Therapy often permanent

»For every ten constipated patients, nine have to be told that long-term use of laxatives is the treatment of choice«, Professor Dr Ahmed Madisch, Centrum Gastroenterologie Bethanien in Frankfurt am Main, began his presentation. Patients with chronic constipation need to be educated so that they actually take laxatives on a long-term basis. For over 80 per cent of those affected, the symptoms, which significantly impair their quality of life, disappear.

The medic performs a number of colonoscopies every day, including on people with chronic constipation - almost always without any findings. He had a tip for patients who are due to have a colonoscopy: they should start using a laxative four days before the appointment. This increases the chance that the unpleasant procedure of bowel cleansing on the day before the examination will be sufficient. Otherwise, he often finds that people with constipation need a second bowel cleansing because otherwise the examination is not possible.

Even though chronic constipation can have various causes, 80 per cent of those affected suffer from functional constipation or irritable bowel syndrome with constipation. It is by no means only older people who are affected. Rather, the symptoms affect all age groups and often begin in infancy. »In a large proportion of patients, we see that there are naturally too few ganglia in the intestinal wall.« This deficiency has a lifelong effect on digestive activity.

According to the S2k guideline »Chronic constipation«, which was updated in 2022, constipation is initially treated with general measures, i.e. fibre. »I always start this with our patients after the colonoscopy, i.e. when the bowel is really empty«, says Madisch. Because giving fibre to an acutely constipated person does not make sense. There are patients whose constipation improves with the regular intake of fibre, but this is not the case for a large proportion of them. »In a very sluggish bowel, which works so little because there are too few nerve cells in the bowel wall from birth, fibre is actually harmful«, says the expert. These patients also need to eat a low-fibre diet. Although physical activity is definitely useful as an accompanying measure, it is rarely decisive for an improvement in symptoms.

Toilet training, another point in the guideline, is important: »You really have to take enough time at fixed times of the day, preferably in the morning, to go to the toilet in peace«. Another point is to drink enough. However, this only has an effect if a person otherwise always drinks too little. Liquids over and above the one and a half to two litres recommended for everyone have no additional effect against constipation.