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. But if you have constipation, you’ll probably go less often and you 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 women are twice as likely as men to get it. It’s also more common in pregnant women, and people over 65. It’s common in children too.
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 they get worse or don’t get better by you taking some steps to help yourself (see below), contact your GP. Also, call your GP surgery if you get tummy pain, as 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 find you’re having more bowel movements than usual (for you), or you alternate between constipation and loose stools.
Diagnosis of constipation
If you go and see your GP about constipation, they’ll ask you about your symptoms, and how often you go to the toilet and what your poo looks like. It will help your GP if, before your appointment, you record these things in a diary. Use the infographic below to help you. Try to do this for at least a week.
Click on the icon below to download the infographic (PDF 1.8MB).
Your GP may ask about your medical history and examine your tummy (abdomen). They might also examine your back passage (rectum) by putting 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 give you, or send you to a hospital, to have some more tests. These might include the following.
- Blood tests.
- An X-ray of your tummy (abdomen).
- Sigmoidoscopy. This is a procedure that’s used to look inside your rectum and lower part of your bowel. You can read more about this in our separate topic: Flexible sigmoidoscopy.
- Colonoscopy or virtual colonoscopy. Similar to a sigmoidoscopy, these are used to look inside your large bowel. You can read more in our separate topics: Colonoscopy and Virtual colonoscopy.
The first thing to do if you’re constipated is to 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
- 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 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. Dried fruit, such as prunes, contains more sorbitol than fresh fruit.
It’s also important to drink plenty of fluids, but not those that contain caffeine, or alcohol. Aim to drink between eight and 10 cups a day (about two litres).
If you exercise more, it may help to ease constipation too. And never put off going to the toilet – go when you need to.
Treatment for constipation
Treating constipation involves first trying out the self-help treatments above. 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.
A type of medicine called a laxative can treat constipation if self-help treatments haven’t worked. You can buy some types of laxatives 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 laxatives are listed below.
- Bulk-forming laxatives, such as ispaghula husk, methylcellulose and sterculia. These work by bulking up your poo and the water it holds on to. This stimulates your bowel muscles to move and push poo out. It may take a few days for bulk-forming laxatives to work. And 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 your poo softer and easier to pass. They take a couple of days to work and it’s also important to drink plenty of water to prevent getting dehydrated.
- 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 more side-effects, such as tummy pain, particularly if you’re pregnant.
- Serotonin (or 5HT) agonists, such as prucalopride. This type of medicine causes your bowel muscles to contract, which moves poo through them. 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 laxatives for at least six months and they haven’t worked.
- A chloride channel activator, such as lubiprostone. This works by increasing the amount of fluid in your bowel, which helps poo to move through your bowel. You’ll need a prescription from a specialist doctor for this medicine. Like prucalopride, you’ll need to have already tried two different types of laxatives for at least six months.
- 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, without affecting 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, and drinking plenty of fluids.
Causes of constipation
There are lots of reasons why you may develop constipation. These include:
- your diet – if you don’t eat enough fibre or drink enough, for example
- taking certain medicines, such as some types of 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
- if you’re 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:
- anal fissure
- irritable bowel syndrome (IBS)
- underactive thyroid
- conditions that affect your nervous system, such as Parkinson’s disease or multiple sclerosis
- spinal cord injuries
- rectal or colon cancer
Some people get constipation for no obvious reason.
Complications of constipation
If you don’t take steps to treat constipation, it might cause 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 – when loose poo leaks out uncontrollably
- anal fissure
FAQ: Can I give my child laxatives for constipation?
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 Symptoms above) 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 also not have any appetite.
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 they have 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 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.
FAQ: What else can I try if laxatives haven’t worked?
If you have constipation, a pharmacist, or your GP will usually recommend you start treatment with what’s called a bulk-forming laxative. We describe the different types of laxatives and how they work in our treatment section above. If you continue to have problems, you might need to add or switch to an osmotic laxative. 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 get impacted poo, 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, often 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 (rectum) to contract. This helps you to go to the toilet. You can usually treat yourself with 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 half an hour.
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 Rachael Mayfield-Blake, Freelance Health Editor, August 2017
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