Constipation
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is constipation?
Constipation means infrequent bowel movements, hard stool or difficulty passing it. Normal frequency varies widely from three times a day to three times a week, so the pattern and difficulty matter more than a fixed number. Most cases are functional, but new persistent change in an adult needs assessment.
Causes
- Low fibre and fluid intake
- Physical inactivity
- Ignoring the urge to defecate
- Medicines including opioids, iron and some antidepressants
- Hypothyroidism and diabetes
- Pelvic floor dysfunction
- Bowel obstruction or cancer in a minority
Symptoms
- Fewer than three bowel movements per week
- Hard, dry or lumpy stool
- Straining to pass stool
- Sensation of incomplete emptying
- Abdominal bloating and discomfort
- Needing manual assistance to pass stool
- Overflow soiling in children with impaction
Risk factors
- Older age
- Female sex, particularly in pregnancy
- Low fibre diet
- Opioid use
- Immobility
- Neurological conditions such as Parkinson disease
Diagnosis
- History of stool frequency, consistency and straining
- Bristol stool chart assessment
- Abdominal and rectal examination
- Blood tests for thyroid function, calcium and anaemia
- Colonoscopy if alarm features are present
- Transit studies or anorectal physiology in refractory cases
Treatment
- Increasing dietary fibre gradually
- Adequate fluid intake
- Regular physical activity
- Responding promptly to the urge to defecate
- Bulk forming laxatives such as ispaghula
- Osmotic laxatives such as macrogol
- Stimulant laxatives for short term use
- Reviewing constipating medicines
Self care
- Increase fibre gradually, since a sudden jump causes bloating
- Drink enough fluid, which fibre needs to work
- Move more, since walking stimulates bowel activity
- Do not ignore the urge to go
- Use a footstool to raise the knees above the hips when sitting
- Allow unhurried time, ideally after a meal
- Review constipating medicines with your pharmacist
When to see a doctor
Book an appointment if:
- A change in bowel habit lasting more than a few weeks
- Constipation not responding to fibre, fluid and laxatives
- Needing to press around the anus to pass stool
- Alternating constipation and diarrhoea
- Constipation with unexplained weight loss or tiredness
- Recurrent constipation in a child
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Eat enough fibre from a mix of sources
- Drink adequately through the day
- Stay physically active
- Respond to the urge promptly
- Manage medicines known to cause constipation
- Establish a regular unhurried routine
Outlook
Most constipation improves with fibre, fluid, activity and, when needed, laxatives, and does not cause lasting harm. Chronic constipation can persist and may need ongoing laxative use, which is safe with the bulk forming and osmotic types. New persistent change in bowel habit, particularly over 50, needs investigation because it can be the first sign of bowel cancer.
Common questions
What warning signs need investigation?
New persistent change in bowel habit over age 50, rectal bleeding, unexplained weight loss, anaemia, a family history of bowel cancer, or constipation with vomiting and no wind require prompt assessment.
Are laxatives habit forming?
Bulk forming and osmotic laxatives can be used long term safely. Prolonged daily stimulant laxative use is generally discouraged, though it is sometimes necessary, for example with ongoing opioid treatment.
Does everyone need a daily bowel movement?
No. Anywhere from three times daily to three times weekly can be normal. Difficulty, hardness and a change from your own usual pattern are more meaningful than frequency alone.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.