Constipation

Constipation is a very common condition that affects your usual pattern of bowel movements. Your bowel movements may occur less often than usual, or may be difficult to pass and uncomfortable.

About constipation
Symptoms of constipation
Complications of constipation
Causes of constipation
Diagnosis of constipation
Treatment of constipation
Prevention of constipation

About constipation

People's bowel habits vary – for example, some people go more than once a day, while others may go every other day. Neither of these is necessarily a problem if there has been no change in your bowel movements and you aren't having any difficulties. However, if you have constipation, there are two main ways in which you may be affected.

• You may not have bowel movements as often as you expect.
• You may have regular bowel movements, but it's uncomfortable and you have to strain.

Constipation can happen for many reasons, and is particularly common in pregnant women and the elderly. Constipation can occur at any age and is a common reason for people going to see a doctor.

Symptoms of constipation

The main symptoms of constipation include:

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

A healthy lifestyle, such as eating enough fibre and exercising regularly, can help prevent and ease symptoms of constipation. However, if your symptoms persist or if you notice any other changes in your usual pattern of bowel movement, you should seek medical advice. In particular, if there is blood from your back passage (rectum) or in the toilet, or if you experience diarrhoea alternating with constipation, you should arrange to see your doctor without delay.

Complications of constipation

If constipation isn't treated it can cause complications, including those listed below.

• Faecal impaction. This is when hard faeces collect in your rectum and you reach a point where you probably won't be able to have a bowel movement without treatment.
• Overflow incontinence. This is when small amounts of loose faeces leak out around the impacted faeces, without you feeling it.
• Bleeding from your anus.
• Psychological problems. Particularly in childhood, pain on defecating can lead to fear of going to the toilet, and there may be feelings of guilt or blame.
• Urinary tract infection.
• Haemorrhoids (piles).

Causes of constipation

There are several reasons why you may develop constipation, including:

• your diet, such as not eating enough fibre or drinking enough fluid
• taking certain medicines, such as antidepressants, calcium or iron supplements, or painkillers (eg codeine or morphine)
• being inactive
• ignoring the need to go to the toilet – because you're busy or because you worry people can see or hear you
• stress or depression
• pregnancy – around four in 10 women who are pregnant have constipation

Constipation can also be a symptom of certain medical conditions, for example:

• piles
• anal fissure
• tears to the anus following childbirth
• irritable bowel syndrome (IBS)
• underactive thyroid
• inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• conditions affecting your nervous system, such as Parkinson's disease or multiple sclerosis
• spinal cord injury
• rectal or colon cancer

If you're worried about what could be causing your constipation, seek advice from your doctor.

Diagnosis of constipation

Your doctor will ask you about your symptoms and examine you – this may include an examination of your rectum. He or she may also ask about your medical history.
Your doctor may refer you for further tests to rule out other medical conditions. These tests are listed below.

• Blood tests.
• Sigmoidoscopy. This procedure involves using a narrow, tube-like telescope (called a sigmoidoscope) to look inside your rectum and lower part of your bowel.
• Colonoscopy. This procedure involves using a narrow, flexible, tube-like telescopic camera (called a colonoscope) 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 via the rectum. X-ray images of your abdomen then show the inside of your bowel more clearly.

Please note that availability and use of specific tests may vary from country to country.

Treatment of constipation

There are several things you can do to help relieve mild symptoms of constipation.

Self-help

It's important that you include enough fibre in your diet, not only to treat constipation, but to maintain your general health. Guidelines may vary from country to country, however, aim to include plenty of fibre in your diet. Fibre is found in all types of plant-based foods, such as fruit and vegetables.
There are two types of fibre; insoluble and soluble. It's important to include both types in your diet to get the balance right.
Good sources of insoluble fibre include:

• fruit and vegetables, preferably eaten raw and in their skins
• wholegrain breakfast cereals
• wholegrain bread
• brown rice
• wheat bran

Good sources of soluble fibre include:

• oats
• seeds
• pulses, such as peas and beans

Soluble fibre can also reduce cholesterol in your blood and help control your blood sugar levels.
If you don't currently eat much fibre, it's important to increase the amount in your diet slowly, otherwise you may get bloating and wind. You should continue with a high-fibre diet even if your symptoms don't immediately improve as it may take up to four weeks to have an effect.
It's also important that you increase your fluid intake; you should aim to drink between eight to 10 cups of fluid a day. This is because insoluble fibre absorbs water and increases the bulk of waste matter in your bowel, which helps to move digested food through your bowel more easily. Increasing the amount of exercise you do may help to ease constipation too.

Medicines

If lifestyle changes don't help to relieve constipation, your doctor may suggest a laxative. You may need to try more than one type to help improve your symptoms. The types of laxative to help relieve constipation are listed below.

• Bulk-forming laxatives (ispaghula husk, methylcellulose and sterculia). These are recommended if you can't manage to increase the fibre in your diet. They contain a type of fibre and work by increasing the amount of content in your bowel. As this builds up, it stimulates your bowel muscles to move and push faeces out. It may take a few days for bulk-forming laxatives to work. You need to make sure you drink enough fluid if you take these to stop your bowel becoming blocked.
• Osmotic laxatives (macrogols or lactulose). These work by increasing the amount of water in your bowel, making faeces softer and easier to pass. These take a few days to work and it's important to drink enough water if you take these laxatives as they can be dehydrating.
• Stimulant laxatives (senna or bisacodyl). These work by stimulating the muscles in your bowel to contract more often and with increased force. These work more quickly than other types of laxative. If you take them at night, you're likely to have a bowel movement in the morning. Stimulant laxatives can sometimes cause abdominal pain.

Once your bowel movement pattern returns to usual, you may be able to stop taking laxatives and try to maintain a healthy bowel habit by eating a balanced diet with enough fluids and fibre. For children, it's important to ensure a regular bowel habit for several weeks after a regular pattern of toilet training has been established, and to taper the dose of laxatives very gradually over several months.
You may be able to buy laxatives over the counter from a pharmacist without a prescription. However, it's a good idea to see your doctor before trying laxatives because he or she may be able to give you advice on how to relieve your symptoms without needing to use medicines. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of constipation

You can reduce your risk of constipation by eating a balanced diet with lots of fibre, drinking enough fluids and taking regular exercise.