Constipation

Bowel complaints and problems with digestion are widespread in the Western world. Rarely can a concrete cause be found and, from a medical standpoint, they are almost always harmless. Physicians speak of these as functional disorders. Surveys suggest that about one in five persons suffer either occasionally or regularly from constipation. Beside general digestive complaints, patients report the feeling that their bowel movements are inadequate.

When patients report symptoms such as abdominal discomfort ranging in severity up to colic-like pain, diarrhoea (sometimes even alternating with constipation), excruciating bloating (meteorism) and passage of gas (flatulence) and general discomfort such as feelings of fullness and nausea (sometimes with vomiting), physicians usually consider the diagnosis of  irritable bowel syndrome.

Independent of these symptoms, complaints regarding the anus are also widespread. These can be due to different disorders. Most common are haemorrhoids and general inflammation of the rectum (proctitis).

Constipation

The term constipation refers to the condition in which a person experiences the reduced or difficult passage of stool, usually with reduced amounts of stool.  Physicians diagnose constipation when bowel movements occur less frequently than once in three days or when the individual bowel movements are very much reduced in volume and are hard or when the passage of stool is associated with physical complaints.

The frequency of “lazy bowels” is dependent on age. About 40% of 60-year-olds report suffering from problems with bowel movements. Women are significantly more often affected than men.

Forms of Therapy

Because the consistency of the stool depends to some degree on stool volume, some general measures can serve as treatment options. A first recommendation is to assure adequate fluid intake, which means at least two to three litres of fluid per day. Also advisable is a diet rich in fibre, since especially soluble forms of fibre coupled with adequate fluid intake serve to increase stool volume. Fibre is found naturally in whole grain products as well as in fruits and vegetables. Persons with stool problems are also advised to be physically active and get adequate exercise. A sedentary lifestyle can make the bowel inactive, while physical activity promotes the intestinal passage of food, thus stimulating normal bowel movements.

Persons who tend to experience constipation should also do what they can to assure a regular bowel movement and under no circumstances hold back a bowel movement because it is not a “suitable time” or because, with the stress of their lifestyles, there is no time for defecation.

If these general measures do not produce adequate results, patients may benefit from the additional intake of fibre substitutes such as bran, linseed or psyllium. 

Psyllium, derived from Plantago ovata, a plant related to plantain, contains seed pods rich in vegetable fibre with an especially pronounced water binding capacity. Bowel movements are promoted because psyllium binds water and increases bulk.

The liquid contained in the bulked vegetable fibre increases stool volume, while at the same time making it soft. This facilitates defecation.  The bacterial metabolism of soluble bulking agents supports healthy intestinal flora and also helps supply the intestinal mucosal layer with necessary nutrients.

When neither general measures nor the use of fibre and bulking agents helps, patients may benefit from the use of a preparation containing polyethylene glycol (PEG).  In the bowel, PEG binds the fluid and increases the stool volume without causing a loss of fluid or electrolytes from the body.

Other laxatives, which draw liquid from the bowel and cause a loss of mineral substances (electrolytes), work in a manner completely different from that of the above described fibre and bulking agents. Such laxatives should not be taken regularly because they lead to dependence. The bowel is actually “taught to be lazy” and the original problem only becomes worse as a result of this vicious circle.