Hard bowel movements can indicate many possible medical abnormalities. Often hard stool is a form of constipation (constipation). In some cases, however, the two symptoms are medically differentiated from one another by not defining constipation as hardening of the stool, but above all as an infrequent bowel movement.
The hard stool arises when it moves through the intestines more slowly than normal and as a result too much water is withdrawn from the porridge. This process can have different causes: In most cases, lifestyle and eating habits play a central role, in addition there are various disorders of the digestive system such as the frequently occurring irritable bowel syndrome and other diseases such as an underactive thyroid or diabetes .
- Causes and symptoms
- Hard bowel movements due to improper nutrition
- Hard bowel movements due to irritable bowel syndrome
- Congenital megacolon (Hirschsprung’s disease)
- Hard stool due to organic bowel diseases
- Colon cancer
- Cause underactive thyroid
- Emptying problems caused by medication
- Other causes of stool
- Treatment for hard bowel movements
- The most important step: changing eating habits
- Laxative support
- Therapy for existing underlying diseases
- Medical measures for Hirschsprung’s disease
- Therapy for irritable bowel
- Colorectal cancer treatment
- Naturopathy in hard stool
- Herbal laxatives
- Home remedies for constipation
Stool or faeces (or faeces) primarily consist of water, intestinal bacteria, dead cells of the intestinal mucosa, secretions of the digestive glands, undigested food residues and fermentation and putrefactive products and therefore usually have a rather soft to medium-hard consistency. If there is a “hard bowel movement”, however, the feces are much firmer and drier than normal.
With a hard bowel movement, bowel movements can become very painful. (Image: michaelheim / fotolia.com)
For example, this can only affect the first few centimeters of the stool, but also the total amount of bowel emptying, if the stool is excreted in the form of small, hard fecal stones (“sheep’s milk” or “rabbit milk”). Due to the hardening, strong, often painful pressing is necessary to empty yourself. This in turn can lead to small cracks in the intestinal and anal mucosa (anal fissures), which also cause burning and stinging pain when using the toilet.
Hard bowel movements can sometimes cause very big problems, because in some cases it can take hours for the sometimes extremely hardened stool to be released under severe pain and pressure. It can also happen that there is not enough “pressure” to completely separate the faeces into one, so that enormous pressing is again necessary. Since the removal of the feces often requires an enormous effort, those affected often feel tired and tired, in addition to this there are in many cases headaches and back pain due to tension.
Most sufferers experience abdominal pain and cramps as well as flatulence or nausea , and depending on the cause, various other symptoms can occur.
Causes and symptoms
The hardened stool arises when it moves through the intestines more slowly than normal and as a result too much water is withdrawn from the porridge. This process can have various causes and should always be examined medically. Because hard bowel movements are not only very uncomfortable, but can lead to various diseases such as hemorrhoids and possibly increase the risk of colon cancer.
Hard bowel movements due to improper nutrition
A common cause of hard bowel movements is an unfavorable diet, because fat and sugar can quickly affect the digestive process and slow it down. In addition, a lack of fiber promotes sluggish digestion, which, especially in combination with insufficient fluid intake, can lead to the body drawing too much water from the faeces, making them solid and dry.
Accordingly, those affected should pay particular attention to a high-fiber diet, which has a positive effect on digestion and prevents hardening of the bowel movements. The reason: since the human digestive juices do not break down the fiber, it remains unchanged in the colon, binds water and swells there. This increases the volume of the stool, there is increased pressure on the intestinal wall and the chyme is ultimately transported faster.
A healthy diet with lots of fiber-rich foods will get your digestion going. (Photo: PhotoSG / fotolia.com)
The fiber promotes a softer and therefore more smooth consistency of the chair. Therefore, on the recommendation of the German Society for Nutrition for healthy digestion, around 30 grams of fiber should be consumed per day, half of which comes from cereals and cereal products, the other half from fresh fruits and vegetables. Apples, oranges, bananas, kiwis and berries are particularly suitable here, as are Brussels sprouts, carrots, peas and celery, which all contain a lot of fiber.
In general, even with hard bowel movements, care should always be taken to drink a lot. This is especially true with a diet rich in fiber, since the plant substances can only swell accordingly with sufficient liquid and can thus make the stool softer again.
Hard bowel movements due to irritable bowel syndrome
The digestive problems can arise from disorders of the digestive system. In many cases there is a so-called “irritable bowel syndrome” (short: RDS, also colon irritable or irritable colon), which describes a functional disorder of the intestine that, despite frequent, constant complaints, is neither malignant nor contagious. It is a very common disease that affects an estimated 20% of the population to a greater or lesser extent, women about twice as often as men.
With an irritable bowel, cramp-like, pulling or stinging pain occurs in the entire abdomen as well as a feeling of pressure in the lower abdomen and right or left upper abdomen. In addition, there is bloating or the feeling of being bloated, constipation and diarrhea, which alternate in many patients. Accordingly, a typical symptom is hard stool, which can also appear as mushy, viscous to liquid or as a very light stool .
In some people, the symptoms subside after bowel movements, in other cases there is a constant uncomfortable feeling that the intestine is not completely empty. Overall, the symptoms are varied and can vary from patient to patient – some have complaints only rarely or in certain situations (stress, hectic pace, excitement, etc.), while others suffer from their irritated bowels.
The cause of the irritable bowel has not yet been clearly clarified, but it is clear that it is a “functional” disorder, which means that the patient is organically considered healthy. A wide variety of factors can be responsible for the symptoms – increased psychological stress can often be identified, which in turn can be triggered by unresolved conflicts, excessive nervousness, anxiety, violent anger or grief, for example.
Furthermore, or in parallel to this, many sufferers experience intestinal hypersensitivity, for example due to disturbed bowel movements, pain accumulates more quickly in air collections than in non-affected people. Correspondingly, irrespective of the lack of an organic cause, an irritable bowel does not mean that those affected only imagine or even simulate the complaints – rather, the intestine in these people apparently reacts particularly sensitively to disorders or irregularities that are often not (yet) perceived consciously.
Even if there is no organic cause in irritable bowel syndrome, the complaints of those affected are real. (Image: Antonioguillem / fotolia.com)
In many cases, an irritable bowel develops after an intestinal infection with diarrhea, and almost everyone affected has a carbohydrate intolerance, usually triggered by milk sugar (lactose) or fruit sugar (fructose). Luxury foods such as coffee, alcohol and nicotine often exacerbate the symptoms. Recent research suggests that inflammation of the intestinal mucosa could also be considered as a cause, and there is also the theory among conventional physicians that a disturbance in the intestinal flora (dysbiosis) can be responsible for the development or persistence of irritable bowel syndrome.
Congenital megacolon (Hirschsprung’s disease)
Another cause of hard bowel movements can be a so-called “congenital megacolon” (Megacolon congenitum), which is often also referred to as “Hirschsprung’s disease” (MH) and mostly affects children. This is a malformation of the rectum that develops around the 4th to 12th week of pregnancy. It is characteristic of MH that nerve cells are missing in part of the intestinal wall and in the inner sphincter, which means that no pushing movement can take place in the intestine in order to transport the faeces towards the intestinal exit (anus).
As a result, the stool builds up in front of the affected part of the intestinal wall and leads to a massive expansion of the large intestine (megacolon), which is often visible externally through a strong bloated stomach (meteorism).
Since Hirschsprung’s disease is congenital, a diagnosis can usually be made quite quickly after birth. The malformation occurs in around one in 5,000 children, boys are affected comparatively more often than girls, and Hirschsprung’s disease also occurs more often in patients with trisomy 21 (Down syndrome) and the rare genetic diseases “Undine syndrome”, “Shah-Waardenburg- Syndrome ”and the“ Mowat-Wilson syndrome ”.
The typical symptoms that usually appear within the first few days of life include a delayed disappearance of the so-called “child’s pitch” (meconium), a pronounced bloated stomach and growth or development disorders. In addition, there may be a functional intestinal obstruction (ileus), as a result of which the child cannot dissipate any child’s speech, sometimes accompanied by bilious vomiting. Some children develop bacterial overgrowth of the large intestine (toxic megacolon) in the course of the disease, which can lead to acute intestinal inflammation (enterocolitis) or even severe blood poisoning (sepsis), possibly with life-threatening circulatory breakdown.
In some cases, due to weak or unremarkable symptoms, MH may not be diagnosed immediately after birth and the child may appear to be healthy instead. Since the stool is easier to transport from the intestine due to the normally thinner consistency of breastfeeding children, irregular bowel emptying and a possible tendency to constipation are not immediately apparent.
Accordingly, in the case of Hirschsprung’s disease, problems arise at the latest when changing food: for example, some small patients can only get rid of the stool with aids or through manipulation (thermometer or fingers), which sometimes leads to “explosive” emptying. Characteristic is still very hard or tough feces, which stinks very strongly, a bloated stomach , generally poor condition of the child, failure to thrive, vomiting or even refusing to eat – which also creates the risk of dehydration (dehydration).
In nursing children, Hirschsprung’s disease is often not noticed until the diet changes. (Image: Antonioguillem / fotolia.com)
Hard stool due to organic bowel diseases
Hardened bowel movements are rarely associated with organic bowel diseases. Here, paralysis of the intestine after an operation, inflammatory processes such as so-called “diverticulitis” and overgrowth of the intestinal mucosa in the form of intestinal polyps, scar tissue or tumors come into consideration, which lead to intestinal narrowing or blockages and thus to constipation or hard stool being able to lead.
In serious cases, solid, dry faeces can indicate an intestinal cancer or a malignant tumor of the intestine, which is the second most common cancer in Germany and affects at least 6% of the population in the course of life. Colon cancer usually arises from initially benign intestinal polyps, which means that symptoms rarely appear at the beginning and the disease is often only discovered at a very advanced stage.
However, there are some signs and symptoms of colorectal cancer that should definitely be taken seriously: These include any sudden changes in the stool (e.g. hard bowel movements, changes in diarrhea and constipation, ” pencil chair “) complaints such as prolonged cramp-like abdominal pain, frequent urge to stool, blood in the stool , black bowel movements , constant tiredness, paleness of the face and loss of weight and performance. Even if these symptoms can have a harmless origin, it is advisable to see a doctor here – especially if blood is discovered in the stool.
Cause underactive thyroid
The symptoms can be caused by an underactive thyroid (hypothyroidism). Since the entire metabolism works too slowly due to a lack of stimulating thyroid hormones, bowel activity is also restricted, which leads to constipation or hard stool as well as other symptoms such as chronic fatigue , loss of performance or changes in skin on hair.
Emptying problems caused by medication
Fixed bowel movements can occur as a side effect of some medications. Here, among other things, psychotropic drugs, sleeping pills, sedatives, iron supplements, codeine-containing cough suppressants, dehydrating drugs, anti-epileptics and opiates (e.g. morphine) come into consideration. Accordingly, especially with new medications, the package insert should always be at hand so that in the event of problems with bowel evacuation, it can be clarified whether there is a connection.
Other causes of stool
Another possible trigger for the problems with bowel evacuation can be a ” gluten allergy ” or “gluten intolerance” (celiac disease), which is a genetically caused autoimmune disease that is often only recognized in adulthood. Here, the small intestine is affected by the fact that it reacts to the protein component gluten with inflammation on the small intestinal mucosa, which in turn means that the nutrients from the food cannot be passed on and there is a risk of a lack of vital substances. In addition to hard bowel movements, celiac disease has very different symptoms, such as abdominal pain, bloating, diarrhea , underweight , muscle pain or joint pain.
Slow bowel activity can be caused by a disorder of the nerves in the intestinal area, such as in the case of chronic inflammatory disease of the central nervous system “multiple sclerosis” (MS). Since bowel activity is regulated by various nerves that are attacked by MS, MS patients often experience a slowdown and thus constipation and hard bowel movements.
Also in diabetes mellitus, lumpy, hard stool, often in connection with a feeling of bloating, premature feeling of fullness or nausea, is one of the most common problems in the gastrointestinal area, since the constantly rising blood sugar level often leads to nerve disorders in the intestinal muscles.
In addition, there are factors such as lack of exercise or stress that favor a sluggish intestine and thus the risk of digestive problems. Not to be forgotten is also the pregnancy, in which women very often suffer from constipation or hardened stools due to hormone changes.
Solid feces are harmless in most cases and can be regulated by changing your lifestyle. Nevertheless, a change in the stool should always be taken seriously, because a strong or prolonged hardening can also be a symptom of a serious organic disease in the digestive area (e.g. a tumor). In addition, sufferers usually suffer from other unpleasant symptoms such as flatulence, headache, fatigue and sometimes extreme pain during bowel movements, which can greatly affect overall well-being and health.
For the diagnosis, it is important to report openly and specifically to the doctor about the existing problems with bowel movements. (Image: Jonas Glaubitz / fotolia.com)
Therefore, if symptoms persist for a long time, a doctor should always be consulted to clarify the cause and prevent further complications – because hard, dry feces can lead to chronic constipation if left untreated. It can also cause hemorrhoids and small cracks (fissures) on the intestinal wall and sphincter. Because the intestinal walls are constantly irritated, the risk of inflammation is increased and the constant strong pressing during the emptying process can lead to a so-called “rectal prolapse”, an incident in the rectum in which part of it is pushed out through the anus .
In the context of diagnostics, the doctor will ask about symptoms and lifestyle in the first step. Information about stool frequency, stool quality (color and consistency), pain during bowel movement and the duration of hard stool are particularly important here. Therefore, those affected should not be shy, but instead speak openly and honestly to their doctor.
This is followed by a physical examination in the form of palpation of the abdomen, localization of pain, examination of gastric and intestinal sounds and assessment of the anus. In addition, blood tests can be used to find evidence of diabetes or an underactive thyroid, for example.
In addition, there may be an examination of a faecal sample to detect any traces of blood that could indicate colon polyps or colon cancer. Colonoscopy (colonoscopy) can be used to investigate suspected irritable bowel syndrome, colon polyps or colon cancer. An ultrasound examination (sonography) of the abdominal cavity is also used to rule out serious illnesses as a possible cause of the problems.
Treatment for hard bowel movements
If a serious bowel disease could be ruled out medically, hard bowel movements or digestion can only be normalized in the long term if unfavorable lifestyle and eating habits are changed. Accordingly, treatment is primarily about stimulating or normalizing bowel activity, which is usually first attempted through a high-fiber diet, plenty of fluids and increased physical activity.
The most important step: changing eating habits
However, getting used to a wholesome diet with lots of fiber should be done slowly and step by step, as many sufferers only react with unpleasant “side effects” such as bloating or a feeling of bloated. In addition, nothing should be eaten that the body does not get, even if this means that certain high-fiber foods have to be left out. In general, it is advisable to eat a lot of fruits and vegetables, and dried fruit such as dried pears and plums are also suitable. Instead of white or mixed bread, wholemeal bread and muesli should be on the daily menu, and the regular consumption of sour milk products such as yogurt or thick milk is very useful, as these have a positive effect on the intestinal flora and thus contribute to a normalization of the digestion.
If that is not enough, digestion can be supported by water-soluble fiber. These act as swelling agents that make the stool slippery and in a lot of vegetables (such as lentils, celery, green peas, broccoli and carrots), fruit (e.g. mango, dried figs, oranges, plums, grapefruit, apples) and seed pods ( for example flax and linseed) are included. Because the water-soluble fibers pass through the stomach and small intestine largely undigested and are only broken down in the large intestine, bloating can occur at the start of therapy – however, this can be counteracted by the simultaneous consumption of sour milk products.
If the food is enriched with non-digestible swelling agents, it is important to take them with plenty of fluids at all times, otherwise the constipation or the hardened bowel movements may increase. In addition, swelling agents should never be taken for longer than 14 days at a time without medical supervision, as there is otherwise a risk that too much water and too many minerals will be removed from the body.
If these measures are not sufficient, the next step is to take the active ingredient “lactulose” from the group of so-called “osmotic laxatives” (laxatives), which ensures a softer stool and thus simplified bowel emptying. Although lactulose, for example in the form of a syrup, is usually well tolerated, bloating is often more common, and the active ingredient is also unsuitable for people with an inherent intolerance to galactose.
Laxatives make it easier to empty your bowels – but should only be taken after consulting your doctor. (Image: diy13 / fotolia.com)
As with all medicines, the laxative should only be taken under medical supervision, especially if the problem of hard bowel movements has been going on for some time. Self-medication is strongly discouraged, as the symptoms can quickly worsen if used improperly and, moreover, there may be a serious illness behind every chronic disorder or impairment of bowel movements.
Therapy for existing underlying diseases
If another disease is the trigger for the complaints, this is first treated in a targeted manner in order to finally normalize bowel movements again, for example by taking thyroid hormones in the event of an underactive thyroid. If the hard bowel movements persist despite the therapy of the underlying disease, stronger laxatives (e.g. bisacodyl or sodium picosulfate) are sometimes prescribed, which stimulate the bowel movements through the irritation of the intestinal wall, faster transport of the food and finally a faster and uncomplicated defecation.
These are used, for example, in the case of nerve damage caused by diabetes (“diabetic neuropathy”) or in cancer, if opioids are used to treat severe pain, which often cause severe constipation as a side effect.
Medical measures for Hirschsprung’s disease
In Hirschsprung’s disease, depending on the state of health of the newborn, an artificial intestinal exit is usually first created until there is an overall better general and nutritional status and the child is stable. Then, in the next step, the main intervention takes place: In this, the affected section of the intestine is surgically removed and then the healthy functioning intestine is connected to the remaining short piece of the rectum (anastomosis).
Depending on the case, both minimally invasive (laparoscopic) and transanal endorectal (through the anus) surgical techniques are used. A lot of experience and specialist knowledge is required for a successful operation with Hirschsprung’s disease, since the operation also includes the area from the lowest part of the intestine to the sphincter – however, the sphincter must not be injured in order to maintain anal continence.
Therapy for irritable bowel
There is no causal treatment for irritable bowel syndrome and therefore unfortunately no complete cure. In many cases, however, it is a “relief” for those affected to know that there is no serious illness behind the symptoms. In order to alleviate the symptoms at least in the short term, a number of medications can be considered, such as painkillers and antispasmodics for abdominal cramps or laxatives (laxatives) for constipation or hard bowel movements, but these should not be used over a longer period of time or in large quantities should be taken, instead, those affected should definitely seek medical advice.
Irritable bowel patients can also take advantage of a number of therapeutic measures within the framework of “self-help”, which can also alleviate the symptoms. This includes, in particular, the switch to a predominantly high-fiber diet, an adequate hydration of at least 2 liters per day and regular exercise. Alcohol, coffee and nicotine should generally only be consumed in moderation.
Regular meals are advisable. Instead of a lavish dinner, it is advisable to eat several meals throughout the day. It is also important to generally take enough time to eat, not to gulp and chew carefully. In addition to the measures mentioned, naturopathy offers a number of gentle and effective options for an irritable bowel.
With an irritable bowel, it is recommended to eat several smaller portions throughout the day. (Image: fahrwasser / fotolia.com)
Colorectal cancer treatment
In the case of colon cancer, therapy is individual and depends on the size and location of the tumor, as well as on the spread to other organs. In most cases, individual degenerate polyps can be removed in the early stage by means of a colonoscopy. In the later course, an operation is usually carried out in which the tumor is removed from the healthy intestinal tissue. The challenge here is that there are no undetectable extensions of the tumor, so the nearby lymph nodes must also be removed, otherwise there is a risk that colon cancer cells could spread over the lymph channels. In some cases, a temporary or permanent artificial bowel (stoma) must also be placed.
After the operation, the course of therapy is decided: If no cancer cells were found in the lymph nodes, no further treatment is usually given. However, if the opposite is the case, subsequent chemotherapy is usually carried out, also in combination with radiation therapy, depending on which areas of the intestine were affected by the cancer. In colon cancer, radiation and chemotherapy can also be used before an operation, for example to reduce the size of the tumor and thus to maintain the sphincter despite surgery.
In advanced colon cancer, immunotherapy with antibodies can also be used, in which the antibodies block the growth of cancer cells or stop the formation of new blood vessels that supply the tumor with nutrients. In addition, painkillers are usually given. If the cancer cannot be completely removed, further measures such as overheating (hyperthermia), cold therapy (cryotherapy) or laser treatments can be used – however, these methods are primarily considered for the destruction of metastases.
Naturopathy in hard stool
If a serious illness can be excluded as a cause, naturopathy offers a number of gentle and effective alternatives to treat hard bowel movements naturally. In general, however, it also applies here that before taking naturopathic medicines, the individual dosage and length of therapy must be thoroughly discussed with a doctor or alternative practitioner in order to avoid health risks.
In the case of irritable bowel syndrome in particular, it is important to first be aware of the factors that trigger the “irritated mood” in the intestine. Accordingly, those affected should ensure a psychological balance by learning how to deal with conflicts and problems in a healthy way and by learning or possibly changing them.
In this context, relaxation measures such as yoga , autogenic training or progressive muscle relaxation can help to relieve tension and thereby improve intestinal problems.
In some cases, it is also advisable to use psychotherapy to overcome problems and conflicts. In addition, in the case of intestinal problems, many people generally feel warmth to be very pleasant – this can be supplied to the body, for example, through herbal teas, hot baths, saunas or moist, warm wraps around the stomach.
Die Pflanzenheilkunde bietet bei einem Reizdarm viele Möglichkeiten: So haben sich beispielsweise bei innerer Unruhe und Nervosität pflanzlichen Mittel bewährt, die Baldrian, Hopfen, Melisse oder Lavendel enthalten. Bei einer Neigung zu Verstimmungen bzw. Depressionen eignet sich eher Johanniskraut. Wichtig ist hier, dass das Präparat individuell sorgfältig abgestimmt und über einen längeren Zeitraum regelmäßig eingenommen wird, da die Wirkung häufig erst nach einiger Zeit eintritt.
Heat is usually very beneficial for digestive problems. (Image: Christian Schwier / fotolia.com)
Various salts (“saline laxatives”) are suitable for cleaning the intestine, which bind water in the intestine and thus have a laxative effect. The so-called Epsom salt (magnesium sulfate) is primarily used here, which has a laxative effect in water and, accordingly, may only be used for a short time.
Homeopathy offers various remedies for intestinal problems, such as “alumina”, which can help with dry, firm, knotty stools, but also with after pain . “Bryonia” is also a proven homeopathic medication for dry hard stools, as is “Magnesium muriaticum”, “Collinsonia canadensis”. The same applies to “Sulfur”, which is also used for afterburn , itching and a strong urge to stool without subsequent emptying.
When the stool is tight, the group of so-called “anthranoids” often offers help, which refers to active ingredients of plant origin that also have a strong laxative effect. This effect is based on an irritation of the intestinal wall and an accompanying increased muscle movement as well as a parallel increase of the mucus secretion in the large intestine. Furthermore, neither water nor salts are extracted from the intestinal contents, which makes the stool softer and more smooth again.
Depending on the plant and dosage, diarrhea-like stools take place about 6–12 hours after ingestion. Anthraquinone-containing plants such as aloe, cascararinde, senna leaves and fruits, rot-tree bark, rhubarb root and buckthorn berries are considered – aloe is said to be the strongest and buckthorn berries the weakest.
The use of these herbal active ingredients should never take longer than 14 days and not without consultation with an experienced doctor or alternative practitioner, otherwise there is a risk of excessive mineral loss (especially potassium deficiency ), which can lead to cardiac arrhythmia, among other things.
Home remedies for constipation
In addition, a number of home remedies for constipation are available for hard bowel movements , which in most cases with a little patience contribute to increased bowel activity and thus to a softer consistency of the stool. For example, a regular morning abdominal massage in the form of circular hand movements clockwise before getting up is good to support the further transport of the food pulp in the intestine.
Just as helpful in many cases is a glass of water or fruit juice on an empty stomach immediately after getting up, which triggers the stool reflex (gastrocolonic reflex), or fruit types such as plums or figs and sauerkraut (as vegetables or juice) around the intestine to stimulate. (No)