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Constipation


Expert reviewer, Dr Angana Nankani, Bupa Clinics GP
Next review due May 2023

Constipation is a common condition that affects your usual pattern of bowel movements. You may go less often than usual or you may find it difficult or uncomfortable to go. You might also feel like you haven’t emptied your bowels completely.

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About constipation

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. Constipation really means going less often than is normal for you. If you have constipation, you’ll go less often than normal and may have hard or lumpy poo that’s smaller or larger than usual. If this goes on for longer than three months, it’s called chronic constipation.

Anyone can get constipation, but it’s twice as common in women than it is in men. It’s also common in pregnant women, people over 65 and children.

Symptoms of constipation

The main symptoms of constipation include:

  • straining when you try to have a poo
  • feeling as though you haven’t fully emptied your bowels
  • passing poo that’s either larger or smaller than normal or that’s hard and lumpy
  • having fewer than three bowel movements a week

You can usually manage these symptoms yourself or ask a pharmacist for advice. But if your symptoms get worse or don’t get better when you take steps to help yourself (see our Self-help section), contact your GP. Also, call your GP surgery if you get tummy pain because your symptoms might be due to another health condition such as irritable bowel syndrome (IBS).

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. Also, give your GP a call if you’re having more bowel movements than usual (for you) or you alternate between constipation and loose stools.

You can use this infographic to check your poo and see what’s normal, and what is constipation or diarrhoea.

Click on the icon below to download the infographic (PDF 1.8MB).

Checking your poo infographic

Diagnosis of constipation

If you go and see your GP about constipation, they’ll ask you about your symptoms, how often you go to the toilet and what your poo looks like.

Your GP may ask about your medical history and examine your tummy (abdomen). They might also examine your back passage (rectum) by gently inserting their finger up into your rectum to check the area. They’ll use some lubricant and wear gloves. This can feel uncomfortable but shouldn’t be painful.

If your GP wants to rule out other health conditions, they may ask you to have some more tests. These might include:

  • blood tests
  • X-ray of your tummy (abdomen)
  • sigmoidoscopy – an investigation to look inside your rectum and lower part of your bowel
  • colonoscopy – an investigation to look inside your large bowel (colon)
  • virtual colonoscopy – a CT scan of the inside of your large bowel

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Self-help

Diet and changes to your lifestyle can help relieve constipation. Make sure you eat plenty of fibre and drink enough fluids. This can help to treat constipation and is 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
  • rolled oats or oat bran
  • seeds such as flax seeds
  • pulses such as peas and beans (though for some people, these can cause some bloating)

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 because it can take up to a month 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 poo. Sorbitol is in lots of fruits including apples, apricots, grapes, plums and strawberries, prunes and other dried fruits.

Doing regular exercise can also be helpful. It doesn’t need to be too strenuous or vigorous – modest exercise can help ease constipation.

Treatment for constipation

Treating constipation involves first trying out self-help treatments. If these don’t work, there’s a range of medicines that you might want to try. If your constipation is caused by another health condition, your GP will treat this. If it’s caused by any medicines you take, they’ll look at alternatives.


Medicines

A type of medicine called a laxative can treat constipation if self-help treatments haven’t worked. You can buy some types of laxative over the counter from a pharmacist without a prescription. You may need to try more than one type to see if they work for you. 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 common types of laxative are listed below.

  • Bulk-forming laxatives such as ispaghula husk, methylcellulose and sterculia. These work by bulking up your poo and drawing in water. This stimulates your bowel muscles to move and push poo out. It may take a few days for bulk-forming laxatives to work. Drink plenty of fluids when you take them.
  • Osmotic laxatives such as macrogols and lactulose. These work by drawing water into your bowel, which makes your poo softer and easier to pass. They take a couple of days to work. Drink plenty of water to prevent dehydration.
  • Faecal softeners such as docusate sodium. These work by increasing the amount of water your poo holds onto, softening your bowel movements. They should work within a day or two.
  • 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 side-effects such as tummy pain.

Suppositories and enemas

Glycerol suppositories and sometimes sodium phosphate enemas (both of which you can insert yourself) can be helpful for easing constipation. Glycerol suppositories soften your poo and stimulate your bowel muscles to move. Sodium phosphate enemas draw water into your lower bowel making your poo softer and easier to pass. For more information on glycerol suppositories, see our FAQ: What else can I try if laxatives haven't worked?

Other medicines

If the remedies mentioned so far haven’t worked or your constipation is caused by taking certain medicines, then your doctor may suggest the following.

  • Serotonin (or 5HT) agonists, such as prucalopride. This type of medicine causes your bowel muscles to contract, which moves poo through your bowel. You’ll need a prescription from a specialist doctor for this. They’ll only suggest it if you’ve tried at least two different types of laxative for at least six months and they haven’t worked.
  • Opioid antagonists, such as naloxegol. If your constipation is caused by taking opioid medicines such as codeine and morphine and laxatives haven’t helped, your doctor might suggest you try this. This type of medicine counteracts how opioids affect your digestive system but doesn’t affect their ability to tackle pain.

Once you get back to normal, you should be able to gradually stop taking laxatives but it can take several months to stop completely. Keep your bowels working well by eating a balanced diet with enough fibre, drinking plenty of fluids and doing regular exercise.

Causes of constipation

There are lots of reasons why you may develop constipation. These include:

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

Long-term constipation (chronic constipation) can lead to complications, such as:

  • faecal impaction – when hard poo collects in your rectum and you reach a point where you can’t go at all
  • incontinence – sometimes called overflow diarrhoea, when liquid poo leaks out uncontrollably around the impacted poo
  • piles
  • anal fissure

Frequently asked questions

  • If your child has constipation, it’s best to go and see your GP to get some advice. They’ll probably advise you to make some changes to your child’s diet, and may give them a laxative.

    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 our Symptoms section) there are other things to look out for in children. For example, poo may leak onto their underwear or they may not want to use the toilet. They may not have any appetite. Constipation may be a sign that your child has a urinary tract infection.

    If you think your child may be constipated, go to see your GP. They may prescribe a laxative, usually a type called an osmotic laxative, to soften their poo. Your GP will give you some advice about your child’s diet too. It’s important children have enough fibre in their diet; sources of fibre include fruit, vegetables, baked beans and wholegrain cereals. Make sure they drink enough water and other drinks. Fruit juice, particularly prune juice or apple juice, can help soften poo naturally. And make sure they’re getting plenty of exercise.

    If your child’s symptoms are severe and these 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 they’re toilet training, give them rewards as encouragement.

  • If you have constipation, a pharmacist or your GP will usually recommend you start treatment with what’s called a bulk-forming laxative. See our Treatment section for more information about laxatives. If you continue to have problems, you might need to add or switch to an osmotic laxative. this sort of laxative draws water into the bowel. If you find your poo is soft but you still find it difficult to have a bowel movement, you can try a stimulant laxative.

    If you’ve tried these medicines but still have constipation, you might have impaction, which is when hard poo collects in your rectum and you reach a point where you can’t go at all. If this happens to you, your GP will tackle this first.

    They’ll adjust doses and combinations of laxatives to clear the impacted poo out but it might take several days to work.

    If this doesn’t work, your GP might suggest a glycerol suppository. A suppository (pronounce suh-poz-i-tree) is a way of delivering medicine into your body by putting it up into your back passage (rectum). Glycerol is a mild irritant, so a glycerol suppository works by encouraging muscles around your back passage to contract. This helps you to go to the toilet. You can usually use a suppository at home. You’ll need to push it up through your anus and up into your rectum as far as possible – it might help to moisten it with water first. It will start to work and you’ll have a bowel movement within about 20 minutes.

    After this, it’s important to take steps to keep your bowel working properly. Make sure you eat a healthy diet that contains plenty of fibre, drink plenty of fluids and get lots of exercise.


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  • Reviewed by Liz Woolf, Freelance Health Editor and Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, May 2020
    Expert reviewer, Dr Angana Nankani, Bupa Clinics GP
    Next review due May 2023



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