Constipation

The definition of constipation is when you have any of the below signs: 

• Difficulty passing stools, which are often dry, hard and sometimes lumpy and may also be unusually large or small — you may strain or feel pain when passing a stool
• Feeling bloated or that your bowel is not completely empty — you may also have a stomach ache and/or feel sick
• Needing help to pass a stool eg by pushing on your stomach or using a finger to help remove a stool from your bottom
• Three or fewer bowel movements a week or, if your bowel movements have always been infrequent, a change in your usual pattern

Constipation is a common condition. At any time, one in seven adults is constipated, with women twice as likely to be affected as men. It’s also estimated that one in three children suffers from constipation, often linked to toilet training. Irritable bowel syndrome can also cause constipation and you can experience abdominal pain or anal pain. 

Although constipation can affect you at any age, you’re more likely to have it as you get older. If you are looking after someone with dementia, it can be easy to miss that they have constipation — look out for behavioural changes that suggest they are uncomfortable or in pain. 

Constipation is also common during pregnancy and after having a baby.

Constipation may happen suddenly and only for a short time (acute) or may be gradual and long-term (chronic). However, whether acute or chronic, simple lifestyle and diet changes usually bring constipation relief.

• It’s often difficult to pinpoint the cause of acute or chronic constipation. In many cases, it is caused by not eating enough fibre (eg fruits, vegetables and cereals), not drinking enough fluids, not taking enough exercise or repeatedly stopping yourself from passing stools when you feel the urge. Sitting or lying down for long periods of time can also cause constipation. 

  You can also develop constipation if the movement of your stools is slowed or stopped by blockages or damage to your colon or rectum. This can occur due to: 

  • An anal fissure — a tear in the skin around your anus 
  • Bowel stricture — narrowing of your colon 
  • Rectocele — bulging of your rectum through the back wall of your vagina
  • Rectal cancer 

  Nerve problems can cause constipation too by disrupting your body's ability to pass stools. They include conditions such as multiple sclerosis, Parkinson's disease, spinal cord injury and stroke.

  Other common causes of constipation include: 

  • An anal abscess
  • Anxiety, depression or stress
  • Changes to your diet eg eating a lot of dairy products 
  • Coeliac disease
  • PMS
  • Side effects of medication (eg antacids containing calcium or aluminium, antidepressants, iron tablets and narcotics) or long-term use of laxatives

Very occasionally, severe constipation can be a symptom of a medical condition, including:

• An eating disorder
• Anal fissure
• Bowel cancer — this includes colon cancer
• Haemorrhoids
• Hypothyroidism (underactive thyroid)
• Irritable bowel syndrome (IBS) or inflammatory bowel disease

Diabetes and nerve or muscle disorders, such as multiple sclerosis and Parkinson’s disease, can also cause severe constipation. 

You should see your GP if you:

• Always feel extremely tired 
• Have blood in your stools and/or your stools have dramatically changed in consistency, shape and size
• Have constipation or bloating that lasts for two weeks or more
• Have severe pain when passing stools or can't pass stools or gas at all
• Have sudden constipation with stomach cramping or pain 
• Have unintentionally lost weight

If you are taking medication (eg opioid painkillers) that is causing your constipation, you should see your GP to discuss solutions — do not stop taking any prescribed medications until you have discussed this with your GP. 

You should also see your GP if current treatments and/or lifestyle changes for your constipation are not working.

Your GP will discuss your symptoms and medical history with you and may carry out a physical examination.

Your GP may refer you for further tests, such as:

• A stomach X-ray
• Anorectal manometry to measure the strength of your rectum muscles
• Blood tests to check your thyroid and calcium levels
• Colonoscopy — a flexible tube with a camera attached is passed into your colon to check for blockages
• CT scan to check for obstructions in your digestive system
• Transit study examination — you will swallow special capsules that show up on an X-ray to determine how long it takes for food to travel through your digestive system

Your GP may also refer you to a gastroenterologist, a consultant who specialises in the digestive system.

In most cases, simple changes to your diet and lifestyle should bring constipation relief. Home remedies for constipation include:

• Avoiding alcohol but drinking more fluids — aim to drink two to four extra glasses of water every day unless your doctor advises against this because of other health conditions or medications you are taking; try drinking warm fluids, particularly in the mornings
• Being more active
• Getting into the habit of passing stools at roughly the same time every day and not rushing toilet visits — don’t delay passing a stool if you feel the urge
• Increasing the amount of fibre you eat — more fruit (eg prunes), vegetables and wholegrain/wholemeal bread, cereals and pasta; you can also add wheat bran, oats and linseed to your diet
• Raising your feet slightly (eg on a small stool or large book) when sitting on the toilet

If you continue to be constipated, your GP might prescribe laxatives or another medication. Your GP might also refer you to a dietitian for specialist advice about constipation relief.

If changes to your diet and lifestyle are not improving your constipation symptoms, you can speak to a pharmacist. They may recommend an over-the-counter laxative. Laxatives help you pass stools more regularly and usually start working within three days. However, they should only be used in the short term. 

Long-term constipation can cause faecal impaction. This occurs when stools accumulate in your rectum. The most common symptom is diarrhoea after a long period of constipation. 

Faecal impaction can be treated with:

• A mini-enema — fluid passed through your bottom and into your bowel
• A suppository — medication placed in your bottom
• Prescription laxatives — these are stronger than over-the-counter laxatives and can be prescribed by your GP
• Removal of your stools by a healthcare professional — you should not try to do this yourself

Long-term constipation can also cause haemorrhoids. This occurs when veins around your anus swell — this can happen when you often strain to pass a stool. Straining to pass stools can also cause a rectal prolapse where part of your rectum stretches and bulges out of your anus.

Long-term constipation can cause anal fissures too — small tears around your anus — due to the strain of passing large or hard stools.