Overview
Constipation is one of the most common digestive complaints and affects people of all ages, with women and older adults affected somewhat more often. Chronic constipation is generally diagnosed when, for at least three months, there are fewer than three bowel movements per week or symptoms such as excessive straining, hard stools and a feeling of incomplete evacuation. Many people find the subject uncomfortable and postpone seeing a doctor. A telemedicine video consultation offers a discreet alternative: based on a structured medical history, the doctor can narrow down the likely cause, recommend dietary and lifestyle measures and, following medical evaluation, issue a private prescription for suitable laxatives. The doctor also checks whether warning signs are present that would require a physical examination or further in-person diagnostics. Billing is carried out as a private medical service under the German medical fee schedule (GOÄ); privately insured patients can usually submit the invoice to their insurer.
Common causes
In most cases the condition is so-called functional constipation, with no detectable organic disease. Contributing factors include a low-fibre diet, insufficient fluid intake, lack of exercise, repeatedly suppressing the urge to defecate, and changes to daily routine, for example when travelling. Numerous medications can also trigger or worsen constipation, including opioid painkillers, certain antidepressants, iron-containing preparations and some blood pressure medications. Hormonal changes, for example during pregnancy, as well as conditions such as an underactive thyroid, diabetes mellitus or irritable bowel syndrome can also be causes. Less commonly, narrowing of the bowel or disorders of pelvic floor function are responsible. An essential part of the medical consultation therefore consists of systematically narrowing down these causes and specifically reviewing current medication for constipation-promoting agents.
When to see a doctor
Medical evaluation is advisable if constipation persists for more than a few weeks, does not improve despite dietary and exercise measures, or if laxatives are repeatedly needed. Certain warning signs should be examined in person promptly: blood in or on the stool, black-coloured stools, unintended weight loss, fever, symptoms at night, known anaemia, and a new, persistent change in bowel habits, particularly from the age of 50. In these cases a colonoscopy may be necessary, which can only be performed in person. If severe abdominal pain, a distended hard abdomen, repeated vomiting, or a complete inability to pass stool and wind occurs, a bowel obstruction is suspected: in this case call emergency services immediately (112 in Germany).