• hormonal factors, e.g. hypothyroidism, pregnancy,
• Electrolyte disorders (e.g. hypokalaemia, hypercalcemia),
• neurological diseases, e.g. Parkinson's disease, multiple sclerosis,
• Diabetes mellitus (the motility of the bowel is reduced),
• Narrowing in the intestinal tract (stenosis), e.g. in diverticulitis, Crohn's disease, tumor,
• Constipation in functional disorders of the intestine, e.g. irritable bowel syndrome,
• psychological causes, e.g. depression, anorexia, stress.

How is the diagnosis made?

The first steps include a detailed anamnesis interview, in which it is discussed which complaints are present and how long they have existed. The doctor will ask about the frequency and composition of stool, eating habits, any accompanying symptoms such as pain and flatulence, and other illnesses. Whether and which medication is taken is also very informative for the doctor, as this can be related to the change in bowel movements.

In addition, a physical examination is part of the basic diagnosis. The doctor feels the stomach and examines the anus (rectal examination). A stool sample, an abdominal ultrasound, or a blood test may be needed.

Depending on the symptoms and the suspected diagnosis, further examinations may be necessary, such as a colonoscopy. An endoscope equipped with a small camera is inserted into the intestine through the anus. Colonoscopy is also recommended as part of preventive medical examinations from the age of 50.

Possible further examination methods include:

• X-ray examination of the intestines and abdomen,
• Determination of the colon transit time (the time it takes for the stool to pass through the large intestine): the patient swallows capsules with radiopaque markers, the path of which through the large intestine can be shown using X-rays,
• radiological representation of defecation by means of x-rays or magnetic resonance imaging (to detect any anatomical or structural changes in the rectum),
• Assessment of the function of the sphincter by measuring the pressure of the rectum (anorectal manometry).

Tip It can be helpful to keep a “stool diary” in preparation for a visit to the doctor. Make a note of the frequency of evacuations over a long period of time and a brief description of the stool. You can also take a photo of the chair.

How is constipation treated?

In principle, in the case of constipation, it would be important to determine the underlying cause and treat it causally.

Constipation is treated primarily through lifestyle changes. Important measures are:

• Increasing the fiber content in the diet (vegetables, whole grain products, fruits, etc.),
• if necessary, additional fiber such as flea seeds or wheat bran,
• Make sure you drink enough (at least two liters per day)
• pay attention to regular, age-appropriate exercise,
• Avoid suppression of bowel movements.

If these measures show no or not the desired success, the doctor decides which further measures are individually sensible. You can choose from:

• rectal evacuation aids in the form of suppositories or enemas (enema),
• oral laxatives (laxatives), e.g. drinking solutions with polyethylene glycol, non-absorbable sugar, lubricants, bisacodyl,
• Prokinetics that affect bowel movement, e.g. prucalopride,
• Promotion of fluid secretion in the intestine (especially in irritable bowel syndrome), e.g. linaclotide,
• Combination of several measures, e.g. rectal evacuation aid plus oral laxative,
• Biofeedback therapy (especially for functional disorders of the pelvic floor).

Depending on the cause, surgical measures can also be taken (as a last therapeutic option), e.g.

• Sacral nerve stimulation (for underlying neurological causes). During an operation, a small electrode is placed in the sacrum area. This sends weak electrical impulses to the nerves that control the function of the bladder and intestines, thus restoring their function;
• Creation of a (temporary) artificial anus (stoma),
• surgical removal of part of the intestine.

Note Under no circumstances should laxatives be used without prior consultation with your doctor - it is imperative that you talk to your doctor about this!

How to prevent constipation

General preventive measures are primarily aimed at eating habits. Adequate fiber intake (supported by adequate drinking) helps counteract constipation. Dietary fiber is found in cereal products (prefer whole grains), legumes and vegetables. Dried fruits (dried fruits) also have a laxative effect. More on the topic: carbohydrates & fiber.

For more tips on how to use diet to combat constipation, see When Your Digestion Is Striking.

Whom can I ask?

For clarification and treatment of constipation, you can contact a general practitioner or a specialist in internal medicine (specializing in gastroenterology and hepatology).

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Rehabilitation & cure
• Medical aids & aids
• Health Professions AZ

and via the online guide to reimbursement of social insurance costs.