Constipation

What you need to know about constipation

The process of digestion and the elimination of the intestinal contents normally takes twelve to twenty-four hours. In thirty percent of people with constipation, intestinal transit is delayed because the rectum does not empty easily. The slow transit is associated with impaired function of the nerve cells present in the rectum that control movement. Constipation is characterised by slow bowel movements with hard, dry stools, and often you only need to go to the toilet to pass stool once every three days – or less often. There is often an urge, but the stool does not come, which causes an unpleasant feeling in the abdomen. Hard stools can also alternate with soft, unformed stools. Constipation occurs twice as often in women as in men. Adults and children who are overweight are also twice as likely to suffer from this condition. Some people have had constipation since childhood, while in others it develops later in life.

Symptoms of constipation

• A bloated feeling
• Abdominal pain or cramps
• The stool is dry, hard or pellet-shaped
• Straining
• Unproductive urge
• Loss of stool
• The feeling of not being completely empty
• Haemorrhoids
• Reduced appetite
• Laxatives are often used, but they do not always work

Causes of constipation

Delayed transit resulting in constipation can be caused by an underlying disease and it is therefore important to have an examination carried out. Causes of constipation include:

• Fear of pain during bowel movements due to tears in the anus or haemorrhoids
• Pelvic floor disorders
• Damage to the spine or neurological diseases
• Gluten intolerance (coeliac disease)
• Food allergies
  An allergy is often not considered when bowel movements are too hard, but a food, soy or cow’s milk allergy can nevertheless be the cause. Lactose, wheat, onions and sorbitol contain sugars that are poorly absorbed and therefore contribute to the complaints.
• Infection with intestinal parasites
  Constipation alternating with diarrhoea can indicate an infection with intestinal parasites, such as Dientamoeba fragilis and Blastocystis hominis
• Colon cancer
  A changing stool pattern can occur with colon cancer
• Pregnancy
  During pregnancy, about a quarter of women are constipated
• An underactive thyroid:
• Age
  Around the age of eighty, more than seventy percent of people have very slow bowel function.
• Work-related
  When stool is held back for too long, transit can slow down, and this occurs particularly in occupations such as drivers and teachers.
• Overweight and diabetes
  Constipation is one of the most common complaints associated with overweight and diabetes, and emptying the intestine takes twice as long. Diabetes can cause neurological complaints in people and may play a role in emptying the intestine. High methane production in the intestine can also be a cause of constipation, and it appears that people who are overweight produce on average four times as much methane.
• Depression and stress
  A bloated abdomen, gas formation or constipation often occur together with depressive feelings. The intestines send signals to the brain via the blood and nerve pathways, and our behaviour and moods are influenced by signals that come from the intestine. Intestinal bacteria and inflammatory substances present in the intestine have a major influence on the brain. The intestinal wall, for example, produces serotonin, which affects intestinal peristalsis. Toxic by-products of intestinal bacteria that enter the blood also affect the brain.
• Medication use
  Painkillers and medicines that can cause constipation include:
  • Codeine (including cough syrup containing codeine)
  • Morphine
  • Antidepressants
  • Some anti-inflammatory medicines
  • Blood-pressure-lowering medicines
  • Antihistamines
  • Iron supplements
  • Acid-suppressing medicines
  • Long-term use of laxatives
• Hirschsprung’s disease or mucoviscidosis diseases
  These diseases develop at birth or in the first weeks of life and manifest as constipation. Narrow, ribbon-shaped stools can indicate a malformation of the anus. Weakness of the lower limbs, delayed motor development or problems with toilet training can cause slow bowel movements. In young children, a milk allergy often occurs and can result in severe constipation.

More information about the tests

• Digestive parameters pH, fat, starch, colour and consistency of the stool – read more…
• Intestinal parasites – Testing for infections with intestinal parasites – read more…
• Intestinal flora analysis – Analysis of part of the intestinal microbiota – read more…
• Antigliadin and anti-ht-Transglutaminase – Markers for gluten intolerance – read more…
• Histamine intolerance – Testing for the absence of the enzyme Diamine oxidase – read more
• Antigliadin and anti-ht-Transglutaminase – Markers for gluten intolerance – read more…

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