Constipation is a common problem faced by almost every fifth resident of developed countries, and among people over 60 years old – already every third (1). It is caused by many factors: violation of the diet and drinking regime, stress, even a vacation in a new place. You can get rid of constipation and prevent its development at home. Together with an expert, in the article we will consider the causes and symptoms of this condition, as well as effective means that help to cope with it.
Constipation is a delicate problem that cannot be ignored. This condition not only reduces the quality of life, but can also lead to serious health consequences. Together with a gastroenterologist, we will explain why constipation occurs, how to get rid of it at home and prevent it from happening again, and in which cases you should see a doctor.
What is constipation
Constipation is a condition when stool occurs less than 3 times a week or when defecation occurs, discomfort occurs: strong straining, a feeling of incomplete emptying of the intestines.
The main and one of the most common signs of constipation is a change in the consistency of feces to the appearance of separate hard lumps (“nuts” or “sheep feces”) or feces of normal shape, but with hard lumps.
The idea that having a bowel movement less than once a day indicates constipation is false. The frequency of bowel movements is individual for each person, and the normal range is considered to be from three times a day to three times a week.
Types of constipation
There is no single classification of constipation, so they can be divided into different groups according to different criteria. To make a diagnosis, the doctor usually evaluates complaints and symptoms taking into account the main types of constipation, which are important for prescribing the correct treatment.
With the flow
| Spicy | Constipation symptoms last less than 3 months |
| Chronic | Constipation symptoms have lasted a total of (not necessarily consecutively) more than 3 months during the past year |
Due to the appearance
| Primary | Not associated with congenital or acquired bowel diseases |
| Secondary | Symptom of another disease (intestines or other organs) |
| Idiopathic | The motor function of the intestines is impaired, the exact causes cannot be determined |
By the speed of movement of feces in the large intestine
| Slow transit constipation | Infrequent bowel movements are associated with decreased intestinal peristalsis, for example after eating |
| Constipation with impaired defecation | Constipation occurs due to the inability to coordinate the muscles of the abdominal wall and pelvic floor when emptying the bowels. |
| Constipation with normal transit | Stool passes through the colon at a normal rate, but bowel movements are difficult for an unknown reason (may occur in irritable bowel syndrome) |
If you have never suffered from constipation before, but it suddenly appeared, you should consult a therapist or gastroenterologist, since problems with stool may be a symptom of an underlying disease that needs to be identified.
Symptoms of constipation in women and men
The manifestations are the same in men and women, but may remain unnoticed in older people due to possible problems with memory, speech, and degenerative diseases of the nervous system. Here are the main symptoms:
- stool less than three times a week;
- change in stool consistency;
- additional straining and/or pain;
- feeling of incomplete bowel movement;
- the need to remove feces from the rectum using the hands.
Some Causes of Constipation in Adults
The cause of constipation cannot always be determined and not in everyone; it is often caused by a combination of several reasons.
1. Lack of fluid
When fluid intake is insufficient and dehydration occurs, the body tries to retain as much water as possible to function normally. This causes increased water absorption from the intestines and hard stools, which leads to constipation.
2. Insufficient fiber intake
Due to its structure, fiber retains water, makes stool softer, improves intestinal peristalsis, so its deficiency leads to constipation.
3. Sedentary lifestyle
A sedentary and inactive lifestyle slows down intestinal peristalsis. When colon muscle contractions are slow or weak, stool moves more slowly, loses more water, and becomes hard.
4. Changes in the usual daily routine
Traveling or other changes in the usual daily routine affect the regularity and quality of stool. Most often, this is due to anxiety and a change in environment (even positive stress affects intestinal motility), changes in diet, drinking regimen, and the inaccessibility of toilets or a change in the usual time for visiting them.
5. Prolonged stress
Stress disrupts the functioning of all organs and systems, including the intestines. The production of stress hormones, which affect its functioning, also increases. The functioning of the intestines is very closely related to the state of the nervous system, and this is especially relevant for sensitive people.
6. Problems with the pelvic floor muscles
These muscles extend from the pubic bone to the tailbone and form a “hammock” that supports the pelvic organs. They are involved in controlling urination and bowel movements in both women and men. Problems with weakness or coordination of the pelvic floor muscles can lead to chronic constipation.
7. Pregnancy
Women experience constipation in 16-26% at any stage of pregnancy (3). Constipation is associated with hormonal changes, which reduce the activity of intestinal peristalsis. At later stages, it is due to the pressure of the uterus on the intestines. Reduced physical activity or taking medications additionally stimulate constipation.
8. Taking medications
Constipation is a common side effect of certain medications: iron supplements, antidepressants, calcium channel blockers, etc.
9. Endocrine diseases
Some endocrine pathologies can be the cause of constipation: diabetes mellitus, hypothyroidism, etc.
10. Formations in the colon or rectum
Growths in the colon or rectum can block the passage of stool and lead to constipation.
Effective ways to get rid of constipation at home
In most cases, constipation can be treated at home. If home remedies do not help within a few days, see a doctor.
1. Folk remedies
If you are faced with constipation, it is better to start treatment with dietary and nutritional correction than with folk recipes. Most of them are outdated, and some may be unsafe when used independently.
Castor oil
Castor oil, when taken orally, increases intestinal peristalsis and softens stool. However, this is an “old school” remedy for constipation, which is rarely used in modern medicine and is considered obsolete.
Senna decoction
Senna decoction is considered a stimulant laxative of plant origin; it increases intestinal motility, which causes bowel movements within a few hours after taking it.
The dose of the active substance in the decoction is difficult to predict – it depends on many factors and is not controlled during production. If the concentration of the active substance in the decoction is too high, side effects such as diarrhea, abdominal pain, headache and increased blood pressure up to hypertensive crisis appear. With prolonged use, addiction to this remedy may develop.
Prunes and kiwi
This is an effective and safe remedy for constipation. Kiwi is rich in fiber, and prunes also contain the natural laxative sorbitol – it is on their action that the laxative effect is based. Daily intake of 1-2 kiwis or 10-40 g of prunes helps to cope with constipation (5).
Flax seeds, plantain, fenugreek, sesame seeds
Recipes based on them are effective in combating constipation. Most often, plantain seeds (psyllium) are recommended (5), adding them to food increases the intake of dietary fiber, which makes the stool softer.
Vegetable oils (sunflower, olive, flaxseed)
Taking vegetable oils separately, or better yet, as part of meals, is a fairly safe way to deal with constipation. They soften stool and maintain a soft stool consistency. Oils are also a source of omega-3 fatty acids.
2. Diet
Dietary fiber or cellulose improves bowel function by retaining water in stool and improving peristalsis, helping to cope with mild constipation in most people (4).
The recommended amount of dietary fiber is 20-35 g per day. You can increase their consumption by eating foods, 100 g of which contains approximately:
- spelt (wheat) – 12.6 g;
- oatmeal – 10.3 g;
- rice – 0.7 g;
- canned beans – 6.3 g;
- eggplant – 6.6 g;
- prunes – 7.1 g;
- kiwi – 3.4 g;
- pear – 3.0;
- raw carrots – 2.5 g;
- strawberries – 2.2 g;
- apple with peel – 2.0 g;
- orange – 1.8 g;
- banana – 1.7 g;
- raw tomato – 1.2 g;
- sesame seeds – 7.8 g.
You can also replenish the lack of dietary fiber in your diet by adding wheat bran. This is an inexpensive and safe product. A few spoons of bran in kefir, yogurt or porridge helps to cope with constipation in 1-2 days. It is important to increase your usual fluid intake by 1-2 glasses.
3. Physical exercise
Physical activity reduces the risk of constipation by increasing peristalsis and blood supply to the intestines. Brisk walking, cycling, fitness, swimming, dancing, etc. are examples of suitable types of physical activity, which are recommended to be spent at least 150 minutes per week (9). If constipation has already occurred, exercise alone will not help to cope with it, it is better to start with more effective methods – primarily diet or laxatives. But regular physical activity will help prevent constipation in the future.
4. Laxatives
First of all, constipation treatment begins with dietary fiber supplements. Their optimal source is psyllium preparations, which are sold in capsule or powder form. It is important to wash down supplements with plenty of water and increase its consumption, otherwise constipation may only worsen.
For mild constipation, in addition to dietary fiber or as an independent treatment, you can use osmotic laxatives – preparations of lactulose, polyethylene glycol, lactitol.
Another group of drugs – stimulant laxatives (sodium picosulfate, bisacodyl) are used as an emergency correction of constipation. They are allowed to be taken in courses of no more than two weeks.
5. Rectal suppositories
Suppositories are inserted into the rectum, where they melt under the influence of body temperature and have a local laxative effect. Suppositories and microclysters act faster than laxative tablets, they are used when a large amount of feces has accumulated in the rectum, that is, they are used as emergency aid for constipation or while laxatives are being selected.
But it is better to try to improve bowel movements in other ways, without the help of rectal suppositories or microclysters.
6. Enema
Involves introducing liquid into the rectum. It creates pressure, softens the stool and reflexively provokes bowel movement. An enema is used if other treatments have not helped with constipation. It is not recommended to use enemas on a regular basis.
You can also buy over-the-counter ready-made enemas at the pharmacy, they may contain additional components to facilitate bowel movements.
Important! Enemas are contraindicated in any proctological diseases (exacerbation of hemorrhoids, anal fissure, etc.). Also, this method can cause addiction when used frequently in older people and, conversely, provoke constipation.
In what cases should you see a doctor?
Consult a physician or gastroenterologist if you experience the following symptoms:
- constipation could not be treated at home within two to four days;
- problems with stool persist for more than three weeks;
- scarlet blood on feces or toilet paper;
- the stool became black;
- unusual changes in the shape or color of stool (black, ribbon-like) have appeared;
- severe abdominal pain that does not go away;
- weight loss without trying to lose weight.
Consequences of prolonged constipation
Constipation rarely causes complications or health problems if treatment is started on time and if the person sees a doctor when symptoms become alarming. But chronic constipation increases the risk of developing:
- hemorrhoids;
- anal fissure;
- rectal prolapse.
Diagnosis of constipation in adults
Most constipation is functional and can be managed with dietary changes, exercise, or other methods. But if constipation is long-term or you notice any worrying symptoms, see your doctor.
Before your visit, remember:
- number of bowel movements over the past week;
- stool consistency;
- is there a need for strong straining, pressure on the perineum or use of a finger;
- how often do you use laxatives and enemas;
- what medications do you take;
- Has your weight changed recently?
During the appointment, the gastroenterologist can perform:
- examination and palpation of the abdomen.
- digital rectal examination. The doctor examines the rectum with a lubricated finger while wearing gloves. The manipulation will help detect pain, anal fissure, hemorrhoids, blood, and assess the tone of the muscles of the anus.
If a specialist suspects that constipation is secondary, that is, caused by some disease, he may prescribe additional tests, for example:
- clinical blood test;
- fecal occult blood test;
- thyroid-stimulating hormone;
- blood glucose;
- blood chemistry;
- colonoscopy, etc.
Important! Do not take tests yourself before seeing a doctor or without his prescription, as they may not be needed at all.
Prevention of constipation in adults
A few lifestyle changes can help prevent constipation.
- Increase the amount of dietary fiber in your diet. The optimal amount of fiber is 20-35 g/day, but most adults do not eat enough. You can increase your fiber intake by:
‣ products. Prunes, kiwi, beans, fruits and vegetables , cereals contain a large amount of fiber. Its intake is also provided by four to five servings of fruits and/or vegetables per day;
fiber supplements. Use bran or psyllium with cereals, yogurts, juices, soups. Fiber intake should be supplemented with plenty of fluids.
- Organize “proper bowel habits.” Try to defecate 15-45 minutes after eating. The digestion process stimulates bowel movements naturally, so do not suppress or ignore the urge to defecate. Before going to the toilet, make sure that you do not need to rush — there is enough time and privacy to defecate comfortably.
- Take a comfortable position. The position of your legs will help facilitate bowel movements: place them on a low stool so that your knees are slightly higher than your pelvis.
- Drink enough fluids. Drink more to avoid dehydration and constipation. Increase your water intake during exercise or in hot weather.
The effect of coffee and other caffeinated drinks is individual: they can either provoke bowel movement or reduce its peristalsis, that is, they do not help with constipation for everyone.
- Don’t forget about physical activity. Regular exercise for at least 150 minutes a week reduces the risk of constipation, leads to increased peristalsis and maintenance of muscle tone. For regular bowel movements, the strength of the abdominal wall and pelvic floor muscles, as well as overall muscle tone, are especially important.
- Change your medication if needed. When constipation is a side effect of medication, your doctor may choose a different medication, change the dosage, or prescribe an appropriate laxative.
- Do Kegel exercises. Pelvic floor muscle exercises can help improve peristalsis. They are suitable for preventing constipation for both men and women.
Gastroenterologist Reviews
Polina Lozovaya, gastroenterologist, nutritionist at the clinic “My Clinic” (Rostov-on-Don), consultant and teacher of the DocMa service, spoke about the approach to treating constipation in her patients.
1. Lifestyle changes
Lifestyle correction is the cornerstone of the treatment of functional constipation. It is necessary to normalize the diet, minimize bad habits and ensure normal physical activity. This is the basis of their treatment and prevention, so if nothing is done, then it will not be possible to achieve a long-term positive effect.
2. Taking laxatives
Many patients are afraid to take laxatives and prefer to replace them with others on their own: choleretics, probiotics, enzymes, but these drugs do not help with constipation, you should not resort to them.
Although choleretic drugs and probiotics have a slight laxative effect and some people respond to them with loose stools, this is temporary. Even if constipation was managed with these drugs, as soon as you stop taking them, in 95% of cases constipation will return.
When this happens, people try to find other “schemes” of probiotics, choleretics, again do not get the effect and get into a vicious circle. To cope with constipation effectively, you just need to choose the right laxative with the help of a doctor and do not forget about changes in diet and lifestyle.
Questions and answers
Gastroenterologist Polina Lozovaya answered popular questions.
Is it possible to get rid of constipation forever?
Depends on the cause of constipation. Most often, with the introduction of certain changes in nutrition, physical activity, and drinking regime, everything gets better.
But there are cases when constipation can only be dealt with by constant maintenance therapy with laxatives. In this case, their use must be agreed upon with a specialist.
Is it okay to push when you’re constipated during pregnancy?
Yes, you can. But there is nothing good in excessive straining. If there is constipation during pregnancy, it should be corrected together with the attending physician.
What won’t help with constipation?
Replacement of laxatives with drugs from other groups: probiotics, choleretics, enzyme preparations, antacids, etc.