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Hard bowel movements - causes, symptoms, and quick help

Hard bowel movements can indicate many possible medical conditions. Hard stool often means some form of constipation (constipation). In some cases, however, the two symptoms are also medically differentiated from one another, in that constipation is not necessarily defined as a hardening of the stool, but primarily as an infrequent bowel movement.

The hard stool occurs when it moves more slowly than normal through the intestines and as a result too much water is withdrawn from the pulp. This process can have various causes: In most cases, lifestyle and eating habits play a central role, as well as various disorders of the digestive system such as the common irritable bowel syndrome and other diseases such as hypothyroidism or diabetes.

definition

Stool or feces (or faeces) primarily consists of water, intestinal bacteria, dead cells of the intestinal mucosa, secretions from the digestive glands, undigested food residues as well as fermentation and putrefactive products and therefore usually has a rather soft to medium-hard consistency. If there is a “hard stool”, however, the faeces are much firmer and drier than normal.

For example, this can only affect the first few centimeters of the stool, but also the entire amount of bowel movement, if the stool is passed in the form of small, hard excrement stones ("sheep droppings" or "rabbit droppings"). Due to the hardening, strong, often painful pressing is necessary to deflate. This in turn can lead to small cracks in the intestinal and anal mucous membrane (anal fissures), which also cause burning and stabbing pain when using the toilet.

Hard stool can cause very big problems under certain circumstances, as in some cases it can take hours before the sometimes extremely hardened stool is brought out with severe pain and pressure. In addition, it can happen that there is not enough “pressure” to completely excrete the manure in one, so that again enormous pressing is necessary. Since the removal of the faeces often requires an enormous effort, those affected often feel exhausted and tired, and in many cases there are also headaches and back pain as a result of tension.

Most sufferers experience abdominal pain and cramps as well as flatulence or nausea, with various other symptoms depending on the cause.

Causes and symptoms

The hardened stool occurs when it moves more slowly than normal through the intestines and as a result too much water is withdrawn from the pulp. This process can have various causes and should always be examined medically. Because hard bowel movements are not only very uncomfortable, they can lead to various diseases such as hemorrhoids and potentially increase the risk of colon cancer.

Hard bowel movements from poor diet

A common cause of hard bowel movements is poor nutrition, because fat and sugar can quickly affect the digestive process and slow it down. In addition, a lack of fiber promotes sluggish digestion, which, especially in combination with insufficient fluid intake, can lead to the body drawing too much water from the faeces and making them firm and dry.

Accordingly, those affected should pay particular attention to a diet rich in fiber, which has a positive effect on digestion and prevents the stool from hardening. The reason: Since the human digestive juices do not break down the fiber, it reaches the large intestine unchanged, where it binds water and swells up. This increases the volume of the stool, there is increased pressure on the intestinal wall and the chyme is ultimately transported on more quickly.

The dietary fiber promotes a softer and therefore more slippery consistency of the stool. Therefore, on the recommendation of the German Nutrition Society for healthy digestion, you should consume around 30 grams of fiber per day, half of which comes from grain and grain products, the other half from fresh fruit and vegetables. Apples, oranges, bananas, kiwis and berries are particularly suitable here, as well as Brussels sprouts, carrots, peas and celery, all of which contain a particularly high amount of fiber.

In general, care should always be taken to drink a lot, even with hard stools. This is especially true for a diet rich in fiber, since the plant substances can only swell with sufficient liquid and thus make the stool softer again.

Hard bowel movements from irritable bowel syndrome

The digestive problems can arise from disorders of the digestive system. In many cases this is what is known as “irritable bowel syndrome” (IBS for short, also irritable colon), which describes a functional disorder of the intestine that is neither malignant nor contagious despite frequent, constant complaints. It is a very common disease that affects an estimated 20% of the population to a greater or lesser extent, women about twice as often as men.

With irritable bowel syndrome, cramp-like, pulling or stabbing pain occurs throughout the abdomen, as well as a feeling of pressure in the lower abdomen and right or left upper abdomen. In addition, there is flatulence or the feeling of bloating, constipation and diarrhea, although these alternate in many patients. A typical symptom is accordingly the hard stool, which, however, can also appear mushy, viscous to liquid or as a very light-colored stool.

For some people the symptoms subside after a bowel movement, in other cases there is a constant uncomfortable feeling that the bowel is not completely emptied. Overall, the symptoms are diverse and can appear very differently from patient to patient - some only have symptoms rarely or in certain situations (stress, hectic, excitement, etc.), while others suffer constantly from their irritated bowel.

The cause of irritable bowel syndrome has not yet been clearly clarified, but it is clear that it is a "functional" disorder, so the patient is organically considered to be healthy. Very different factors can be responsible for the complaints - often increased psychological stress can be identified, which in turn can be triggered, for example, by unresolved conflicts, excessive nervousness, fears, intense anger or grief.

Furthermore, or parallel to this, many sufferers show hypersensitivity of the intestines, for example because of disturbed bowel movements when air accumulates, pain occurs more quickly than in those who are not affected. Accordingly, despite the lack of an organic cause, irritable bowel syndrome does not mean that those affected only imagine or even simulate the symptoms - rather, the bowel in these people apparently reacts particularly sensitively to disorders or irregularities that are often not (yet) consciously perceived.

In many cases, irritable bowel syndrome develops following an intestinal infection with diarrhea, and almost every person affected has an intolerance to carbohydrates, usually caused by milk sugar (lactose) or fruit sugar (fructose). Luxury foods such as coffee, alcohol and nicotine often exacerbate the symptoms. Recent research suggests that inflammation of the intestinal mucosa could also be the cause, and there is also the theory among orthodox doctors that a disturbance of the intestinal flora (dysbiosis) could be responsible for the development or persistence of irritable bowel syndrome.

Congenital megacolon (Hirschsprung's disease)

Another cause of hard bowel movements can be a so-called “congenital megacolon” ​​(Megacolon congenitum), which is often referred to as “Hirschsprung's disease” (MH) and mostly affects children. This is a malformation of the rectum that develops around the 4th to 12th week of pregnancy. It is characteristic of MH that nerve cells are missing in part of the intestinal wall as well as in the internal sphincter, which means that no sliding movement can take place in the intestine in order to transport the feces towards the anus.

As a result, the stool builds up in front of the affected part of the intestinal wall and leads to a massive expansion of the large intestine (megacolon), which is often externally visible through a strong bloated stomach (meteorism).

Since Hirschsprung's disease is congenital, a diagnosis can usually be made fairly quickly after birth. The malformation occurs in around one in 5,000 children, boys are affected comparatively more frequently than girls, and moreover, Hirschsprung's disease occurs more frequently in patients with trisomy 21 (Down syndrome) and the rare genetic diseases "Undine syndrome", "Shah-Waardenburg- Syndrome ”and the“ Mowat-Wilson Syndrome ”.

The typical symptoms that normally occur within the first few days of life include a delayed departure of the so-called “child piss” (meconium), a pronounced bloated stomach and growth or development disorders. In addition, there may be a functional intestinal obstruction (ileus), as a result of which the child is unable to evacuate any kind of bad luck, sometimes accompanied by bilious vomiting. In the course of the disease, some children develop bacterial overgrowth of the large intestine (toxic megacolon), which can lead to acute intestinal inflammation (enterocolitis) up to severe blood poisoning (sepsis), possibly with life-threatening circulatory collapse.

In some cases, due to weak or normal symptoms, MH is not diagnosed immediately after birth and the child appears to be healthy instead. Since the stool can be more easily transported from the intestine due to its normally thinner consistency, especially with breastfeeding children, irregular bowel movements and a possible tendency to constipation are not immediately apparent.

Correspondingly, in the case of Hirschsprung's disease, problems arise at the latest when changing food: For example, some small patients can only get rid of the stool with aids or manipulation (thermometer or finger), which sometimes leads to "explosive" evacuations. Characteristic is also very hard or tough manure that smells very badly, a bloated stomach, generally poor condition of the child, failure to thrive, vomiting or even refusal to eat - which also increases the risk of dehydration.

Hard stool due to organic bowel disease

Relatively seldom is hardened bowel movements associated with organic bowel disease. Paralysis of the intestine after an operation, inflammatory processes such as so-called "diverticulitis" and growths of the intestinal mucosa in the form of intestinal polyps, scar tissue or tumors, which lead to intestinal constrictions or blockages and thus to constipation or hard stool, come into consideration here being able to lead.

Colon cancer

In severe cases, solid, dry faeces can indicate colon cancer or a malignant tumor of the intestine, which is the second most common cancer in men and women in this country and affects at least 6% of the population in the course of life. In most cases, colon cancer develops from initially benign colon polyps, which means that symptoms rarely appear at the beginning and the disease is often only discovered at a very advanced stage.

However, there are some colon cancer signs and symptoms that should definitely be taken seriously: In addition to any sudden change in stool (for example, hard stool, alternation of diarrhea and constipation, "pencil stool"), these include symptoms such as persistent cramping abdominal pain, frequent urge to stool, blood in the stool, black stool, constant tiredness, paleness, and loss of weight and performance. Even if these symptoms can have a completely harmless origin, it is advisable to consult a doctor here - especially if blood is discovered in the stool.

Cause hypothyroidism

The cause of the symptoms may be an underactive thyroid (hypothyroidism). Since the entire metabolism works too slowly due to a lack of stimulating thyroid hormones, the intestinal activity is also restricted, which leads to constipation or hard stools as well as other symptoms such as chronic fatigue, loss of performance or changes in the skin on hair.

Problems emptying from medication

Solid bowel movements can occur as a side effect of some medications. Psychotropic drugs, sleeping pills, sedatives, iron supplements, cough suppressants containing codeine, dehydrating drugs, anti-epileptic drugs and opiates (e.g. morphine) come into consideration here. Accordingly, especially with new medications, the package insert should always be close at hand so that in the event of problems with bowel evacuation, you can clarify whether there is a connection.

Other causes of solid stool

Another possible trigger for the problems with bowel emptying can be a "gluten allergy" or "gluten intolerance" (celiac disease), which is a genetically determined autoimmune disease that is often only recognized in adulthood. Here the small intestine is diseased to the extent that it reacts to the protein component gluten with an inflammation on the mucous membrane of the small intestine, which in turn means that the nutrients from the food cannot be passed on and there is a risk of a lack of vital substances. In addition to hard stool, the symptoms of celiac disease are very different, for example abdominal pain, flatulence, diarrhea, underweight, muscle pain or joint pain.

Slowed bowel activity can be caused by a disturbance of the nerves in the bowel area, for example in the case of the chronic inflammatory disease of the central nervous system "multiple sclerosis" (MS). Since the bowel function is regulated by various nerves that are attacked by MS, this often slows down in MS patients, resulting in constipation and hard stools.

Even with diabetes mellitus, lumpy, hard stool, often in connection with a feeling of bloating, premature bloating or nausea, is one of the most common problems in the gastrointestinal area, as the constantly high blood sugar level often leads to nerve disorders in the intestinal muscles.

In addition, there are factors such as lack of exercise or stress, which promote a sluggish bowel and thus the risk of digestive problems. Not to be forgotten here is pregnancy, in which women very often suffer from constipation or hardened stools due to hormonal changes.

Diagnosis

Solid faeces are harmless in most cases and can be regulated by changing your lifestyle. Nevertheless, a change in the stool should always be taken seriously, because severe or prolonged induration can also be a symptom of a serious organic disease in the digestive area (e.g. a tumor). In addition, those affected usually suffer from other unpleasant complaints such as flatulence, headaches, exhaustion and sometimes extreme pain when defecating, which can have a major impact on overall well-being and health.

Therefore, in the event of persistent symptoms, a doctor should be consulted in any case to clarify the cause and prevent further complications - because hard, dry faeces can lead to chronic constipation if left untreated. It can also cause hemorrhoids and small cracks (fissures) on the intestinal wall and sphincter muscle. Since the intestinal walls are constantly irritated, the risk of inflammation is increased and the constant strong pressure during defecation can lead to a so-called "rectal prolapse", a prolapse of the rectum in which part of it is pushed out through the anus .

As part of the diagnosis, the doctor will first ask about symptoms and lifestyle habits. Information on stool frequency, stool composition (color and consistency), pain during bowel movements and the duration of hard bowel movements are particularly important here. Therefore, those affected should not be shy, but instead speak openly and honestly with their doctor.

This is followed by a physical examination in the form of palpation of the abdomen, localization of the pain, the examination of stomach and intestinal noises and an assessment of the anus. In addition, blood tests can be used to find indications of diabetes or an underactive thyroid, for example.

In addition, a fecal sample may be examined to detect any traces of blood that could indicate colon polyps or colon cancer.With the help of a colonoscopy, suspected irritable bowel syndrome, colon polyps or colon cancer can be investigated. An ultrasound examination (sonography) of the abdominal cavity is also used in order to be able to rule out serious illnesses as a possible cause of the problems.

Treatment for hard stools

If a serious bowel disease has been ruled out by a doctor, hard bowel movements or digestion can only be normalized in the long term if unfavorable lifestyle and eating habits are changed. Accordingly, the treatment is primarily about stimulating or normalizing the intestinal activity, which is usually initially attempted through a diet rich in fiber, plenty of fluids and increased physical activity.

Most important step: changing eating habits

Getting used to a full-fledged diet with lots of fiber should take place slowly and step by step, as many of those affected only react with unpleasant "side effects" such as flatulence or a feeling of bloatedness. In addition, basically nothing should be eaten that the body cannot eat, even if this means that certain high-fiber foods have to be left out. In general, it is advisable to eat a lot of fruit and vegetables; dried fruit such as dried pears and prunes are also suitable. Whole-grain bread and muesli should be on the daily menu instead of white or mixed bread, and the regular consumption of sour milk products such as yoghurt or curd milk is very useful, as these have a positive effect on the intestinal flora and thus help normalize digestion.

If that is not enough, digestion can be supported by water-soluble dietary fiber. These act as swelling substances that make the stool smoother and can be found in many vegetables (such as lentils, celery, green peas, broccoli and carrots), fruits (such as mango, dried figs, oranges, plums, grapefruit, apples) and seed peel ( e.g. flax and flax seeds) are included. Since the water-soluble fiber passes through the stomach and small intestine largely undigested and is only broken down in the large intestine, flatulence can occur at the beginning of the therapy - this can, however, be counteracted by the simultaneous consumption of sour milk products.

If the food is enriched with non-digestible bulking agents, it is important to take them with plenty of fluids at all times, otherwise the constipation or the hardened bowel movements can intensify. In addition, swelling agents should never be taken for longer than 14 days in a row without medical supervision, as otherwise there is a risk that too much water and too many minerals will be withdrawn from the body.

Laxative assistance

If these measures are not sufficient, the next step is to take the active ingredient "lactulose" from the group of so-called "osmotic laxatives" (laxatives), which ensures a softer stool and thus a simplified bowel movement. Even if lactulose, for example in the form of a syrup, is normally well tolerated, flatulence often increases, and the active ingredient is not suitable for people with a congenital intolerance to galactose.

As with all medicines, the laxative should only be taken under medical supervision, especially if the problem of hard stool has been going on for a long time. Self-medication is strongly discouraged, as the symptoms can quickly worsen if used improperly, and behind every chronic disorder or impairment of bowel movement there can be a more serious illness.

Therapy for existing underlying diseases

If another illness is the trigger for the symptoms, this is first treated in a targeted manner in order to finally normalize the bowel movements again, for example by taking thyroid hormones in the case of an underactive thyroid. If the hard stool persists despite treatment of the underlying disease, sometimes stronger laxatives (e.g. bisacodyl or sodium picosulfate) are prescribed, which stimulate bowel movements by irritating the intestinal wall, causing the food to be transported more quickly and ultimately causing stool to be emptied more quickly and easily.

These are used, for example, in the case of nerve damage caused by diabetes ("diabetic neuropathy") or in the case of cancer, when opioids are used to treat severe pain, which often cause severe constipation as a side effect.

Medical measures for Hirschsprung's disease

In the case of Hirschsprung's disease, an artificial anus is usually created first, depending on the health of the newborn, until the overall general and nutritional condition is better and the child is stable. Then, in the next step, the main operation takes place: In this, the affected section of the intestine is surgically removed and then the healthy, functioning intestine is connected to the remaining short piece of the rectum (anastomosis).

Depending on the case, both minimally invasive (laparoscopic) and transanal endorectal (through the anus) surgical techniques are used. For a successful operation for Hirschsprung's disease, a lot of experience and specialist knowledge is required, as the procedure also includes the area of ​​the lowest intestinal section up to the sphincter - the sphincter must, however, under no circumstances be injured in order to maintain the anal continence.

Therapy for irritable bowel syndrome

There is no causal treatment for irritable bowel syndrome and, unfortunately, there is no complete cure. In many cases, however, it is a "relief" for those affected to know that there is no serious illness behind the symptoms. In order to alleviate the symptoms at least in the short term, a number of medications can be considered, such as pain relievers and anticonvulsants for abdominal cramps or laxatives for constipation or hard bowel movements Instead, those affected should definitely seek medical advice.

Irritable bowel patients can also fall back on a number of therapeutic measures within the framework of "self-help", which can also alleviate the symptoms. This includes, in particular, switching to a predominantly fiber-rich diet, sufficient fluid intake of at least 2 liters per day and regular exercise. Alcohol, coffee and nicotine should generally only be consumed in moderation.

Regular meals are advisable. Instead of a lavish dinner, it is advisable to eat several meals throughout the day. It is also important to generally take enough time to eat, not to swallow and to chew carefully. In addition to the measures mentioned, naturopathy offers a range of gentle and effective options for irritable bowel syndrome.

Treatment of Colon Cancer

The therapy in the case of colon cancer is individual and depends on the size and location of the tumor, as well as on the spread to other organs. In the early stages, in most cases individual degenerate polyps can be removed by means of a colonoscopy. Later on, surgery is usually carried out to remove the tumor from healthy intestinal tissue. The challenge here is that there are no unrecognizable extensions of the tumor, so the nearby lymph nodes must also be removed, as otherwise there is a risk that colon cancer cells could spread through the lymphatic system. In some cases, a temporary or permanent artificial anus (stoma) must also be placed.

After the operation, the course of therapy is decided: If no cancer cells can be found in the lymph nodes, no further treatment is usually given. If the opposite is the case, however, subsequent chemotherapy is usually carried out, also in combination with radiation therapy, depending on which areas of the intestine were affected by the cancer. Radiation and chemotherapy can also be used for colon cancer before an operation, for example to reduce the size of the tumor and thereby ensure that the sphincter is preserved despite the operation.

In the case of advanced colon cancer, immunotherapy with antibodies can also be used, in which the antibodies block the growth of cancer cells or stop the formation of new blood vessels that supply the tumor with nutrients. In addition, pain medication is usually given. If the cancer cannot be completely removed, further measures such as overheating (hyperthermia), cold therapy (cryotherapy) or laser treatments can be used - however, these methods are primarily intended for the destruction of metastases.

Naturopathy for hard stools

If a serious illness could be ruled out as the cause, naturopathy offers a range of gentle and effective alternatives to treat hard bowel movements naturally. In general, however, it is also true here that the individual dosage and duration of the therapy must be discussed thoroughly with a doctor or alternative practitioner before taking naturopathic medicines in order to avoid health risks.

In the case of irritable bowel syndrome, in particular, it is important to first become aware of the factors that trigger the “irritable mood” in the intestine. Accordingly, those affected should ensure a psychological balance by learning or possibly changing a healthy way of dealing with and attitudes towards conflicts and problems.

In this context, relaxation measures such as yoga, autogenic training or progressive muscle relaxation can help to relieve tension and thereby improve intestinal problems.

In some cases, it is also advisable to use psychotherapy to manage problems and conflicts. In addition, many sufferers generally find warmth to be very pleasant in the case of intestinal problems - this can be supplied to the body, for example, through herbal teas, hot baths, saunas or moist, warm wraps around the stomach.

Herbal medicine offers many options for irritable bowel syndrome: For example, herbal remedies containing valerian, hops, lemon balm or lavender have proven to be effective in treating inner restlessness and nervousness. If there is a tendency to upset or depression, St. John's wort is more suitable. It is important here that the preparation is carefully tailored to the individual and taken regularly over a longer period of time, as the effect often only takes place after a while.

Various salts ("saline laxatives") that bind water in the intestine and thus have a laxative effect are suitable for cleaning the intestines. The so-called Epsom salt (magnesium sulphate) is used here, which when dissolved in water has a laxative effect and accordingly may only be used for a short time.

Homeopathy offers various remedies for intestinal problems, such as "Alumina", which can help with dry, firm, knotty stool, but also with anus pain. "Bryonia" is also a proven homeopathic for dry, hard stool, as is "Magnesium muriaticum", "Collinsonia canadensis". The same applies to “Sulfur”, which is also used for burning anus, itching and strong urge to defecate without subsequent emptying.

Herbal laxatives

In the case of solid stools, the group of so-called "anthranoids" often offers help, which refers to active ingredients of plant origin that also have a strong laxative effect. This effect is based on an irritation of the intestinal wall and an accompanying increase in muscle movement as well as the parallel increase in mucus secretion in the large intestine; in addition, neither water nor salts are withdrawn from the intestinal contents, which makes the stool softer and smoother again.

Depending on the plant and dosage, diarrhea-like stools occur about 6–12 hours after ingestion. Plants containing anthraquinone such as aloe, cascara bark, senna leaves and fruits, buckthorn bark, rhubarb root and buckthorn berries are considered - aloe is said to have the strongest and buckthorn berries the weakest.

These herbal ingredients should never be used for more than 14 days and not without consulting an experienced doctor or alternative practitioner, as otherwise there is a risk of excessive mineral loss (especially potassium deficiency), which, among other things, can lead to cardiac arrhythmias.

Home remedies for constipation

In addition, there are a number of home remedies for constipation in the case of hard bowel movements, which in most cases, with a little patience, contribute to increased bowel activity and thus to a softer consistency of the stool. For example, a regular morning stomach massage in the form of circular hand movements in a clockwise direction before getting up is good to support the further transport of the food in the intestine.

In many cases, a glass of water or fruit juice on an empty stomach immediately after getting up, which triggers the bowel reflex (gastrocolonic reflex), or types of fruit such as plums or figs and sauerkraut (as a vegetable or juice) around the intestines are just as helpful in many cases to stimulate. (No)

Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.

Dipl. Social Science Nina Reese
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  • P. Layer et al .: S3 guideline for irritable bowel syndrome: definition, pathophysiology, diagnostics and therapy, German Society for Digestive and Metabolic Diseases (DGVS), German Society for Neurogastroenterology and Motility (DGNM), (accessed on 02.09.2019), AWMF
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Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.