Patient information from BMJ

Constipation

Last published:Mar 17, 2023

Being constipated can make you feel uncomfortable. Eating more fibre, drinking more fluids, and taking some gentle exercise might help. If that doesn't help, there could be something else causing your symptoms.

You can use our information to talk to your doctor or pharmacist and decide which treatments are right for you.

A sign of something else?

Constipation is very common and is not usually serious. But sometimes it can be a sign of another, sometimes more serious condition. If you have symptoms that come on suddenly, or if you have other worrying features, your doctor may want to do some tests to rule out other causes, such as colon cancer.

You should see your doctor if you have any of the following symptoms alongside constipation, or if you have constipation and you are over 50 years old:

• Rectal bleeding. Blood in stools is usually caused by piles (haemorrhoids). But it can sometimes be a sign of a more serious condition.

• Sudden weight loss

• Constipation that came on suddenly

• A feeling that something is blocking or obstructing your stools

• Rectal prolapse (this is when part of your rectum sticks out through your anus)

• Change in the thickness and shape of your stools.

What is constipation?

If you have constipation you have difficulty passing stools, or you don't pass a stool very often, or your stools are very hard. It is very common.

In most people constipation is not a sign of anything serious and can usually be treated with some simple lifestyle changes. This information is about constipation not linked to another condition.

What are the symptoms?

It's hard to say exactly when someone is constipated. Bowel habits vary a lot, and people have different ideas about what's normal. Your bowel movements becoming less frequent is often the best way of telling if you're constipated.

Constipation is often linked to not eating enough fibre, not drinking enough fluids, and not taking enough exercise. Sometimes medicines and supplements can cause constipation, so be sure to tell your doctor if you are taking any.

If you have constipation:

• you find passing a stool difficult or uncomfortable, even though you go to the toilet fairly regularly, or

• you don't pass a stool often enough.

You may also find that your stools are hard or lumpy. You may feel that your bowels aren't completely empty after going to the toilet. Sometimes there are other symptoms, such as stomach pain or feeling bloated or tired.

Constipation is very common. But if it lasts longer than a few weeks you should see your doctor.

Your doctor will probably be able to diagnose constipation by asking you about your symptoms. Most people don't need any tests for constipation. You'll need tests only if your doctor wants to make sure there isn't something more serious that's causing your symptoms.

What treatments work?

The treatments for constipation depend on what your doctor thinks might be causing it.

Constipation caused by medicines or by another condition

Constipation can be a symptom of another medical condition, such as Parkinson's disease or irritable bowel syndrome, or it can happen during pregnancy. Constipation can also be caused by colon cancer. So it's important to get it checked out.

Another common cause is certain medications, so it's important to tell your doctor about any medicines or supplements you are taking. If your constipation is caused by medications, your doctor may be able to prescribe other treatments instead.

If your constipation is caused by being pregnant your doctor will probably suggest that you try eating a high-fibre diet and possibly try taking laxatives. He or she might also suggest that you stop taking iron supplements if you are taking them.

Fibre makes stools bulkier and softer. High-fibre foods include:

• bran

• root vegetables

• nuts

• fresh or dried fruit

• wholemeal cereals, and

• wholemeal bread and wholemeal pasta.

Constipation with no obvious other cause

If your constipation is not caused by another condition or by a medication, the treatment your doctor suggests might depend on how long you have had your symptoms.

Constipation that comes on slowly or has been going on for a long time, and that doesn't have a specific medical cause, can usually be treated by some simple changes to your lifestyle. For example, you should:

• add more fibre to your diet

• try to do some exercise every day: for example, walking or running. Many people find that this helps, especially if they are not usually very active.

• make sure you drink plenty of fluids. This should make your stools heavier and more slippery.

Constipation that does not improve

If changes to your lifestyle don't help enough, you may need to take laxatives as well. You can buy some types from a pharmacy without a prescription. But you should see your doctor if you need to take them for longer than two weeks.

There are two types of laxative that people usually try first. These are bulk-forming laxatives and stool softeners. If you have hard stools then stool softeners may be more suitable for you. If you sometimes have loose stools in between periods of constipation, you may find that bulk-forming laxatives are more helpful.

If you would prefer a natural laxative prunes work well for many people. This is because they contain a lot of fibre.

If your symptoms don't improve after about 6 weeks your doctor might recommend a stronger, prescription laxative. There are several types. Some are not suitable for pregnant women and some can cause side effects in some people, such as headaches, nausea, and diarrhoea.

Your doctor should talk to you about who these drugs are suitable for and about side effects before you start taking them.

Constipation caused by muscle problems (dyssynergia)

Some people have a condition called dyssynergia. This means that some of their muscles don't work in a regular, predictable way. Dyssynergia that involves the muscles around the anus can cause problems with passing stools, including constipation.

If you have dyssynergia you might be offered a treatment called biofeedback training. This treatment helps you gain control over physical processes that are causing you problems, including muscle problems such as dyssynergia.

You will have sessions with a therapist who will help you understand how your muscles work and how to control them better. Most people with dyssynergia find that their symptoms improve with biofeedback training.

Long-term problems

People with severe constipation that doesn't improve with any of the treatments listed above may be able to have surgery. But this is usually a last resort.

There are several types of surgery including colectomy and caecostomy. Colectomy involves removing part of the colon in order to make passing stools easier. Caecostomy involves removing anything that is causing an obstruction in the bowel.

What will happen to me?

Most constipation lasts for just a few days. If it lasts longer there are treatments that can help. Changes to your lifestyle and laxatives when needed are effective in most people.

Constipation rarely becomes serious. But if it doesn't go away and is left untreated it can lead to complications including anal fissures (tears in the skin of the anus), haemorrhoids, and faecal impaction (hard stools that won't pass). So it's important to get treatment if the problem continues.