Questions and answers about constipation

It can have many causes. What patients can do in acute cases and also preventively

© Getty Images / Suki Photography / Sandra Grimm

Why can't I go to the bathroom?

Stress, lack of exercise and dehydration, a diet low in fiber - there are many reasons for a sluggish bowel. Certain foods, including chocolate, blueberries, red wine and black tea, have a constipating effect.

Medicines are also possible causes, especially strong opiate painkillers, as well as certain antihypertensive drugs and some antidepressants. Metabolic and nervous diseases can promote constipation, such as poorly controlled hypothyroidism, Parkinson's disease, as well as dementia and depression.

Do I really have to "have to" every day?

Twice a day or twice a week: How often a person has a bowel movement varies from person to person. The expectation that it should happen every day creates unnecessary pressure. Chronic constipation is only present if fewer than two bowel movements per week are the norm for at least three months, as well as symptoms such as a feeling of fullness and pain when pressing.

Good to know: There is no such thing as self-poisoning due to infrequent bowel movements.
The norm of the amount of stool is often overestimated: on average, people only excrete 100 to 200 grams per day.

I don't want to take laxatives. Is it possible without it?

Adequate hydration, a high-fiber diet, and regular exercise are essential for healthy digestion. But with persistent constipation, changing your lifestyle is often not enough.

Then dietary fibers such as flaxseed, psyllium husks or wheat bran, which are consumed with plenty of water, help. They swell in the intestines, increase stool volume and are suitable for long-term ingestion. To avoid gas and cramps, the dose should be increased slowly.

If this is unsuccessful within two weeks, so-called osmotically effective laxatives such as lactulose and macrogol can be tried. They bind fluid in the intestine and make its contents softer and more voluminous. Bisacodyl and sodium picosulfate also stimulate the colon muscles. Anyone suffering from constipation should seek individual advice from the pharmacy.

I don't have to go to the doctor right away - do I?

Constipation is no trivial matter. The limits of self-medication are reached at the latest when additional symptoms occur. If you have cramp-like pain, a feeling of pressure, fever, nausea and blood in your stool, you should not hesitate to see a doctor. Older people in particular should always seek medical advice as a precaution if their bowel habits change.

For chronic constipation that has persisted for more than three months, pharmacists advise against self-medication: If over-the-counter laxatives do not work sufficiently or are needed permanently, patients should consult a doctor. This also applies when constipation and diarrhea alternate.

Since I've got older, I've been having more problems. Why?

It is estimated that up to 40 percent of people over 60 years old have chronic constipation - women are more likely to be affected than men and the problem increases with age. Possible reasons: Elderly people swallow medication more often or suffer from diseases that promote constipation.

Over the years, the intestinal muscles also become weaker, so that the chyme is transported more slowly. In addition, seniors often drink too little and do not get enough exercise.

Are Laxatives Really Addictive?

Laxatives do not have any psychological effects that would encourage misuse. Nevertheless, they are abused, especially by young women with eating disorders, in doses that are often much too high for weight loss. The lower weight achieved in this way is not sustainable, but is only based on severe water and electrolyte losses.

Caution is also advised when patients also take diuretics: These increase the risk of electrolyte loss, which can lead to complications such as cardiac arrhythmias.

If used as intended, over-the-counter laxatives are well tolerated. Swelling agents such as flea seeds or wheat bran are also suitable for long-term use.

Can the pharmacist help me?

With constipation, the suffering is often high, but many sufferers shy away from talking about it. "The pharmacy offers the possibility of discreet and personal advice that everyone should use," explains Christian Schulz, specialist pharmacist for general pharmacy from Bielefeld. That is better than doing your own research on the Internet out of false shame.

"The pharmacist helps with the choice of a suitable drug and provides information on how patients can recognize an over- or under-dose themselves," says Schulz. In the case of mushy or liquid stool, for example, the laxative dose is probably too high.

During the consultation, pharmacists also pay attention to possible signs of drug misuse. "Some active ingredients should not be taken for longer than one to two weeks without medical advice, as they can cause constipation themselves if they are taken for a long time," says Mathias Arnold, Vice President of the Federal Association of German Pharmacists' Associations. As the body gets used to taking it regularly, an existing sluggishness is increased.

Tip: This breakfast gets the bowels going

250 grams of natural yoghurt,
2 tablespoons of oatmeal,
1/2 tablespoon of chia seeds
Mix together 1/2 tablespoon of flaxseed.

Add some fruit. Apples, nectarines or berries are good.
The best way to do this is to drink unsweetened tea or water.