Hidden constipation

Hidden constipation

Constipation is very common, with many people experiencing symptoms to varying degrees. Hidden constipation can negatively affect quality of life, as the symptoms can be both limiting and disabling. The incidence of constipation increases with age, and women are more likely to suffer from constipation, including hidden constipation.

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Symptoms of hidden constipation

• Sluggish stool
• Difficulty passing stool
• Bloating and flatulence
• Abdominal pain and discomfort
• Visible distension of the abdomen
• Stomach cramps
• Fatigue and restlessness
• False urge to go to the toilet
• Sensation of not having emptied the bowels
• Headache

Cause of hidden constipation

The causes of hidden constipation can be many and often a combination of different factors. Diet, especially fluid and fiber intake, plays a significant role in digestion, but what is experienced as normal or burdensome for digestion can vary from person to person. Psychological and emotional conditions such as stress, anxiety and depression can also affect digestion and increase the risk of hidden constipation. Since digestion is supported by movement, limited physical activity can contribute to the development of hidden constipation. Finally, medications and certain diseases can also affect the risk of hidden constipation (1).

Diet and hidden constipation

Christian Lodberg Hvas, senior physician at the Department of Liver, Stomach and Intestinal Diseases at Aarhus University Hospital, emphasizes that which foods are experienced as burdensome for digestion can be very individual. Nevertheless, there are some typical “culprits” that often contribute to hidden constipation. Preserved and highly processed foods such as chips and sweets, as well as foods with a lot of white wheat flour or onions, can reduce the speed of digestion. Foods containing fiber, on the other hand, can regulate intestinal function by stimulating the production of beneficial substances in the intestine and promoting peristalsis (bowel movements). Foods such as coarse vegetables, including root vegetables, broccoli, cabbage and beans, are therefore recommended. A varied diet and high fluid intake can further contribute to reducing the risk of hidden constipation (2, 3).

Stress and hidden constipation

Stress and constipation are closely linked. Stress is a neurological response that activates the body’s “fight or flight” response, leading to increased tension and alertness. During stress, blood flow to the brain and large muscle groups increases to prepare the body to respond, while blood flow to internal organs, especially the digestive system, decreases as digestion is de-prioritized in stressful situations.

Persistent stress therefore inhibits the normal functioning of digestion, including peristalsis (the movement of the intestines), which can lead to constipation. The symptoms of hidden constipation can appear delayed, so it is not unusual for the problems to only appear once the period of stress is over.

Anxiety, depression and hidden constipation

Anxiety, depression, and other psychological or emotional stressors can lead to digestive problems such as reflux, diarrhea, or constipation. In people with anxiety, digestion is affected by the body’s autonomic nervous system. When the “fight-or-flight” response is activated, digestive activity is reduced, which over time can lead to constipation.

Christian Lodberg Hvas, senior physician at the Department of Liver, Stomach and Intestinal Diseases at Aarhus University Hospital, points out that anxiety and depression often occur together with constipation or irritable bowel syndrome, rather than as isolated cases(3).

Back pain and hidden constipation

Back pain often occurs in conjunction with hidden constipation, as the intestines and spine are connected via the autonomic nervous system. When the intestines become irritated or pressured due to constipation, it can lead to overactivity of the autonomic nervous system, affecting the nerves that originate from the spine. This can create increased muscle tension and a state of tension in the tissues around the spine, often resulting in back pain.

Additionally, hidden constipation can cause mechanical restrictions in the back due to tension in the areas surrounding the digestive system and abdominal cavity. This tension can result in pain in the back or in the sacroiliac joints (SI joints) in the pelvis.

Sleep and hidden constipation

Digestion continues when we sleep, but at a slower pace. During sleep, the body processes food, rebuilds tissues, and maintains important functions, including digestion. Eating a large meal shortly before bedtime can challenge digestion, as the body is not optimized to process large amounts of food at rest. Bowel movements decrease when we sleep, and ideally we should be able to sleep without being awakened by the urge to defecate. However, people with hidden constipation or irritable bowel syndrome may experience waking up at night due to the urge to defecate, abdominal pain, or discomfort.

Is hidden constipation dangerous?

Hidden constipation is usually not dangerous, but can cause discomfort that can be very limiting in everyday life. Christian Lodberg Hvas, senior physician at the Department of Liver, Stomach and Intestinal Diseases at Aarhus University Hospital, describes a normal bowel movement pattern as regular and within a range of three times a day to twice a week. He recommends that you contact your doctor if you fall outside this range, if your bowel movement pattern fluctuates greatly, or if you experience discomfort such as indigestion, abdominal pain or loose stools that affect your daily life (3).

What can I do myself to prevent hidden constipation?

Here are some tips to reduce the symptoms of hidden constipation (1,3,4):

• Drink plenty of fluids: Adequate fluid intake is important for bowel function as it helps keep stools soft and easy to pass.
• Increase your fiber intake gradually: Eat coarse vegetables and possibly psyllium husks as a source of fiber. Be aware that a sudden increase in fiber intake can cause bloating; therefore, a gradual increase is recommended. Fiber works best with water, so remember to drink extra fluids.
• Chew your food thoroughly: Good chewing breaks down food, making digestion easier, and at the same time stimulates stomach acid production, which benefits the entire digestive process.
• Get daily exercise: Physical activity promotes bowel movements, and the respiratory muscle helps create pressure variations that stimulate digestion and the passage of food through the intestines.
• Reduce stress: Find ways to reduce stress, such as prioritizing activities that help you relax, as lower stress levels help digestion.
• Avoid Retention: Do not ignore the urge to use the toilet, as this can worsen constipation over time.
• Eat frequent meals: Several small meals daily stimulate digestion via the gastrocolic reflex, which promotes bowel movements and maintains regular bowel movements.

Osteopathic treatment of hidden constipation

Osteopathic treatment can be an effective method of alleviating gastrointestinal problems, including hidden constipation. As physiotherapists and osteopaths, we possess extensive knowledge of physiology, anatomy and pathology, which allows us to identify the underlying issues that can lead to constipation.

Treatment often focuses on the vagus nerve, which is essential for regulating gastrointestinal function. Through manual techniques, we can also treat the organs and structures in the abdominal cavity that are related to digestion. This includes musculoskeletal areas that can affect bowel movements and function.

In addition to manual therapy, we also offer advice on lifestyle changes that can help reduce symptoms. This may include recommendations for diet, exercise, and stress management, all of which play an important role in optimizing digestion and reducing the discomfort of hidden constipation.

Reference list

(1) https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/mave-tarm/tilstande-og-sygdomme/tyktarm/forstoppelse-hos-voksne/ 

(2) https://www.sundhed.dk/borger/patienthaandbogen/mave-og-tarm/sygdomme/oevrige-sygdomme/forstoppelse-hverdagskost/ 

(3) Christian Lodberg Hvas, overlæge på afdelingen for lever-, mave- og tarmsygdomme på Aarhus Universitetshospital og klinisk lektor på institut for klinisk medicin på Aarhus Universitet (interview m. Svend Brinkmann)

(4) Danmarks Nationalleksikon: https://denstoredanske.lex.dk/gastro-colisk_refleks