Digestive health – Constipation
Constipation is a common condition that affects people of all ages. It can mean that you're not passing stools regularly or you're unable to completely empty your bowel.
Constipation can also cause your stools to be hard and lumpy, as well as unusually large or small.
The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life.
What causes constipation?
It's often difficult to identify the exact cause of constipation. However, there are a number of things that contribute to the condition, including:
not eating enough fibre, such as fruit, vegetables and cereals
a change in your routine or lifestyle, such as a change in your eating habits
ignoring the urge to pass stools
side effects of certain medications
not drinking enough fluids
anxiety or depression
In children, poor diet, fear about using the toilet and problems toilet training can all lead to constipation.
Who is affected
Constipation can occur in babies, children and adults. It's estimated that around one in every seven adults and up to one in every three children in the UK has constipation at any one time.
The condition affects twice as many women as men and is also more common in older adults and during pregnancy.
Should I see my GP?
You may be able to treat constipation yourself by making simple changes to your diet and lifestyle (see below). If these changes do not help and the problem continues, see your GP.
You should also speak to your GP if you suspect your child might be constipated.
How constipation is treated
In many cases, diet and lifestyle changes are recommended as the first treatment for constipation.
These include gradually increasing your daily intake of fibre, making sure you drink plenty of fluids, and trying to get more exercise.
If these aren't effective, your GP may prescribe an oral laxativemedication that can help you empty your bowels.
Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established.
Making the diet and lifestyle changes mentioned above can also help reduce your risk of developing constipation in the first place.
It may also help to give yourself enough time and privacy to pass stools comfortably and you should try not to ignore the urge to go to the toilet.
For most people constipation rarely causes any complications, but people with long-term constipation can develop:
faecal impaction (where dry, hard stools collect in the rectum)
bowel incontinence (the leakage of liquid stools)
Find out how to beat common digestive problems like bloating and indigestion
Symptoms of constipation
When you are constipated, passing stools becomes more difficult and less frequent than usual.
Normal bowel habits vary from person to person. Some adults normally go to the toilet more than once a day, whereas it's normal for others to go only every three or four days. Some infants pass stools several times a day, while others pass stools only a few times a week.
A reduction in the number of times you or your child would normally pass stools could be a sign of constipation.
You may also have to strain while passing stools and you may feel unable to completely empty your bowel. Your stools may appear dry, hard and lumpy, as well as abnormally large or small.
Other symptoms you may experience if you have constipation include:
stomach aches and cramps
loss of appetite
Constipation in children
As well as infrequent or irregular bowel movements, a child with constipation may also have any of the following symptoms:
loss of appetite
a lack of energy
being irritable, angry or unhappy
foul-smelling wind and stools
stomach pain and discomfort
soiling their clothes
generally feeling unwell
When to see your GP
You may be able to help treat constipation yourself by making simple changes to your diet and lifestyle (see treating constipation for more information about this), but you should see your GP if these changes do not help.
You should also see your GP for advice if you notice any rectal bleeding, unexplained weight loss or persistent tiredness.
Take your child to see a GP if you think they may have constipation, as treatment with medications called laxatives is often recommended for children alongside diet and lifestyle changes.
Causes of constipation
Constipation usually occurs when stools remain in the colon (large intestine) for too long and the colon absorbs too much water from them, causing the stools to become hard and dry.
Most cases of constipation are not caused by a specific condition and it may be difficult to identify the exact cause. However, several factors can increase your chances of having constipation, including:
not eating enough fibre, such as fruit, vegetables and cereals
a change in your routine or lifestyle, such as a change in your eating habits
having limited privacy when using the toilet
ignoring the urge to pass stools
immobility or lack of exercise
not drinking enough fluids
having a high temperature (fever)
being underweight or overweight
anxiety or depression
psychiatric problems, such as those brought on by sexual abuse, violence or trauma
Sometimes, constipation may be a side effect of a medicine you are taking. Common types of medication that can cause constipation include:
aluminium antacids (medicine to treat indigestion)
antiepileptics (medicine to treat epilepsy)
antipsychotics (medicine to treat schizophrenia and other mental health conditions)
opiate painkillers, such as codeine and morphine
diuretics (water tablets)
If your constipation is caused by medication, the condition usually eases once you stop taking the medicine. However, you should not stop taking any prescribed medication unless your GP advises you to.
Speak to your GP if you experience constipation due to a medicine. They may be able to prescribe an alternative.
About two in every five women experience some constipation during their pregnancy, mostly during the early stages of their pregnancy.
Constipation occurs during pregnancy because your body produces more of the female hormone progesterone which acts as a muscle relaxant.
Your bowel normally moves stools and waste products along to the anus by a process known as peristalsis. This is when the muscles lining the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along.
If you are pregnant, there are ways that you can safely treat constipation without harming you or your baby.
In rare cases, constipation can be a sign of an underlying condition, such as:
irritable bowel syndrome (IBS)
hypercalcaemia – when there is too much calcium in the bloodstream
underactive thyroid gland
muscular dystrophy – a genetic condition that causes muscle wasting
multiple sclerosis – a condition that affects the nervous system
Parkinson's disease – a brain condition that affects the co-ordination of body movements
spinal cord injury
anal fissure – a small tear of the skin just inside the anus
inflammatory bowel disease – a condition that causes the intestines to become inflamed (irritated and swollen)
colon or rectal cancer
Babies and children
Constipation in babies and children is quite common. It's estimated that up to one in every three children in the UK has constipation at any time. Poor diet, fear about using the toilet and poor toilet training can all be responsible.
Children who are over-fed are more likely to have constipation, as are those who do not get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, it is very important that your child has enough fibre in their diet.
Make sure that you do not make your child feel stressed or pressured about using the toilet. It is also important to let your children try things by themselves (when appropriate). Constantly intervening when they are using the toilet may make them feel anxious and may contribute to constipation.
Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel that they are unable to use the toilets at school.
This fear or phobia may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, this will mean that their condition only worsens.
In rare cases, constipation in babies and children can be a sign of an underlying condition, such as:
Hirschsprung's disease – which affects the bowel, making it difficult to pass stools
anorectal malformation – where the baby's anus and rectum do not form properly
spinal cord abnormalities – including rare conditions such as spina bifida and cerebral palsy
cystic fibrosis – a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation
Constipation is a very common condition. Your GP will not usually need to carry out any tests or procedures, but will confirm a diagnosis of constipation based on your medical history and your symptoms.
Your GP will ask you some questions about your bowel habits. Do not feel embarrassed about discussing this with your GP as it is important they are aware of all of your symptoms so they can make the correct diagnosis.
Your GP may also ask questions about your diet, level of exercise and whether there have been any recent changes in your routines.
Doctors define constipation in a number of ways:
opening the bowels less than three times a week
needing to strain to open your bowels on more than a quarter of occasions
passing a hard or pellet-like stool on more than a quarter of occasions
If your GP suspects that you may have faecal impaction (when dry, hard stools collect in your rectum), they may carry out a physical examination. See complications of constipation for more information about faecal impaction.
A typical examination will begin with you lying on your back while the GP feels your abdomen (tummy). You will then lie on your side while the GP performs a rectal examination using a lubricated, gloved finger. Your GP can feel for any stools that may have collected.
Your GP will rarely have to conduct an internal physical examination on a child. Instead, the diagnosis can normally be made by feeling their tummy.
If you are experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions.
Other tests you may have include:
an abdominal X-ray – where X-ray radiation is used to produce images of the inside of your abdomen
transit study examination – where you are given a course of special capsules that show up on X-rays to take over the next few days, and one or more X-rays are taken later on to see how long it takes for the capsules to pass through your digestive system
anorectal manometry – where a small device with a balloon attached to one end is inserted into your rectum and is attached to a machine that measures pressure readings from the balloon as you squeeze, relax and push your rectum muscles; this gives an idea of how well the muscles and nerves in and around your rectum are working
As there is an increased risk of colorectal cancer in older adults, your doctor may also request tests to rule out a diagnosis of cancer, including a computerised tomography (CT) scan or colonoscopy.
Treatment for constipation depends on the cause, how long you have had the condition and how severe your symptoms are.
In many cases it is possible to relieve symptoms through dietary and lifestyle changes.
Changes to your diet and lifestyle are often recommended as the first treatment for constipation and in many people this will improve the condition without needing medication.
Some ways you can help treat your constipation are listed below.
Increase your daily intake of fibre. You should eat at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables and cereals.
Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.
Avoid dehydration by drinking plenty of water.
Try to get more exercise, for example by going for a daily walk or run.
If your constipation is causing pain or discomfort, you may want to take a painkiller such as paracetamol. Make sure you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin.
Work out a routine of a place and a time of day when you are comfortably able to spend time on the toilet. Respond to your bowel's natural pattern: when you feel the urge, do not delay.
Try resting your feet on a low stool while going to the toilet, so that your knees are above your hips, as this can make it easier to pass stools.
If medication you are taking could be causing constipation, your GP may be able to prescribe an alternative.
If these diet and lifestyle changes do not help, your GP may prescribe an oral laxative.
Laxatives are a type of medicine that help you pass stools. There are several different types and each one has a different effect on your digestive system.
Your GP will normally start you on a bulk-forming laxative. These laxatives work by helping your stools to retain fluid. This means they are less likely to dry out, which can lead to faecal impaction (read about the complications of constipation for more information). Bulk-forming laxatives also make your stools softer, which means they should be easier to pass.
Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids. Also, do not take them before going to bed. It will usually be two to three days before you feel the effects of a bulk-forming laxative.
If your stools remain hard after you have taken a bulk-forming laxative, your GP may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. This helps to stimulate your body to pass stools and also softens stools.
Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be two to three days before you feel the effect of the laxative.
If your stools are soft but you still have difficulty passing them, your GP may prescribe a stimulant laxative. This laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus.
The most commonly prescribed stimulant laxatives aresenna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they will usually start to work within six to 12 hours.
According to your individual preference and the speed with which you require relief, your GP may decide to combine different laxatives.
How long will I take laxatives for?
If you have only experienced constipation for a short time, your GP will normally advise you to stop taking the laxative once your stools are soft and easily passed.
However, if you have constipation due to a medicine or an underlying medical condition, you may have to take laxatives for much longer, possibly many months or even years.
If you have been taking laxatives for some time, you may have to gradually reduce your dose rather than coming off them straight away. If you have been prescribed a combination of laxatives, you will normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.
Your GP will advise you when it is best to stop taking them.
Treating faecal impaction
Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.
If you have faecal impaction, you will initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative.
If you do not respond to these laxatives, you may need one of the medications described below.
Suppository – this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl is an example of a medication that can be given in suppository form.
Mini enema – this is when a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.
Pregnancy or breastfeeding
If you are pregnant, there are ways for you to safely treat constipation without harming you or your baby. Your GP will first advise you to change your diet by increasing fibre and fluid intake. You will also be advised to do gentle exercise.
If dietary and lifestyle changes do not work, you may be prescribed a laxative to help you pass stools more regularly.
Lots of laxatives are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.
Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these do not work, your GP may advise a small dose of bisacodyl or senna (stimulant laxatives).
However, senna may not be suitable if you are in your third trimester of pregnancy because this medicine is partially absorbed by your digestive system.
Babies who have not yet been weaned
If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make the formula as directed by the manufacturer and do not dilute the mixture.
You may want to try gently moving your baby's legs in a bicycling motion or carefully massaging their abdomen (tummy) to help stimulate their bowels.
Babies who are eating solids
If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pureed or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:
Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience.
If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this does not work, they can be prescribed a stimulant laxative.
For children, laxatives are often recommended alongside changes to diet. Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary.
As well as eating fruit, older children should have a well-balanced diet, which also contains vegetables and wholegrain foods such as wholemeal bread and pasta.
Try to minimise stress or conflict associated with using the toilet or meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet to make sure they have passed as many stools as possible.
To encourage a positive toilet routine, try making a diary of your child's bowel movements linked to a reward system. This can help them focus on using the toilet successfully.
Some people with constipation may benefit from taking laxative medication
Top tips for parents
A diet rich in fibre and with plenty of fluids will help, even if your child is being treated with laxatives.
Children with chronic (long-term) constipation do not normally have anything physically wrong with them. However, it can take time to correct the problem, so be patient.
Encourage your child to have a regular toilet habit and allow them plenty of time.
A reward chart for passing a stool can be useful if your child tends to ‘hold on’.
Compare your options
Take a look at a simple guide to the pros and cons of different treatments for constipation
Complications with constipation
Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if it is started promptly.
However, if you have chronic (long-term) constipation, you may be more at risk of experiencing complications.
If you continually strain to pass stools, it can cause pain, discomfort and rectal bleeding.
In some cases, bleeding is the result of a small tear around the anus (anal fissure), but it is more often the result of haemorrhoids (piles). Haemorrhoids are swollen blood vessels that form in the lower rectum and anus.
As well as bleeding, haemorrhoids can cause pain, itching around the anus, and swelling of the anus.
Haemorrhoid symptoms often settle down after a few days without treatment. However, creams and ointments are available to reduce any itching or discomfort.
You should see your GP as soon as possible if you experience any rectal bleeding.
Chronic constipation can increase the risk of faecal impaction, which is where dried, hard stools collect in your rectum and anus.
Once you have faecal impaction, it is very unlikely that you will be able to get rid of the stools naturally.
Faecal impaction worsens constipation because it makes it harder for stools and waste products to pass out of your anus as the path is obstructed.
If you experience faecal impaction, it can lead to a number of other complications. These include:
swelling of the rectum
losing sensation in and around your anus
bowel incontinence, when you uncontrollably leak soft or liquid stools
bleeding from your anus
rectal prolapse, when part of your lower intestine falls out of place and protrudes from your anus (this can also occur as a result of repeated straining caused in people with chronic constipation)
Faecal impaction is usually treated with laxative medication, although suppositories (medication inserted into the anus) and mini enemas (where medicine in fluid form is injected through your anus) may sometimes be used.
Although constipation is common, you can take several steps to prevent it, including making diet and lifestyle changes.
Making sure you have enough fibre in your diet can significantly reduce your chances of developing constipation. Most adults do not eat enough fibre.
You should aim to have at least 18g of fibre a day. You can increase your fibre intake by eating more:
Eating more fibre will keep your bowel movements regular because it helps food pass through your digestive system more easily. Foods high in fibre also make you feel fuller for longer.
If you are increasing your fibre intake, it is important to increase it gradually. A sudden increase may make you feel bloated. You may also produce more flatulence (wind) and have stomach cramps.
Make sure that you drink plenty of fluids to avoid dehydration and steadily increase your intake when you are exercising or when it is hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks you consume.
Never ignore the urge to go to the toilet. Ignoring the urge can significantly increase your chances of having constipation.
When you use the toilet, try to make sure you have enough time and privacy to pass stools comfortably.
Keeping mobile and active will greatly reduce your risk of getting constipation. Ideally, do at least 150 minutes of physical activity every week.
Not only will regular exercise reduce your risk of becoming constipated, but it will also leave you feeling healthier and improve your mood, energy levels and general fitness.