Constipation is a common yet frustrating issue that affects millions of people. While occasional constipation isn’t a cause for concern, chronic constipation can lead to discomfort, digestive complications, and overall health issues. The good news? It’s often preventable and treatable with the right approach.

This guide covers everything you need to know about constipation: causes, symptoms, potential risks, and natural solutions to restore healthy bowel function.

What is Constipation?

Constipation involves difficulty in emptying the bowels, often associated with hardened stool. It can manifest as:

• Infrequent Bowel Movements: Fewer than four times per week.
• Difficulty During Defecation: Straining or pain while passing stool.
• Incomplete Evacuation: A sensation that the bowel hasn’t been fully emptied.

What Are the Symptoms of Constipation?

Constipation typically means irregular bowel movements due to hard, dry stool that is difficult or painful to pass. Other symptoms may include:

• A feeling of incomplete evacuation
• Bloating or gas
• Nausea
• Abdominal pain or cramping

Occasional constipation, like when traveling, is usually not a concern. However, chronic constipation—defined as experiencing at least two of the following for 12 weeks within a year—may indicate a more serious issue:

• Fewer than four bowel movements per week
• Hard stool
• Feeling of incomplete evacuation
• Feeling of intestinal blockage
• Straining during bowel movements

What Are the Causes of Constipation?

Constipation can be caused by multiple factors, from diet to underlying medical conditions.

1. Lifestyle & Dietary Factors

• Low-fiber diet – Lack of whole grains, vegetables, and fruits slows digestion.
• Dehydration – Insufficient water intake leads to hard, dry stool.
• Lack of physical activity – Movement stimulates digestion, so a sedentary lifestyle can slow bowel function.
• Ignoring the urge to go – Frequently delaying bowel movements can desensitize the body’s natural reflex.
• Stress & anxiety – Psychological factors can impact gut motility.

2. Medical Conditions & Medications

• Thyroid disorders (hypothyroidism) – A slow metabolism leads to sluggish digestion.
• Diabetes – High blood sugar can damage nerves that regulate digestion.
• Hormonal fluctuations – Pregnancy, menstruation, and menopause can slow bowel function.
• Medication side effects – Painkillers, antidepressants, calcium channel blockers, and diuretics may cause constipation.

3. Structural & Neurological Issues

• Pelvic floor dysfunction – Poor coordination of pelvic muscles can prevent normal evacuation.
• Irritable bowel syndrome (IBS) – Constipation-dominant IBS (IBS-C) can cause irregular, hard stools.
• Colon issues – Rectal prolapse, diverticulitis, or tumors may lead to obstruction.

What Are the Consequences of Chronic Constipation?

From a holistic perspective, at least one bowel movement per day is considered essential for optimal health. Ideally, a high-fiber diet should lead to two to three bowel movements daily. Ignoring chronic constipation can have serious long-term effects:

• Hemorrhoids & Anal Fissures – Straining can cause swollen veins (hemorrhoids) or small tears in the anal mucosa (fissures), leading to pain and bleeding.
• Rectal Prolapse – Chronic straining can weaken tissues, causing part of the rectum to protrude from the anus.
• Diverticulitis – Hard stool can push into intestinal bulges (diverticula), leading to painful inflammation.

How Does Constipation Develop?

Constipation occurs when stool moves too slowly through the intestines, allowing excessive water absorption. This results in dry, hard stool that is difficult to pass.

In Western countries, chronic constipation is one of the most prevalent lifestyle-related conditions, affecting over 50% of the population. It’s particularly common among older adults, with 75% of hospitalized or nursing home patients relying on laxatives.

Three Main Groups of Constipation

1. Primary, functional constipation

This fairly common form of constipation occurs when at least two of the following symptoms are present in at least one in four bowel movements:

• The impression of an incomplete emptying
• The feeling of blocking (despite stool urge, no bowel movement)
• Strong pressing during the emptying of the bowel
• Hard or lumpy stool
• It must be helped manually.
• Over a longer period (keep a stool diary!) less than three bowel motions per week.

The experience that in the long run, only laxatives lead to the desired success can be part of the problem but does not belong to the definition of chronic constipation.

In primary (functional) constipation, doctors also distinguish two forms:

• Slow transit-time
  • This occurs when intestinal contents move too slowly (two to five days), often leading to bloating and a persistent feeling of fullness. In about 20% of constipation cases, intestinal propulsion is weakened across the entire colon. Diagnosis may involve measuring colon transit time using an X-ray dye substance.
  • Treatment: Initial strategies include exercise, a high-fiber diet, and adequate hydration. Some probiotics may provide additional support, but in severe cases, these measures may not be sufficient.
• Normal transit-time
  • Despite normal colon transit (12–16 hours), stool is often hard, and passing it can be difficult. Around 75% of constipation sufferers experience this type, sometimes linked to irritable bowel syndrome (IBS).
  • Treatment: Adjusting lifestyle habits—such as regular toilet visits, increased physical activity, and a high-fiber diet—can help restore normal bowel reflexes. In some cases, swelling agents or osmotic laxatives may be necessary. If symptoms persist, medical evaluation is recommended to rule out emptying disorders or prolonged slow transit constipation.

2. Rectal problems: anorectal disorders

• Functional Issues: Cramping at the intestinal exit (anismus) and pelvic floor weakness.
• Organic Issues: Rectal prolapse, fissures, hemorrhoids, vein thrombosis, rectocele (rectum bulging into the vagina), and proctitis (rectal inflammation).

Common Rectal Disorders Affecting Bowel Movements:

• Abscesses, fistulas (abnormal connections between the rectum and skin), and anal canal narrowing.
• Painful anal tears, eczema, hemorrhoids, and rectal prolapse, which obstruct stool passage.
• Larger intestinal polyps or rectal cancer can also hinder bowel movements.

Since the anal region is highly sensitive, even minor irritation can cause cramps. Seek medical evaluation to rule out organic causes.

Sphincter & Pelvic Floor Dysfunction

Poor muscle coordination (pelvic floor dyssynergia) can prevent proper emptying, often affecting women. Biofeedback training may help.

Neurological & Structural Causes

Nerve damage, aging, or pelvic floor malformations can lead to constipation and continence issues. Proper diagnosis is key.

3. Secondary constipation

Hormonal & Metabolic Factors

• Thyroid Disorders: Hypothyroidism slows intestinal activity, causing constipation.
• Parathyroid Issues: High calcium (hypercalcemia) disrupts muscle signals, leading to constipation, thirst, kidney stones, and fatigue.
• Pregnancy: Hormones slow digestion, while the growing uterus adds pressure. Fiber, fluids, and exercise can help.
• Menstrual Cycle & Contraceptives: Hormonal changes may cause bloating and constipation. Adjusting diet or considering alternative contraception might help.
• Diabetes: High blood sugar can damage nerves, impairing digestion and causing constipation.

Mineral & Systemic Disorders

• Kidney Failure: Leads to high calcium levels, worsening constipation.
• Potassium Deficiency (Hypokalemia): Can cause severe constipation or even intestinal paralysis.
• Amyloidosis & Collagenosis: These diseases affect connective tissues and can impair bowel function.

Proper diagnosis is essential to address underlying conditions.

Medications Sometimes Promote Constipation

Numerous medications can lead to constipation. Examples include agents that reduce or block the formation of gastric acid such as H ₂ receptor antagonists (can also cause diarrhea) or proton pump blockers, furthermore gastric acid binders containing aluminum or calcium salt, colestyramine, codeine, cardiovascular drugs such as calcium channel blockers and water-propelling drugs, so-called diuretics.

Other options include sleeping pills and sedatives, antidepressants, medication for epilepsy, for Parkinson’s disease, for bladder weakness (urinary incontinence), and for cramp-like pain (spasmolytics, for example for colic pain).

Strong pain relievers such as morphine preparations often significantly dampen the intestines. Oxy-Power works wonder for this kind of constipation.

Laxatives at a glance

Laxatives are available in various preparations, such as tablets, dragees, drops, soluble powder, or suppositories. Common side effects include intestinal cramps and diarrhea. The latter may also indicate an overdose.

In the case of acute gastrointestinal inflammation, suspicion of intestinal obstruction and disturbances of the fluid and salt balance, do not take a laxative. Here is a quick overview:

• Osmotic (water-pulling) laxatives: polyethylene glycol (PEG, macrogol): side effects: abdominal pain, bloating; Lactulose is split by bacteria in the large intestine, resulting in lactic acid and osmotic active particles. Counter-indication: galactose intolerance.
• Salinic (salt-like) laxatives: magnesium sulfate (bitter salt): Contraindications: among other things kidney weakness; Sodium sulfate (faith salt): Contraindications: hypertension, heart failure, edema, kidney weakness.
• Stimulant (promoting intestinal movements) laxatives: bisacodyl, sodium picosulfate, sennosides (from Senne’s leaves and fruits): Increased transfer of water and salts into the intestine, risk of potassium loss (hypokalemia) with increased constipation.
• Prucalopride (so-called selective serotonin (5HT4) receptor agonist): Increases the movements of the large intestine, accelerates the intestinal passage, promotes intestinal emptying. The drug is prescribed by the doctor in case of chronic constipation, which does not respond to other means. Contraindications include certain inflammatory bowel diseases, intestinal obstruction, certain heart disease.
• Doctors use opiate antagonists such as methylnaltrexone and other substances to combat severe constipation in opiate pain therapy.

Don’t use laxatives as a self-treatment or only for a very short time. There are better natural alternatives.

In case of persistent constipation, see your Holistic Colon Hydrotherapist and Naturopath who might then refer you to the doctor.

This should also be noted when using laxatives:

• Don’t use it habitually, as long term use will make it worse.
• Choose the lowest possible dosage.
• Whether with or without therapy: In case of acute changes in stool habits, persistent unclear constipation, or acute abdominal discomfort, seek professional help
• Making your lifestyle more gastro-friendly (more in the section “Self-help in case of constipation”) is always worth a try.

Natural Remedies for Constipation

Fortunately, there are many natural ways to relieve and prevent constipation without medication. Here’s what you can do:

1. Increase Fiber Intake

A diet rich in fiber helps add bulk to the stool and promotes regularity. Include:

• Whole grains (brown rice, oats, quinoa)
• Fruits (apples, berries, pears)
• Vegetables (broccoli, spinach, carrots)
• Legumes (beans, lentils, chickpeas)
• Natural fiber supplements like psyllium husk, flaxseeds, or inulin

2. Stay Hydrated

Drink plenty of water throughout the day to soften the stool and aid its movement through the intestines. Avoid excessive caffeine and alcohol, as they can dehydrate the body.

3. Move Your Body

Regular exercise, such as walking, yoga, or abdominal massages, can stimulate digestion and bowel movement.

4. Establish a Routine

• Stick to fixed meal times to help regulate digestion.
• Never ignore the urge to go to the bathroom.
• Dedicate time to sit on the toilet each day, especially after meals.

5. Manage Stress

Since stress can slow digestion, consider relaxation techniques like deep breathing, meditation, or gentle yoga to support gut health.

6. Check Your Medications

If you suspect that your medications are causing constipation, consult your doctor for alternatives or adjust the dosage accordingly.

7. Try Natural Laxatives

• Prunes & figs – Natural sources of fiber and sorbitol, which act as mild laxatives.
• Castor oil – A well-known remedy for quick relief.
• Magnesium citrate – Helps draw water into the intestines, softening the stool.
• Vitamin C – High doses can act as a natural laxative.
• Herbal teas – Senna, peppermint, and ginger teas can aid digestion.

Colon Cleansing Methods for Severe Constipation

For persistent cases, deeper cleansing may be necessary:

1. Enema

An enema involves introducing water or a cleansing solution into the rectum to stimulate a bowel movement. It’s a quick relief option but should not be used regularly to avoid dependency.

2. Colon Hydrotherapy (Colonics)

Colonic irrigation flushes out accumulated waste from the colon. When combined with a fiber-rich diet and probiotics, it can help retrain the bowel for regular function.

3. Oxy-Powder Supplements

Oxygen-based colon cleansers, like Oxy-Powder, help break down and remove waste buildup without harsh side effects.

How Therapists Make the Diagnosis

Diagnosis begins with a discussion of symptoms, including duration, stool quality, frequency, color changes, mucus or blood, pain, and appetite. A stool diary may help. Additional concerns include abdominal pain, bloating, fever, weight changes, or other conditions like back pain or gallbladder issues. Family history is also considered.

The physical exam includes abdominal and rectal palpation. Further tests may involve lab work, ultrasound, colonoscopy, CT/MRI scans, or transit time studies. Specialized exams like anorectal manometry, defecography, and electromyography assess rectal and sphincter function.

Depending on findings, specialists in gastroenterology, proctology, urology, gynecology, or neurology may be consulted. Neurogastroenterology focuses on motility disorders affecting intestinal movement.

The Nervous System, Psyche, and Intestine

For the intestine to function properly, a balanced interaction between the gut, nerves, and brain is essential. Since the brain’s psychological centers are connected to the gut, the intestinal system is vulnerable to various issues.

Diseases affecting nerves, the spinal cord, or the central nervous system (e.g., Parkinson’s, MS, stroke, dementia) can impact both the small and large intestines. Psychological disorders like anorexia can also disrupt gut function due to malnutrition and misuse of laxatives or diuretics.

Disorders Affecting Intestinal Nerves

Hirschsprung Disease

A congenital condition affecting nerve supply, occurring more often in boys. It leads to a lack of ganglion cells in the rectum, causing severe constipation, abdominal pain, and megacolon. Diagnosis often requires a biopsy, and treatment is usually surgical.

Chronic Intestinal Pseudo-Obstruction

This condition mimics intestinal blockages and can be acute or chronic, with genetic or secondary causes (e.g., diabetes, autoimmune diseases, medication side effects). Symptoms include bloating, pain, nausea, vomiting, and constipation. Treatment depends on the cause and may involve dietary changes, medications, or surgery.

Hereditary Muscular Dystrophies

These muscle disorders can lead to weakness, gait issues, heart damage, and intestinal dysfunction, causing persistent constipation.

Chagas Disease

A parasitic disease transmitted by predatory bug bites, primarily affecting South American children. It targets the heart, brain, and intestinal ganglion cells, leading to severe constipation and possible intestinal blockage. There is no vaccine, so prevention is key.

Emergency: Acute Constipation – Bowel Obstruction?

Intestinal inflammation (e.g., ulcerative colitis, Crohn’s disease), diverticular disease, circulatory issues, radiation, or surgery can cause strictures that obstruct bowel movements. Less common causes include intestinal stones, foreign bodies, gallstones, tumors, or hernias. Acute appendicitis can also disrupt bowel activity, leading to obstruction (mechanical ileus). Post-surgical bowel palsy (paralytic ileus) or pancreatitis may also cause complications.

⚠ Important: If an obstruction is suspected, do not take laxatives or pain medication. Seek immediate medical attention.

Warning Signs:

• Severe abdominal pain or pressure
• Loud or absent bowel sounds
• Nausea, bloating, vomiting (possibly stool)
• Stool blockage

Cause-Related Therapies for Persistent Constipation

After ruling out serious conditions, consult a Holistic Colon Hydrotherapist trained in constipation relief. For pelvic floor weakness, biofeedback and pelvic floor training are effective. Severe rectal emptying disorders may require nerve stimulation or surgery if other treatments (suppositories, enemas, irrigators) fail.

If medication is the cause, consult your doctor before stopping it.

Colonics together with a good diet plan and Oxy-Powder can retrain your bowel to work regularly.