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Constipation

Constipation is a common condition that affects your usual pattern of bowel movements. You may go less often than usual, or it can be difficult or uncomfortable to go.

Although anyone of any age can get constipation, women are twice as likely as men to get it. It’s also more common in pregnant women and people over 65.

People’s bowel habits vary – while some people go more than once a day, others may go every other day or less. Neither of these is necessarily a problem if it’s usual for you and you aren’t having any difficulties.

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  • Symptoms Symptoms of constipation

    The main symptoms of constipation include:

    • straining when you try to have a bowel movement
    • feeling as though you haven’t fully emptied your bowels
    • passing faeces that are either unusually large or small, or that are hard and lumpy
    • having fewer than three bowel movements a week
    • pain or discomfort in your tummy (abdomen)

    You can probably manage these symptoms yourself, or with a pharmacist’s advice. But if they get worse or aren’t helped by self-help measures (see below), contact your GP.

    If you notice any blood coming from your back passage (rectum), on toilet paper or in the toilet, contact your GP as soon as possible.

  • Diagnosis Diagnosis of constipation

    Your GP will ask you about your symptoms. Before your appointment, note down how often you go to the toilet and what your faeces look like. Try to do this for at least a week. Your GP may also ask about your medical history and examine your tummy (abdomen) and back passage (rectum).

    Your GP may suggest referring you to have some tests to rule out other medical conditions.

    • Blood tests – you may be able to have these at your GP surgery.
    • Sigmoidoscopy. This is done using a narrow, telescopic camera to look inside your rectum and lower part of your bowel.
    • Colonoscopy. Similar to a sigmoidoscopy, this involves using a telescopic camera to look inside your large bowel.
    • Barium enema X-ray. This test involves placing a fluid containing barium (a substance which shows up on X-rays) into your bowel through your anus. X-ray images of your tummy then show the inside of your bowel more clearly.
  • Treatment Treatment of constipation

    Treating constipation involves first making changes to your lifestyle. If these don’t work, there’s a range of medicines that you may wish to try.

    Self-help

    Eat plenty of fibre. Not only can it help to treat constipation but it’s also good for your general health. Fibre is in all types of fruit and vegetables, so aim to eat at least five portions of these a day.

    Other good sources of fibre include:

    • wholegrain cereals
    • wholemeal bread
    • brown rice
    • wheat bran
    • rolled oats or oat bran
    • seeds, such as flax seeds
    • pulses, such as peas and beans

    If you don’t currently eat much fibre, increase the amount in your diet slowly, otherwise you may feel bloated and pass wind. Stick with a high-fibre diet even if your symptoms don’t immediately improve as it may take a few weeks to have an effect.

    You might also find it helps to include a naturally occurring sugar called sorbitol in your diet. This draws water into your bowel which can soften your faeces. Sorbitol is in lots of fruits including apples, apricots, grapes, plums and strawberries. Dried fruit, such as prunes, contains more sorbitol than fresh fruit.

    It’s also important to drink enough fluid (that doesn’t contain caffeine or alcohol); aim to drink between eight and 10 cups a day. Fibre absorbs water and increases the bulk of waste matter in your bowel, which helps to move digested food through your bowel more easily.

    If you exercise more, it may help to ease constipation too. And never put off going to the toilet – go when you need to.

    Medicines

    If you’ve tried the self-help treatments above but they haven’t helped to relieve constipation, you might like to try a laxative. You can buy some laxatives over the counter from a pharmacist without a prescription. You may need to try more than one type to help improve your symptoms. Ask a pharmacist for advice if you’re unsure which to take, especially if you’re pregnant. Always read the patient information leaflet that comes with your medicine.

    Some of the common types of laxatives are explained here.

    • Bulk-forming laxatives, such as ispaghula husk, methylcellulose and sterculia. These work by bulking up your faeces and the water they hold on to. This stimulates your bowel muscles to move and push faeces out. It may take a few days for bulk-forming laxatives to work. It’s important to drink plenty of fluids while you take them.
    • Osmotic laxatives, such as macrogols and lactulose. These work by increasing the amount of water in your bowel, which makes faeces softer and easier to pass. They take a few days to work and it’s important to drink plenty of water to prevent getting dehydrated.
    • Stimulant laxatives, such as senna and bisacodyl. These work by stimulating the muscles in your bowel to contract more often and with more force. These work more quickly than other types of laxative but can cause more side-effects if you’re pregnant. Stimulant laxatives can sometimes cause pain in your tummy (abdomen).
    • Serotonin (or 5HT) agonists, such as prucalopride. This type of medicine causes your bowel muscles to contract, which moves faeces through them. You’ll need a prescription from your GP for this. They will only suggest it if you’ve tried at least two different types of laxatives for at least six months and they haven’t worked.

    Once you get back to normal, you should be able to gradually stop taking laxatives. Keep your bowels working well by eating a balanced diet with enough fibre and fluid.

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  • Causes Causes of constipation

    There are lots of reasons why you may develop constipation, including:

    • your diet – if you don’t eat enough fibre or drink enough, for example
    • taking certain medicines, such as antidepressants, calcium or iron supplements, or painkillers (eg codeine or morphine)
    • not doing enough exercise
    • not going to the toilet when you need to go
    • stress or depression
    • if you’re pregnant – around four in 10 pregnant women get constipation, possibly because of the hormones you’re producing or if you’re taking iron supplements

    You can also get constipation as a symptom of some health conditions, which include:

    Some people get constipation for no obvious reason.

  • Complications Complications of constipation

    If you don’t take steps to treat constipation, it might cause complications, such as:

    • faecal impaction – when hard faeces collect in your rectum and you reach a point where you can’t go at all
    • incontinence – when loose faeces are forced around the impacted faeces and leak out uncontrollably
    • bleeding from your bottom
    • a urinary tract infection
    • piles
    • anal fissure
  • FAQs FAQs

    Can I give my child laxatives for constipation?

    Answer

    It’s best not to give your child a laxative without seeing your GP. They may advise you to make some changes to your child’s diet first.

    Explanation

    It’s important to be sure your child really is constipated before you give them a laxative. As well as the usual symptoms of constipation (see Symptoms above) there are other things to look out for in children. For example, faeces may leak onto their underwear or they may be irritable and not want to use the toilet. They may also pass smelly wind and not have any appetite.

    If you think your child may be constipated, go to see your GP. They will give you advice about your child’s diet. It’s important your child has enough fibre in their diet, such as fruit, vegetables, baked beans and wholegrain cereals. Make sure they drink enough fluid too, such as water. Fruit juice, particularly prune juice or apple juice, can help soften faeces naturally.

    If you’ve made changes to your child’s diet but they still have constipation, your GP may prescribe an osmotic laxative to soften their faeces. If their symptoms are severe and initial treatments don’t work, your GP may refer your child to see a paediatrician. This is a doctor who specialises in children’s health.

    Try to help your child stay relaxed about going to the toilet and give them plenty of time and regular opportunities to go. If you’re toilet training your child, give them rewards as encouragement.

    Is there any other treatment for constipation if laxatives haven’t worked?

    Answer

    If your symptoms haven’t got better by eating more fibre or taking laxatives, your GP may suggest a suppository or an enema to treat constipation.

    Explanation

    If other measures don’t help to ease constipation, your GP may suggest you take a glycerol suppository. This is a stimulant laxative that increases your bowel’s activity. You can usually treat yourself with a suppository at home but you’ll need to insert it through your anus and into your rectum. This can cause a bowel movement within about half an hour. They are generally only for occasional use to get rid of impacted faeces. This is when hard faeces collect in your rectum and you reach a point where you can’t go.

    Your GP may also suggest you try an enema to soften the faeces in your bowel, or to stimulate you to go to the toilet. You may need to have more than one enema to clear your bowel if your faeces are very hard.

  • Resources Resources

    Further information

    Sources

    • Constipation. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2015
    • Constipation. BMJ Best Practice. www.bestpractice.bmj.com, published 18 December 2014
    • Understanding constipation. American Gastroenterological Association. www.gastro.org, published January 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 12 March 2015
    • Map of Medicine. Constipation in Adults and the Elderly. International View. London: Map of Medicine; 2014 (Issue 4)
    • Constipation in adults. PatientPlus. www.patient.info/doctor, reviewed 28 February 2013
    • Constipation. Medscape. www.emedicine.medscape.com, published 1 October 2014
    • Prucalopride for the treatment of chronic constipation in women. National Institute for Health and Care Excellence (NICE), December 2010. www.nice.org.uk
    • Constipation in children and young people. National Institute for Health and Care Excellence (NICE), May 2010. www.nice.org.uk
    • Gastrointestinal disease and pregnancy. Medscape. www.emedicine.medscape.com, published 28 March 2013
    • Laxatives. Bladder and Bowel Foundation. www.bladderandbowelfoundation.org, published 2014
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, April 2015.

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