There’s nothing more frustrating than trying to go to the toilet but not being able to go no matter how much you strain. But you’re not alone – lots of people of all ages suffer from constipation where they have less than three bowel movements a week and when they do, their poos are larger than normal, hard, dry or lumpy. Diet and lifestyle changes are the best way to get your bowels working normally but if that doesn’t work and you need a little extra help we can get you the right medication.
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We all experience constipation at some point in our lives. In order to prevent and manage this condition you need to first understand what causes it.
Constipation is a very common condition that can occur in people of all ages. Constipation sufferers can be affected in a variety of ways including;
The severity of constipation varies from person to person – constipation is when you are passing stools less frequently than you would normally. For many people constipation is an acute, short term issue that is easily treated. For others it can be a chronic, long-term issue that can cause considerable pain and discomfort, affecting ones quality of life. The type of constipation you suffer with will affect the type of treatment used.
Your colon extracts water from your food. However, as waste builds in your colon, it can lose too much of its water content, making it dry and harder to pass and hence resulting in constipation. Constipation has many causes, the most common being:
To put it simply, a reduction in the number of times in which you would normally pass a stool could be a symptom of constipation. If you need to strain or feel as though you are unable to completely empty you bowel then you may be constipated.
The symptoms of constipation may include:
Diagnosis of constipation will rarely include any tests or procedures. Normally constipation can be self-diagnosed and treated although you should see your GP if you experience:
If you decide to visit your GP, they can make a diagnosis based on your medical history and symptoms. Performing this diagnosis will usually involve questions about your bowel habits, diet and levels of exercise. It is important not to feel embarrassed about discussing this with your GP as it could affect their decision and choice of treatment.
If a physical test is required it will usually involve the GP feeling the abdomen. An internal examination will involve a lubricated, gloved finger being inserted into the rectum, where the GP will be able to feel for any hard, dry stool that has collected (faecal impaction). If symptoms are severe, your doctor may need to perform blood or thyroid tests to rule out the possibility of any underlying conditions.
Treatment for constipation will vary, depending on the cause, severity and how long you have suffered.
In most simple cases it is possible to relieve the symptoms through simple dietary and lifestyle changes. For example:
If these lifestyle choices aren’t sufficiently adequate then you may wish to try a laxative. Laxatives are medicines designed to help you pass stools. There are several different types of laxatives available, which all work in a different way.
Stimulant laxatives are best suited if your stools are soft but you still experience difficulty passing them. These laxatives work by stimulating the muscles in your digestive tract, which helps progress the stool through the large intestine and into the anus. The most common example of stimulant laxatives are Senna (Senokot, ExLax), Bisacodyl (Dulocolax), Sodium Picosulphate (Picolax, Dulcolax Pico). These laxatives are fairly fast acting and usually take effect within 6-12 hours. This form of laxative is ideally suited for short-term use only.
Bulk-forming laxatives contain high levels of fibre which swells when in comes into contact with water in the gut. This will increase the volume of the faeces, making them easier for the digestive to push through the system and pass. The absorbed fluid also helps to keep them soft, again making them easier to pass. Examples of bulk-forming Laxatives include; Ispaghula Husk (Fybogel) and Sterculia (Normacol).
It’s important when taking bulk-forming laxatives to drink plenty of fluids. It’s also advised not to take them immediately before going to bed, as it may solidify and get stuck in the throat if taken when lying down. The effects take a little longer to take effect in comparison to stimulant laxatives, usually between 2-3 days. Bulk-forming laxatives are usually a GP’s first line of treatment for most cases of constipation and are particularly useful where problems are caused by low faecal volumes. They should not be used in cases of faecal impaction as they can make the problem worse due to adding extra bulk to an already blocked system.
Osmotic laxatives have a similar effect to bulk-forming laxatives; they increase the amount of fluid in the bowels. This helps to stimulate the bowel and soften the stools. Osmotic laxatives are usually used if bulk-forming laxatives have been tried without success. Common examples of Osmotic Laxatives include Lactulose and Macrogol (Movicol, CosmoCol). As with the bulk-forming laxatives it usually takes 2-3 days to have an effect. Osmotic laxatives are a popular first choice for people suffering with occasional constipation due to their more ‘gentle’ effects.
Suppositories and enemas (Micralax, Cleen) are usually used to treat faecal impaction where osmotic and stimulant laxatives have been unsuccessful or where bowel cleansing is required, for example before a medical procedure. They are generally a more serious intervention and usually act very quickly.
There are several steps you can take to prevent getting constipated. Making sure you’re eating enough fibre is very important, as most adults do not get enough. The recommended intake of dietary fibre is 18 grams a day. Food rich in fibre includes; fruit, vegetables, seeds, nuts, oats, wholemeal bread, wholegrain rice, whole-wheat pasta. By eating more fibre your bowel movements will become more regular as it helps move food through your digestive system with more ease. It is recommend to slowly introduce more fibre into your diet. An excessive, immediate increase may cause stomach cramping and or discomfort, bloating and increased flatulence.
Exercise is important in preventing constipation. Staying active will not only reduce your chances of experiencing constipation, it will also make you feel better, healthier with increased energy levels. The minimum recommended amount of physical activity per week is 150 minutes.
Drinking plenty of fluids will help prevent constipation. Staying hydrated, particularly when partaking in exercise or when it’s hot is very important to keep the bowels functioning properly. Cutting back on the amount of caffeine, alcohol and fizzy drinks you consume will also reduce the risk of developing constipation.
Don’t ignore the call to go to the toilet. Ignoring the urge to go to the toilet can lead to constipation so it’s important to always answer the call of nature. When you go to the toilet try to ensure you have enough time and privacy to comfortably pass stools in a relaxed environment.
Constipation is more common in women. It is not entirely understood why but it is thought that women suffer with constipation almost three times more often than men.
There is no set number of times a day or week that you should have a bowel movement, everyone is different in their make up and metabolism. For some people going a number of times a day will be normal whereas in others it may only be once or twice a week.
The important thing to remember is that constipation is a change in your normal frequency of bowel movements.
Constipation is not normally anything to worry about – most people will likely experience it at some point in their life and will find it easy to treat using the methods mention above in ‘Treatments’.
Constipation, however, can become a serious issue if it is persistent or you have been unable to pass a bowel movement in over 7 days. If this is the case you should see you doctor for investigation and treatment.
Yes, diet is the most common cause of constipation. Constipation can potentially be caused by too much or too little fibre in the diet. A balanced diet containing fruits, vegetables, seeds, nuts and wholegrain products will give you adequate fibre to keep your bowels healthy – you should aim for around 18g of fibre a day.
Ensuring you stay properly hydrated will also help to keep your stools soft and easy to pass.
No not at all, constipation is common in pregnancy – it is thought to affect around 40% of pregnant women. It is normally due to a number of causes including changing hormones, the positioning of the baby and iron supplements.
Most cases of constipation are short-lived and can be managed by adhering to the lifestyle advice detailed in ‘Prevention’ above. Failing lifestyle changes, gentler laxatives such as Fybogel, Movicol or Lactulose may provide relief.
Yes, laxatives are perfectly safe to use if they are used occasionally following the manufacturer’s directions. Irregular use for a few days at a time to help resolve occasional constipation is no problem and will not be ‘habit-forming’ as commonly perceived.
If constipation is frequent or problematic then it is not advised to continually self-treat – frequent or persistent constipation can be a sign of an underlying condition and needs to be investigated by a doctor.
Authored by
Andy is a co-founder and the Superintendent Pharmacist and Director at The Independent Pharmacy.
Reviewed by
Dan is an experienced pharmacist having spent time working in both primary and secondary care. He currently supports our clinical team by providing robust clinical governance review of our internal processes and information.
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