People who drink too little and have a low fiber diet tend to have hard bowel movements. Stool that is too hard can also be a sign of bowel disease. In the following, causes and treatment options are presented. In addition, there are warning signals that require medical clarification.
What is meant by a hard stool movement?
Usually stool has a rather soft consistency. Going to the toilet then poses no problems. Hard stool is however dry and consists of smaller lumps. In these cases, excretion (defecation) usually requires strong pressing. It takes more time than usual to go to the toilet if you have hard stool.
Sometimes hard bowel movements are equated with constipation. However, the definition of constipation is somewhat more complicated and includes both subjective as well as objective criteria. The following table shows how these subjective and objective criteria interact in the definition of constipation.
|Subjective level||Unsatisfactory defecation +|
|Objective level||Strong pressing...
Hard / lumpy stool…
Feeling of incomplete emptying...
Perceived obstacle to defecation...
Using hand to help is necessary at least every 4th bowel movement
|Or||< 3 bowel movements a week|
What are the causes of hard bowel movements?
Hard bowel movements occur, among other things too much water is withdrawn when the stool passes through the intestines. This can happen when the body urgently needs the fluid. In most cases, a lack of fluid is caused by low drinking volume, More rarely, excessive sweating is the cause.
Another reason for hard bowel movements is slow intestinal movement. Sitting for long periods in the office combined with too little movementt also affects the gut. On top of that, going to the toilet is often not possible immediately if you have the urge to go. It can happen then that the stool becomes harder or constipation occurs more often.
What role do foods play in hard bowel movements?
Eating fiber can stimulate bowel movement and prevent hard bowel movements. Dietary fiber is a component of food that is not absorbed into the bloodstream. Indigestible plant fibers made from cellulose are among the fibers. They can bind water and cause the stool to swell. The amount of stool is significantly affected by the dietary fiber intake. The increased volume of the stool in turn increases the muscle movement of the intestine (peristalsis). The consequence is faster passage of bowel movements through the intestine. The reason is that stretching the intestinal wall stimulates natural intestinal movements (peristalsis).
Also certain drugs and hormones, for example thyroid hormones, change the movement of the intestine. Some foods such as chocolate, black tea, and bananas may also make the stool harder.
What is special about hard bowel movements in children?
Hard bowel movements are a common cause of abdominal pain in children. In children, hard bowel movements and constipation can lead to a vicious cycle: Long and strong pressing hurts. In addition, the skin of the anal region may tear (anal fissures). For this reason, the children avoid going to the toilet and hold back the stool. This leads to constipation. The rectum can also contain extremely hard stool (also called feces stones), some of which even have to be cleared with the finger.
When do you need to see a doctor if you have a hard bowel movement?
Basically, changes in bowel movements can occur depending on the diet. This is usually harmless. However, digestion should not limit your quality of life. Seeing a doctor can therefore make sense, especially if hard bowel movements last for a few weeks. Doctors can get to the bottom of the symptoms with examinations such as ultrasound or a colonoscopy.
People over the age of 50 should generally take abnormalities in bowel movements more seriously. The reason is that the risk of colon cancer at this age increases. Blood in the stool is always a warning sign. Fever, night sweats and weight loss should also be discussed with the doctor.
With which diseases do hard bowel movements occur?
In most cases, hard bowel movements are a sign of poor nutrition, too little fluid intake and lack of exercise. However, there are also diseases that can lead to constipation and changes in bowel movements.
Stool can become too hard due to an underactive thyroid
Hypothyroidism is a common trigger for these symptoms. In addition, there are often hair and skin problems, an increased feeling of cold, an increase in weight or depressive moods.
Hard bowel movements with medication
Some medications, especially opiates, can slow bowel movements and thicken the stool. Disorders of the blood salts (electrolytes) also inhibit peristalsis. An example of this is a lack of potassium (so-called Hypokalemia). If affected people use laxatives in the long term, the loss of electrolytes can increase.
Hard bowel movements due to bowel diseases
Many bowel diseases can present through hard bowel movements. This also applies to some bowel diseases, which are more likely to lead to diarrhea. These include, among others inflammatory bowel disease like Crohn's disease or diverticulitis. With diverticulitis protrusions become inflammed in the wall of the colon. With severe inflammation, blood may be added to the hard stool.
A narrowing in the intestine can also trigger hard bowel movements. These include, for example, adhesions after operations (brides), protuberances of the mucous membrane (polyps), abdominal wall hernias or intestinal tumors. Elimination pain, constipation, and hard stool can also be caused by diseases of the rectum or anal region. In particular tears or hemorrhoids can lead to discomfort and sometimes blood in the stool.
Hard stool due to nervous diseases
In rare cases, hard bowel movements are caused by the nerves (neurogenic disorders). In Parkinson's disease, multiple sclerosis or diabetic neuropathy, the signals from the intestine are no longer properly transmitted. This leads to disorders of the bowel movements.
Hard bowel movements with irritable bowel syndrome
If no organic causes for gastrointestinal complaints are found, it may be a case of Irritable Bowel Syndrome. Most sufferers suffer from diarrhea. Others, on the other hand, are more plagued by constipation. Frequently abdominal pain, nausea, a feeling of fullness and bloating also occur. In many cases, the symptoms improve briefly after excretion (defecation).
So far it has not been finally clarified which causes lead to irritable bowel syndrome. The symptoms were often preceded by a gastrointestinal infection. Doctors therefore suspect irritable bowel syndrome to be a bacterial overgrowth, mild intestinal inflammation or an over-sensitive perception of pain. The symptoms often improve when the affected person avoids stress and gets adequate sleep. The first step in treatment is to change your lifestyle and eating habits.
What are the consequences of hard bowel movements?
Hard bowel movements can be a sign of a more serious illness on the one hand. On the other hand, hard bowel movements, if the problem persists for a long time, can lead to new diseases. It is assumed that the increased pressure in the colon, caused by pressing during defecation, promotes some diseases. For example, diverticular disease is said to occur more frequently with constipation, because the pressure tends to cause bulges. Hemorrhoids and anal fissures are also more common with hard bowel movements.
Which home remedies help against hard bowel movements?
Regular physical activity can stimulate bowel movements. The urge to defecate should also not be ignored. Instead, you should go to the toilet early.
2. Enough liquid
Stool that is too hard can often be remedied by drinking enough: one and a half to two liters of water should be consumed per day.
3. Dietary fiber
The German Nutrition Society recommends about daily 30 grams of fiber. Germans, however, only consume an average of half of this per day. You should drink a lot with a high-fiber diet. Fiber should preferably be taken in with normal food, for example with high-fiber foods such as whole grain products, (especially from rye) and vegetables and fruit.
If this is not enough, you can also get more fiber in the form of psyllium husks, bran, linseed or chia seeds. Here, however, the package information or the recommendations of the treating doctor must be observed so that you do not take too much. In addition, these agents bind a lot of water in the intestine so fluid intake has to be adjusted accordingly.
Can I use medication for hard bowel movements?
There are certain medications that soften the stool. Examples of this are lactulose or macrogol, They bind water in the intestine and thus ensure softer bowel movements. Other drugs work through acceleration of bowel movement or increase the amount of fluid in the intestine.
All laxatives can be habituating. In this case, the stool only becomes sufficiently soft if that certain drug is taken. In addition, continued use of these drugs can lead to water and electrolyte imbalances and should therefore only be done with medical supervision.
Heavily thickened faeces from the rectum may have to be removed with your fingers. The use of fatty enemas and suppositories is also possible. This can make defecation less painful. Extreme caution is required with such methods.
T. Karow, R. Lang-Roth. Allgemeine und Spezielle Pharmakologie und Toxikologie. Thomas Karow Köln, 2011. S. 392ff.
B. Koletzko. Kinder- und Jugendmedizin. 14. Auflage, Springer-Verlag Berlin Heidelberg, 2013. S. 413.
Andresen V, Enck P, Frieling T, et al. [S2k guideline for chronic constipation: definition, pathophysiology, diagnosis and therapy]. _Z Gastroenterol. _2013;51(7):651-672.
Deutsche Gesellschaft für Ernährung e.V.: Vollwertig essen und trinken nach den 10 Regeln der DGE https://www.dge.de/ernaehrungspraxis/vollwertige-ernaehrung/10-regeln-der-dge/, 27.08.2016
Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Benninga, Marc Alexander. Constipation and Constipation Predominant Irritable Bowel Syndrome: a Comparative Study Using Rome III Criteria. Journal of Pediatric Gastroenterology and Nutrition, 2016. [epud ahead of print]
Yang, Jing, et al. Effect of dietary fiber on constipation: a meta analysis. World J Gastroenterol, 2012, 18. Jg., Nr. 48, S. 7378-83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544045/, 27.08.2016
Müller-Lissner, Stefan A., et al. The perceived effect of various foods and beverages on stool consistency. European journal of gastroenterology & hepatology, 2005, 17. Jg., Nr. 1, p 109-112.