Constipation

Constipation means passing stools less often than usual, or finding them hard to pass. Almost everyone has it at some time. Bowel habits differ, so what matters is what is normal for you, but fewer than three bowel movements a week, or hard, dry, painful stools, is the usual yardstick.

It is more common in pregnancy, after childbirth and over the age of 65, and can sometimes be a sign of another problem.

• Fewer than three stools a week, or less often than usual for you
• Stools that are hard, dry or lumpy
• Straining or pain when passing stools
• A feeling that the bowel has not emptied fully

There may also be tummy ache, bloating or nausea. In older people, including those with dementia, it can show up as confusion.

See a doctor if constipation does not improve with self-care or keeps returning, or if there is blood in the stools, weight loss without trying, tiredness all the time, tummy pain or a sudden change in bowel habit. Do not stop a prescribed medicine yourself. A family history of bowel cancer is a reason to be checked sooner.

Often there is no obvious cause. Common contributors are:

• Too little fibre, such as fruit, vegetables, pulses and wholegrains
• Not drinking enough fluids
• Little physical activity
• Ignoring the urge to go to the toilet
• Some medicines, such as iron tablets, antacids, opioid painkillers, and some for depression, epilepsy or high blood pressure
• Stress, anxiety or depression

Less often, a condition such as an underactive thyroid, diabetes, irritable bowel syndrome or coeliac disease is behind it. Bowel cancer is a rare cause.

• Older age
• Being a woman, especially during or after pregnancy
• A low-fibre diet or low fluid intake
• Little physical activity
• Taking medicines or supplements that cause constipation
• Diabetes, an underactive thyroid or Parkinson's disease

Most constipation causes no lasting harm. Long-term constipation can lead to faecal impaction, where hardened stool builds up in the rectum. The main sign is watery stool leaking around it. This needs treatment from a healthcare professional, so do not try to remove the stool yourself.

Straining can also make piles (haemorrhoids) more likely.

• Eat plenty of fibre, such as fruit, vegetables, pulses, oats and wholegrains, adding more a little at a time
• Drink enough fluids
• Stay active, for example with a daily walk
• Go to the toilet when you feel the urge, at a regular time, and take your time
• Rest your feet on a low stool so your knees are above your hips

A doctor asks how often you pass stools, what they look like, and about your diet, activity and every medicine you take, then examines your tummy and may do a rectal examination. Noting your bowel movements beforehand helps.

Tests are not always needed. If they are, they may include:

• Blood tests, for anaemia, an underactive thyroid or coeliac disease
• Stool tests, for blood, infection or inflammation
• A colonoscopy or sigmoidoscopy, to look inside the bowel

Most people improve with more fibre and fluids, daily activity and a regular toilet routine, though it can take days to weeks.

If this is not enough, a pharmacist or doctor may suggest a laxative for short-term use, such as fibre supplements, laxatives that draw water into the bowel, stool softeners, or stimulant laxatives for severe cases. If a medicine is the cause, the doctor may change it.

If these fail, a doctor may prescribe other medicines to soften stools or help the bowel move, or suggest biofeedback to retrain the muscles used to pass stools. Faecal impaction needs stronger laxatives, suppositories, enemas or removal of the stool by a professional.