Basically, a distinction is made between pseudo obstruction, acute constipation and chronic constipation.
Failure to pass stools is not always a sign of constipation. As already mentioned a stool frequency of 3 times a day to 3 times a week can be considered normal. Using a laxative often means the intestine is very thoroughly emptied with the result that there are no bowel movements for 1 to 3 days. This is normal and should not be misinterpreted as rebound constipation.
There are a number of different causes of acute constipation, which generally clears up after a short time. Causes can include:
- Change in diet (e.g. when travelling)
- Hormonal changes (e.g. in the second half of a woman’s cycle)
- Medicines (e.g. codeine-containing cough remedies and painkillers, opioids)
If acute constipation is accompanied by warning signals (e.g. blood in the stools, severe stomach pain), it may also be a sign of intestinal obstruction (e.g. due to a tumour, growths), tears in the rectal mucosa (anal fissures) or haemorrhoids. In the case of haemorrhoids the persons concerned often avoid defecating for fear of the expected pain. In such cases a doctor must be consulted immediately and patients should only take laxatives on medical advice.
If there are no such warning signs, it is advisable to be patient as constipation generally clears up untreated within a few days. Short-term use of laxatives with a known safety profile, such as the Dulcolax® range, is recommended in such cases as required.
If constipation persists over a prolonged period of time, it is believed to be ‘chronic’. Patients should always consult a doctor about chronic constipation. There are various levels of disease processes that lead to chronic constipation. As several processes are usually involved at once in the case of chronic constipation and these may affect each other mutually, it is often difficult to interpret a single finding.