Constipation

Overview

Constipation means having fewer bowel movements than usual, typically less than 3 per week, with stools that are hard, dry, and difficult to pass. It is one of the most common digestive complaints. Most cases are short-lived and respond well to simple measures.

How common is it?

Constipation is common at all ages, including in children. It is more common in older adults and during pregnancy. Estimates vary with how constipation is defined and measured.

Causes and risk factors

In most cases constipation is functional, related to diet, fluid intake, activity, or bowel habit. The colon absorbs too much water from stool or transit is too slow, producing dry, hard stools.

Common risk factors

• Low dietary fibre intake
• Inadequate fluid intake
• Physical inactivity
• Suppressing the urge to open bowels
• Certain medications (opioids, iron tablets, antidepressants, calcium channel blockers)
• Pregnancy
• Thyroid underactivity or other medical conditions

Symptoms

• Fewer than 3 bowel movements per week
• Hard, dry, lumpy, or pellet-like stools
• Straining to pass a stool
• Feeling of incomplete emptying
• Abdominal bloating and discomfort
• Needing to use fingers or hands to help pass stools in severe cases

When to see a doctor

See a doctor for persistent or recurrent constipation, a lasting change in bowel habit, blood in stools, unexplained weight loss or ongoing abdominal pain. Severe pain with vomiting, a swollen abdomen or inability to pass stool or wind needs emergency assessment for possible obstruction. Do not self-treat these warning signs with extra laxatives.

Diagnosis

Usually clinical. Blood tests check for thyroid disease and calcium levels. Colonoscopy or CT scan is done if cancer or structural cause is suspected. Bowel transit studies are available for refractory constipation.

Treatments

Self-care and lifestyle

• Eat a high-fibre breakfast daily
• Do not ignore the urge to open your bowels
• A low footstool under your feet while on the toilet improves the angle for natural defecation
• Regular walking significantly improves bowel transit time

Prevention

A diet high in fibre, adequate fluid, and regular physical activity prevents most cases of constipation. Regular bowel habits and prompt response to the urge to defecate help maintain normal function.