Constipation

What is constipation?

Constipation means you're finding it difficult to empty your bowels, or are emptying them less frequently than usual. It's very common and, most of the time, it clears up on its own with a few simple changes to what you eat and do each day.

What are the common causes of constipation?

Most cases come down to everyday habits rather than anything more serious. Common triggers include:

• a diet that's short on fibre, or not getting through enough fluids in the day
• long stretches spent sitting or lying down, with little movement
• putting off a trip to the toilet when you feel the need to go
• a change to your usual eating pattern or daily routine, such as travelling
• feeling stressed, anxious or low, since your gut and your brain are closely linked
• certain medicines, particularly strong opioid painkillers, as a side effect

You may also notice it more during pregnancy, at certain points in your monthly cycle, or once you're past 65. Less often, it's linked to an eating disorder, weakened pelvic floor muscles, or, rarely, an underlying condition like diverticular disease or cancer of the bowel. If you suspect a medicine is to blame, mention it to your doctor rather than stopping it on your own.

Are there different types of constipation?

Doctors generally group constipation into three types, based on what's happening inside your bowel:

• with slow transit constipation, your bowel wall muscles push things along more sluggishly than usual
• normal transit constipation is the type most people have, where your bowel muscles work as they should but symptoms still occur, often alongside irritable bowel syndrome
• a defaecatory disorder means your pelvic floor muscles make full emptying difficult, however much you strain

How is constipation diagnosed?

Your doctor will usually ask about your symptoms and when they started, and may gently feel your abdomen to check whether anything feels tender or swollen. Depending on symptoms, a rectal examination may be required. For most people, no further tests are needed.

If your doctor has any concerns, based on your symptoms, age or family history, they may arrange:

• a blood test, to check for anaemia or a thyroid or metabolic problem
• a stool sample, which can be tested for hidden blood using what's known as a FIT test
• a scope test, such as a sigmoidoscopy or colonoscopy, or a CT scan, to look at the lining of your bowel
• a transit study, an X-ray that tracks how quickly markers move through your bowel
• specialist tests of the pelvic floor's structure and function, which are rarely needed and usually only done in specialist centres

How is constipation treated?

Most people can manage constipation themselves with a few changes:

• build up your fibre intake gradually to 18–30g a day, choosing from things like brown rice and wholegrain cereals, nuts, wholemeal bread or pasta, and plenty of fruit and veg, roughly five portions between them each day
• try to get through about eight cups of fluid spread across the day
• go to the toilet as soon as you feel the urge, rather than delaying, and try raising your knees above your hip level while sitting
• get moving, since a daily walk can help things along
• take paracetamol if you're in pain or discomfort (avoid aspirin if you're under 16)

If these changes are not enough, ask your pharmacist about a laxative. Laxatives generally work by softening your stool or by stimulating your bowel to contract, and most start working within 3 days. It's best to use them for a short spell only, unless your doctor tells you otherwise, and they are not a way to lose weight.

If laxatives and lifestyle changes together do not solve the problem, your doctor may discuss:

• newer prescription medicines that improve bowel movement or increase the water content of your stool
• biofeedback, which trains you to coordinate your rectal and abdominal muscles
• psychological support, including cognitive behavioural therapy, particularly where constipation overlaps with irritable bowel syndrome
• transanal irrigation, which uses water to help empty your bowel, and you'd be shown how to use the equipment by a healthcare professional first
• surgery, which is very rarely needed and reserved for specific structural problems

When should you see a doctor?

Get in touch with your GP if home measures and pharmacy treatments are not helping, if you're regularly constipated or bloated, or if your usual bowel habit changes suddenly, particularly past the age of 40.

Get medical advice as soon as possible if you also have any of the following:

• blood in your poo, or rectal pain
• unexplained weight loss
• constant tiredness alongside your constipation
• ongoing abdominal pain

Seek urgent medical help if you develop severe bloating and pain and are unable to pass wind or you're being sick, as this can occasionally signal a blockage in your bowel.