Constipation – Causes, Symptoms and Treatment

Constipation is when you’re unable to pass stool (poo) less than 3 times per week. You may also be straining when you use the toilet, and your stool is likely to be large, dry, hard or lumpy. It’s common and it affects people of all ages, including babies, children and adults.

There are many reasons why constipation happens, for example, not eating enough fibre, a side effect of certain medication, dehydration, being inactive, and ignoring the urge to use the toilet.

Thankfully, there’s a range of treatments available to give you constipation relief, such as managing your diet or taking a type of medicine known as a laxative if other things haven’t worked. Laxatives work by softening your stool, making it easier to pass.

Symptoms

Constipation symptoms include not being able to pass stool regularly, or more specifically, less than 3 times per week. When you are able to go, you’re straining and your stool will usually be large, dry, hard and lumpy. Additionally, you may experience stomach ache, bloating and nausea.

Spotting constipation in someone with dementia is harder and can easily be missed. Look out for any changes in their behaviour or signs of pain or discomfort.

Symptoms in children and babies

The symptoms of constipation differ slightly in children and babies. Constipation is common in children, especially while they’re being potty trained. Symptoms to look out for in your child include:

They haven’t passed stool in at least 3 days
They’re straining when they use the toilet
Their stool is large and hard, or it may look like ‘rabbit droppings’ or small pellets
Bleeding after they pass stool, due to it being large and hard
No appetite
Stomach pain

Additionally, if your child is over 1 years of age, they may soil their pants, meaning runny stool (diarrhoea) has leaked out around the constipated stool. This is something known as overflow soiling, and it’s another symptom of constipation in young children.

Faecal impaction

If you have constipation for a long period of time, it can lead to faecal impaction, where the stool builds up in part of the large intestine (rectum). One of the main symptoms of faecal impaction is diarrhoea after a prolonged bout of constipation.

Faecal impaction can be treated by:

Stronger laxatives
A suppository (a type of medicine you insert into your bottom)
A mini enema (where fluid is inserted through your bottom and into your bowel to clear the impaction)
A healthcare professional removing some of the stool - please note, you should not do this yourself

Causes

Constipation occurs when stool moves too slowly through the digestive tract, or it cannot be passed effectively from the rectum, causing the texture to become dry and hard. There are many causes of constipation in adults, the most common including:

Not having enough fibre in your diet. Fibre is found in things like cereals and fruits and vegetables
Eating too much processed foods
Dehydration
Living a sedentary lifestyle
Being inactive
Frequently ignoring the urge to use the toilet
Altering your diet or daily routine
A side effect of certain medication
Stress, anxiety or depression
An eating disorder
During pregnancy, and for 6 weeks after giving birth
Rarely, a medical condition like diabetes or an underactive thyroid (hypothyroidism)

Who is at risk?

Some people will be more at risk of developing constipation than others. If you’re an older adult, a woman, or you’re taking medications like sedatives, opioid painkillers, certain antidepressants or blood pressure medicines, this can increase your risk.

Diagnosis

If you’re unsure whether you’ve got constipation, you should speak to a pharmacist for advice. They’ll ask about your symptoms and how long you’ve had them to make a diagnosis, and even determine the severity of your constipation. They may offer advice you can adopt yourself, or recommend a treatment like laxatives.

When to speak to your doctor

Typically, you can treat constipation yourself by making lifestyle changes or by speaking to a pharmacist for short-term stool softeners. However, you should always book in to see your GP if:

Your constipation isn’t getting better with treatment
You’re frequently constipated and it lasts for a long period of time
You’re bloated and it lasts for a long period of time
You have blood in your stools
You’ve lost weight unintentionally
You’re constipated and feel tired all the time
You’re taking a medicine that’s causing constipation, like sedatives or opioid painkillers

Remember, if it’s your medication that’s causing your constipation, ensure that you speak to your GP before you stop any medication.

Treatment

Treatments for constipation include making simple changes to your diet and lifestyle to relieve your constipation, and medical treatments you can get from your GP or a pharmacist if these haven’t helped. If you have severe constipation, there are procedures you can undertake to clear your constipation.

Medical treatments

Medical treatments range from oral medicines like laxatives, to an enema or a manual removal. Your healthcare professional will determine which treatment option is right for you by looking at your age, the severity of your symptoms, and how long you’ve had them.

Laxatives

If you’ve made changes to your diet like eating more fibre, or lifestyle changes like a daily walk or run and these haven’t been effective, you should speak to a pharmacist or your GP about laxatives. Alternatively, you’re able to get some off the shelf in your local supermarket.

Laxatives are a type of medicine that helps you go to the toilet more often, and there are 4 main types that you may be offered depending on your symptoms. Sometimes, it can just depend on your personal preference.

The first type is a bulk-forming laxative (Fybogel) that works by increasing the weight of your stool, helping to stimulate a bowel movement. These take around 2 to 3 days to work.

Stimulant laxatives (bisacodyl, also known by the brand name Dulcolax; senna, also called Senokot) stimulate the muscles that line your gut, helping to shift the stool to your back passage. These are faster-acting laxatives that take around 6 to 12 hours to work.

There are also osmotic laxatives like lactulose (Duphalac and Lactugal). Macrogol is another osmotic laxative that’s known by the brand names Movicol and Laxido. These draw in water from the rest of your body to soften the stool and make it easier to pass. Again, these take around 2 to 3 days to work.

Finally, there are stool-softener laxatives that allow water into the stool to soften it, making it easier and more comfortable to pass. These include docusate, also known by Dulcoease.

Laxatives should only be used for a short period of time. Frequent use of laxatives or using them for too long can cause diarrhoea, an intestinal obstruction, and an imbalance of minerals and salts in your body.

It’s important that you follow the instructions from your healthcare provider when taking laxatives. Like all medicines, they can cause side effects too, but they’re typically mild and should subside once you stop taking them. Side effects include:

Bloating
Flatulence
Stomach cramps
Nausea
Dehydration, which in turn can cause lightheadedness, headaches, and urine that’s darker than normal

Procedures

If your constipation is severe, there are procedures your healthcare professional may suggest. The first is an enema, which you can purchase from a pharmacist and perform it yourself at home.

Enemas work by flushing fluid into the lower half of your bowel to loosen, soften and encourage the stool to pass. Enemas are also used to clear the bowel before a procedure such as a colonoscopy.

The other procedure is a manual removal of the stool, which must be performed by a healthcare professional. They will insert one or two fingers carefully into the rectum to break up the mass into smaller pieces.

Alternative treatments

There are natural remedies that may increase your bowel habits, like syrup of figs, papaya, rhubarb, prunes and prune juice. However, there isn’t enough evidence to support how effective these are.

Prevention

The NHS recommends you to try things yourself by making some small, simple changes to your diet and lifestyle to prevent constipation, such as:

Staying hydrated and avoiding alcohol
Increasing the amount of fibre in your diet (this includes wholemeal breads, cereal, pulses like beans, lentils and chickpeas, and plenty of fruits and vegetables)
Introducing wheat bran, oats or linseed into your diet
When you feel the urge to use the toilet, don’t ignore it. Ensure that you keep to a regular time and place to use the toilet, in addition to allowing yourself plenty of time
Become more active, like introducing a daily walk or run into your routine

It may take a couple of days to a few weeks to notice a change, so it’s important to give these methods time to work before you resort to other treatments. These methods are even safe to try while pregnant.