Constipation
WHAT IS CONSTIPATION?
Constipation is a common condition that causes difficulty in passing stools (poo), infrequent bowel movements or being unable to completely empty your bowel. It affects people of all ages, and whilst there are many causes, the exact cause may not always be obvious.
From recognising the signs and symptoms in adults and children to knowing how to help prevent it and when to speak to your GP, we're here to help you understand and manage constipation.
Constipation can be very uncomfortable and can affect your daily life, although simple diet and lifestyle changes can help prevent and treat it. However, it’s important to note that constipation can sometimes be a symptom of an underlying condition.
Constipation is a common condition that affects people of all ages and is usually defined as when you’re experiencing less frequent passage of stools than usual. In adults, symptoms of constipation include:
• Passage of harder, smaller stools than normal
• Feeling as though you can’t empty your bowel (an incomplete passage of stools)
• Straining to produce stools
Constipation can also cause your stools to be hard or lumpy, as well as unusually large or small. Many people only experience constipation for a short period of time, but for others, it can be a long-term condition that causes significant discomfort.
Normal bowel habits differ from person to person. Some adults will pass stools more than once a day, whereas others may only pass stools every three or four days. A change in your normal pattern may indicate that you’re constipated. It’s likely you’re constipated if you’ve not passed stools at least three times in the last week. Other symptoms can include:
• Feeling bloated
• Feeling sick
• A loss of appetite
There are many causes of constipation, and not all of them are obvious, so it can sometimes be difficult to identify the exact cause. The most common causes include:
• Not eating enough fibre (found in fruits, vegetables and cereals)
• Not drinking enough fluids causing dehydration
• Spending long periods sitting or lying down
• Not exercising or being less active
• Often ignoring your urge to go to the toilet
• Changing your diet
• Travel or changes in your daily routine
• A side effect of medicine
• Stress, anxiety or depression
• Pregnancy and post-birth
Constipation can usually be treated with some simple diet and lifestyle changes. You may notice a difference within a few days, but it might take a couple of weeks for your symptoms to improve.
Changes to your diet could include:
• Drinking plenty of fluids – six to eight cups of water a day is a good target for most people. Read our tips for drinking more water
• Avoiding alcohol, as this can make dehydration worse
• Increase the amount of fibre you eat daily – government guidance suggests adults should aim for 30g a day. Raw fruits and vegetables are a good source of fibre, as well as whole grains, beans, prunes or bran
Exercising regularly can help with constipation, such as going for a daily walk or run. Adults aged 19 to 64 years should aim for around 150 minutes of moderate-intensity activity a week, or 75 minutes of vigorous-intensity activity. This activity can be spread evenly over four to five days in a week. Speak to your GP first if you have not exercised for some time, or if you have medical conditions or concerns. Make sure your activity and its intensity are appropriate for your fitness. If you feel the urge to go to the toilet, don’t delay it. Try to keep to a regular time and place and give yourself plenty of time. If it feels uncomfortable, you can try resting your feet on a low stool – if possible, raise your knees above your hips. If you think the medication you’re taking could be causing constipation, talk to your GP. If lifestyle and diet changes don’t help, speak to a member of the pharmacy team for advice about products available over the counter which may help.
Constipation in babies is most often caused by their diet, and it’s usually easy to treat from home. The signs of constipation in babies include:
• Pooing less than three times a week
• Finding it difficult to poo, or stools that are larger than usual
• Dry, hard, lumpy or pellet-like stools
• Unusually smelly wind and stools
• Being less hungry than usual
• Their tummy feels firm
• A lack of energy
• Being a bit grizzly
Constipation in babies is quite common, particularly when they start taking first infant formula – this is because it’s harder to digest than breast milk. Constipation should ease as the body learns how to cope with digesting new things. It could also be due to dehydration caused by a lack of fluids – this could be due to the teething and finding feeding uncomfortable, an illness like a cold, ear or throat infection, or, if they’re older, not drinking enough fluids with their food.
There are a few things you can do to help relieve your baby’s constipation at home:
• Lie them down and gently move their legs like they’re riding a bicycle (to help get things moving)
• While lying down, give them a gentle tummy massage
• If they’re bottle-fed, try giving them extra water between feeds
• Make sure they’re getting enough fibre if they’re eating solids – apples, pears and prunes are all good for constipation
It might take a few days to see a change. Speak to your health visitor or GP if you’re unsure or would like any help or advice.
Constipation in children is common, particularly when they are being potty trained (around two to three years old). As well as irregular bowel movements, your child may be showing signs of constipation if:
• Their stool is large and hard
• They have less than three poos in a week
• The stool looks like little pellets
• They are straining or in pain when on the toilet
• They have some bleeding during or after going to the toilet
• They have a poor appetite or stomach pain that improves after going to the toilet
• Soiled pants (if they’re over the age of one – diarrhoea may leak out around the hard stools)
There are many possible causes of constipation in children, and there might not be an obvious reason. Make sure they are getting enough fibre in their diet and are drinking plenty of fluids. It’s also possible they feel pressured or are being regularly interrupted while potty training, or they may be feeling worried or anxious about something. The treatment for constipation will depend on your child’s age, so take them to a GP if you think they’re constipated. Make sure to get help as soon as possible – the longer your child is constipated, the more difficult it can be for them to return to normal.
Your GP may recommend a medicine for children who are eating solid foods, alongside other diet and lifestyle changes as it might take several months for any treatment to work. Treatment and prevention measures include addressing any underlying cause, encouraging regular physical activity, drinking plenty of water and making sure the child has enough fibre in their diet.
Constipation is common in older adults. Older adults are more likely to be taking medication, which may affect the digestive system and general aging can make avoiding constipation difficult. Some causes of constipation in the elderly include:
• Reduced mobility
• Multiple (chronic) illnesses
• Medication
• Dehydration
• Not eating enough
As the body ages, some structural changes occur which can increase the chance of constipation, including:
• The colon thickening
• Stenosis of the anus (narrowing of the anal canal)
• Rectocele (when the rectum bulges into the vagina)
• Haemorrhoids
• Loss of abdominal strength
• Motility disorders
• Bowel obstructions and perforations
It’s important to drink plenty of water, get regular exercise and aim for 25-30g of fibre a day, and it may also help to time toilet visits after meals. Always speak to a GP if constipation affects an older adult as they are more at risk of chronic constipation and complications such as faecal impaction.
Making the lifestyle and diet changes suggested in the treatment section should also reduce your risk of developing constipation. Eat plenty of fruit and vegetables to help you reach the recommended goal of 30g of fibre a day. You can also find fibre in wholegrain rice, wholewheat pasta, wholemeal bread, seeds and oats. You may also want to consider a supplement designed to aid digestion. Drinking plenty of water and regular exercise should also help keep your bowel habits regular. Try to give yourself enough time and privacy to pass stools and don’t ignore your urge to go to the toilet.
If you’re still experiencing symptoms of constipation despite diet and lifestyle changes and after speaking to a member of the pharmacy team, make an appointment with your GP. If you notice any of the following symptoms, alongside your constipation, ask for an urgent GP appointment:
• You’re constipated and it’s not getting better with treatment
• You’re regularly constipated for a long period of time
• You have blood in your stools or they are black and tarry
• You’ve lost weight without trying
• You’re constipated and feel tired all the time
• You’re taking a medicine that may be causing constipation
If your GP suspects an underlying bowel condition they may consider one of the following tests or checks:
Rectal examination
Where a doctor or nurse uses their finger to check for any problems inside your rectum. It’s usually very quick and painless.
Colonoscopy
A long, thin tube with a small camera inside is passed into your bottom to look inside your large bowel. This will usually be done in a hospital.
Barium enema
A white liquid called barium is passed into your bowel through your bottom to help highlight the large bowel so it can be seen clearly on an X-ray. This will usually be done in a hospital by a radiologist or radiographer.
Constipation doesn’t usually cause complications or long-term health problems. However, infrequent bowel movements or difficult passage of stools that last longer than a few weeks is known as long-term or chronic constipation.
Long-term constipation can lead to faecal impaction, which is where the stool has built up in the last part of the intestine (rectum). The main symptom of faecal impaction is diarrhoea after a long bout of constipation. It’s important to speak to your GP if you suspect faecal impaction as it’s likely to require treatment. If you’re struggling with chronic constipation, your GP may suggest treatment such as a laxative, a suppository or a mini enema (when fluid is passed through your bottom into your bowel).
If you’re continually straining to pass stools, this may also cause some pain, discomfort or rectal bleeding. In some cases, this bleeding is a result of a small tear around the anus (anal fissure). Some people with chronic constipation may develop haemorrhoids (piles) or bowel incontinence (the leakage of liquid stools).
Irritable bowel syndrome (IBS) is a common, long-term condition that affects the digestive system – while the large intestine appears physically normal, it’s not functioning as it should. It can therefore cause digestive issues. IBS causes many symptoms, some of the most common are:
• Stomach cramps
• Bloating
• Diarrhoea
• Constipation
These symptoms can come and go, there may be days when symptoms are better and days when they are worse (flare-ups). Sometimes symptoms can last for days, weeks or months at a time. It’s usually a lifelong problem and can be very frustrating to live with. The exact cause of IBS is unknown and there is no cure, but diet changes and medicines can help to control the symptoms. Some general tips to help relieve IBS symptoms include:
• Cooking homemade meals using fresh ingredients
• Keeping a diary of what you eat and the symptoms you feel
• Finding ways to relax
• Getting plenty of exercise
• Not delaying or skipping meals
• Not eating too quickly
• Avoiding lots of fatty, processed or spicy foods
• Avoiding more than three portions of fresh fruit a day
• Not drinking more than three cups of tea or coffee a day
• Limiting alcohol to within government guidelines and avoiding fizzy drinks
Speak to your GP if you think you may have IBS, they will ask you about your symptoms and may suggest tests to rule out an underlying condition. If your GP has confirmed it’s IBS and you are experiencing symptoms speak to the pharmacy team for advice about suitable products which may help.
Read more about treatment for IBS.
Coeliac disease is a serious illness where the body’s immune system attacks its own tissues when you eat gluten. This damages the lining of the gut, meaning the body can’t properly absorb nutrients from food. Gluten is a protein found in three types of cereal – wheat, barley and rye. That means gluten is found in any foods that contain those cereals, including:
• Pasta
• Cakes
• Breakfast cereals
• Bread
• Some sauces
• Some ready meals
• Most beers
Coeliac disease is common, affecting one in 100 people, but it’s estimated only 36% of people with the condition have been diagnosed. Eating foods that contain gluten will cause symptoms such as:
• Diarrhoea (which may smell unpleasant)
• Tummy aches
• Flatulence (bloating and farting)
• Indigestion
• Constipation
It may also cause more general symptoms, like:
• Tiredness (fatigue) from not getting enough nutrients from food
• Weight loss
• An itchy rash (dermatitis herpetiformis)
• Infertility
• Nerve damage
• Disorders that affect co-ordination, balance and speech
See your GP if you have any symptoms of coeliac disease. While there’s no cure, following a gluten-free diet should help control symptoms and prevent any long-term complications. Any complications only tend to affect people who continue to eat gluten after diagnosis or have not yet been diagnosed – potential long-term complications include weakening of the bones (osteoporosis), iron deficiency anaemia, vitamin B12 or folate deficiency anaemia. Even if you have mild symptoms, changing your diet is still recommended. Your GP will be able to offer advice on this.
A food intolerance is different to a food allergy. An intolerance is not usually serious, it’s when you have difficulty digesting certain foods or ingredients in foods. You can be intolerant to any type of food, including gluten, and eating the food you’re intolerant to can make you feel unwell. Common symptoms include:
• Diarrhoea
• Bloating
• Farting
• Tummy pain
Other symptoms may include:
• Headaches
• Feeling tired or exhausted
• Feeling sick
• Constipation
• Joint Pain
• Rashes
These symptoms could last for a few hours or a few days. If your GP has confirmed you don’t have coeliac disease, but you notice you still have symptoms that keep returning, speak to them about the possibility of gluten intolerance. If gluten intolerance is suspected, you may be encouraged to keep a food diary, keeping track of everything you eat and the symptoms you feel. You may also be referred by your GP to a food and nutrition specialist. Treatment for a gluten intolerance includes following a gluten-free diet, which means avoiding foods like bread, pasta, wheat, rye and barley.
Bowel cancer is defined as cancer found anywhere in the large bowel, including the colon and rectum (the lower portion of your digestive system). It’s one of the most common types of cancer in the UK. How serious bowel cancer is depends on how big the cancer is, if it has spread and your general health. Bowel cancer screening can help pick up the condition early, which may make it easier to treat. It’s not always known what causes bowel cancer, but it can be linked to certain health conditions, genetic changes, environmental and lifestyle factors. The main symptoms of bowel cancer include:
• Changes in your stool (such as softer stools, diarrhoea or constipation that is not usual for you)
• Needing to poo more or less often than usual
• Blood in your stools (may look red or black)
• Bleeding from your bottom
• Often feeling like you need to go to the toilet, even if you’ve just been
• Tummy pain
• Bloating
• Losing weight without trying
• Feeling tired for no reason
See your GP if you’ve had any of these symptoms for longer than three weeks. The treatment for bowel cancer will depend on a variety of factors, including the size and location of the cancer. Treatments can include surgery, chemotherapy, radiotherapy and medication.
Hypothyroidism (an underactive thyroid) is where your thyroid gland does not produce enough hormones.Your thyroid is a small, butterfly-shaped gland in the neck that produces hormones that regulate the body’s metabolism (the process that turns food into energy). Many of the body’s functions slow down when the thyroid doesn’t produce enough of these hormones. See your GP and ask to be tested for an underactive thyroid if you have symptoms such as:
• Tiredness
• Weight gain
• Constipation
• Depression
• Being sensitive to the cold
• Dry skin and hair
• Muscle aches
As these symptoms are often similar to those of other conditions and can develop slowly, you may not notice them for years. The only accurate way of finding out is to have a thyroid function test – a blood test to measure your hormone levels. There’s no way of preventing an underactive thyroid but it can be successfully treated by taking daily hormone tablets to replace the hormones you’re not naturally making. There is a risk of several complications if you have an underactive thyroid that’s not treated. These include heart problems or pregnancy complications like pre-eclampsia and anaemia in the mother. Read more about underactive thyroid.
Haemorrhoids (also known as piles) are lumps that appear inside or around your bottom (the rectum and anus). The lumps are swellings that contain enlarged blood vessels. They can occur internally (in the lower rectum) or externally (developing under the skin around the anus). In most cases, haemorrhoids don’t cause symptoms and some people don’t realise they have them. However, symptoms may include:
• Bleeding after passing a stool (the blood will be bright red)
• An itchy bottom
• A lump hanging down outside of the anus (this may need to be pushed back in after passing a stool)
• Mucus discharge after passing a stool
• Soreness, redness and swelling around the anus
Haemorrhoids won’t usually be painful unless their blood supply slows down or is interrupted.The exact cause of haemorrhoids isn’t clear, but they’re associated with the blood vessels in and around the anus experiencing increased pressure. This could be due to straining when going to the toilet due to constipation. Other factors that heighten your risk of developing them are:
• Pregnancy
• Being overweight
• Ageing
• Frequent coughing
• Frequent vomiting
• Sitting for an extended amount of time
• A family history of haemorrhoids
• Lifting heavy items on a regular basis
Lifestyle changes may reduce your chances of developing constipation and haemorrhoids. Make sure you’re getting enough fibre in your diet from foods like fruit, vegetables and wholegrain rice, and drink plenty of fluids throughout the day. Limiting your intake of alcohol to within government guidelines, losing weight if you are overweight and taking regular exercise should also help. Symptoms tend to settle down after a few days without needing treatment, but if symptoms are bothering you, speak to a member of the pharmacy team for advice and information about products to treat haemorrhoids. It’s important to speak to your GP if you are experiencing symptoms for the first time, or you’re bleeding from the anus or you’re concerned about your symptoms. Read more about haemorrhoids.
An anal fissure is a tear or open sore that develops in the lining of the large intestine (near the anus). They’re normally caused by damage to the lining of the anus or anal canal and mostly occur in people who have constipation. The most common symptoms include:
• Sharp pain when you go to the toilet, often followed by a burning pain that lasts several hours
• Bleeding when you go to the toilet (bright red blood either in the stool or on the toilet paper)
Other possible causes include persistent diarrhoea, an inflammatory bowel disease (like Crohn’s disease) or pregnancy and childbirth. See your GP if you think you have an anal fissure. They will ask about your symptoms and the type of pain you’ve been experiencing and will usually be able to see the fissure with a visual examination. Anal fissures usually heal within a few weeks without the need for treatment.
Your GP may prescribe medicine to help relieve any symptoms and help the healing process. This may include a medicine to help you pass stools more easily. Surgery may be recommended in persistent cases of anal fissures where self-help measures haven’t helped.
A rectal prolapse is when the end of your bowel slides out through your anus, forming a lump. At first, this may only happen when you’re passing stools, but eventually, it might be there all the time. While it may cause pain, it’s rarely a medical emergency. It’s not clear why some people get a rectal prolapse, however, they’re sometimes linked to having constipation for a long period of time. Other things that can increase the risk of a rectal prolapse include pregnancy, diarrhoea, an enlarged prostate and conditions that make you cough a lot, such as cystic fibrosis.
The most obvious symptom of a rectal prolapse is having a lump or swelling coming out of your anus, often while straining during a bowel movement. Other symptoms include:
• Being unable to control when you pass stools – you might not be able to hold it in until you reach the toilet
• Constipation
• Bright red blood coming from your rectum
• Slimy mucus coming from your rectum
• Feeling discomfort or pain
• Feeling that your bowel isn’t empty after going to the toilet
If you have any symptoms of rectal prolapse, see your GP. They should be able to diagnose it by asking about your symptoms and examining you. If they think you have a rectal prolapse, they’ll likely refer you to a colorectal surgeon who may recommend further tests.
LEARN MORE ABOUT CONSTIPATION
FREQUENTLY ASKED QUESTIONS
Very hard stools and straining when going to the toilet can lead to issues like anal fissures or haemorrhoids, both of which can cause rectal bleeding. If you notice any bleeding when you go to the toilet, speak to your GP.
An intestinal obstruction occurs when your small or large intestine is blocked – this could be partial or total and the blockage may prevent fluids or digested foods from passing through. This causes a build-up of things like:
• Food
• Fluids
• Gastric acids
• Gas
Symptoms of bowel obstruction include:
• Feeling very bloated or full
• Tummy pain
• Feeling sick
• Vomiting large amounts (undigested food or bowel fluid)
• Constipation (not passing any wind or bowel sounds)
Bowel obstruction is often associated with advanced bowel cancer or another medical condition which affects the bowel. It can be a serious condition which may require urgent medical attention. Speak to your GP or contact NHS 111 if you are concerned about your symptoms. Phone 999 or go to A&E if your symptoms are severe.
Constipation usually doesn’t cause any complications, but some people may develop long-term (chronic) constipation. If this is the case, they may also develop conditions like:
• Haemorrhoids
• Faecal impaction (dry, hard stools collecting in the rectum)
• Bowel incontinence (leakage of liquid stools)
If you notice any symptoms that could be long-term constipation, speak to your GP.
*Buscopan IBS relief contains hyoscine hydrobromide. Dulcoease 100mg capsules contain docusate for constipation relief. Always read the label
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