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?
About 1 in 7 adults and 1 in 3 children have chronic constipation at any one time. It becomes more common with age and affects women more than men.
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 if constipation is new, persistent, or associated with blood in stools, unexplained weight loss, severe abdominal pain, or alternating with diarrhoea. New constipation in someone over 50 should always be investigated.
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
Dietary and lifestyle changes
Increase fibre gradually to 25 to 30g per day from wholegrains, fruits, and vegetables. Drink at least 6 to 8 glasses of water daily. Exercise regularly.
Osmotic laxatives
Macrogol (Movicol, Laxido) draws water into the bowel to soften stools. Safe, effective, and suitable for regular use in both adults and children.
Stimulant laxatives
Senna or bisacodyl promote bowel contractions and are used short-term for persistent constipation. Can be used with macrogol for faecal impaction.
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.