Constipation

Constipation means different things to different people, but it generally refers to infrequent bowel movements, difficulty passing stools, or passing hard stools. In some cases, it may involve a feeling of incomplete emptying of the bowel (obstructed defaecation syndrome).

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Most people have bowel movements between three times a day and once every three days. However, if your bowel habits change, or you experience discomfort, it could indicate constipation.

 

What causes constipation?

Constipation can have multiple causes, and in many cases, these causes are interlinked. Some of the most common causes include:

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• Low-fibre diet – Not eating enough fruits, vegetables, and whole grains

• Inadequate fluid intake – Not drinking enough water and fluids can harden stools

• Lack of exercise – Physical inactivity can slow bowel movements

• Certain medications – Painkillers, calcium or iron supplements, and some antidepressants can cause constipation

• Pregnancy – Hormonal changes and pressure on the bowel can slow digestion

• Ageing – Reduced intestinal movement and dietary changes may contribute to constipation

• Stress, anxiety, and depression – Emotional stress can impact gut health and lead to constipation

 

Serious causes of constipation

In some cases, constipation may be a symptom of an underlying condition, including:

• Bowel cancer – If you experience persistent constipation along with blood in the stool, unexplained weight loss, or severe abdominal pain, seek urgent medical advice

• Narrowing of the bowel – Caused by conditions like diverticular disease or Crohn’s disease

• Neurological conditions – Multiple sclerosis, Parkinson’s disease, or spinal cord injuries can slow bowel function

 

If your constipation lasts more than three weeks or you notice bleeding, you should consult a doctor immediately.

 

Symptoms of constipation

You may have constipation if you experience:

• Fewer than three bowel movements per week

• Hard, small, or lumpy stools that are difficult to pass

• Straining during bowel movements

• A feeling of incomplete emptying after a bowel movement (obstructed defaecation syndrome)

• Bloating, abdominal discomfort, or pain

 

Around 80% of people experience constipation at some point in their lives. If your symptoms persist, seeking medical advice can help identify the cause and provide effective treatment.

 

How is constipation diagnosed?

If you visit a clinic for persistent constipation, your consultant will:

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• Take a full medical history and assess your symptoms

• Perform a clinical examination, which may include:

• Rigid sigmoidoscopy or proctoscopy – To examine the rectum and lower bowel

• Flexible sigmoidoscopy or colonoscopy – To assess the entire colon for abnormalities

• Blood tests – To check for thyroid issues, blood chemistry, or inflammation

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Advanced tests for persistent constipation

If symptoms continue despite treatment, further tests may be needed:

• Colonic transit studies – Assess how well food moves through your colon

• Video proctogram or MRI proctogram – Evaluate how well your bowel empties

• Anorectal physiological testing – Includes an endoanal ultrasound scan to check the sphincter muscles

 

Treatment for constipation

 

Lifestyle and dietary changes

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Most cases of constipation can be successfully treated through diet and lifestyle modifications, including:

• Increasing fibre intake – Eat more fruit, vegetables, whole grains, and legumes

• Drinking plenty of fluids – Water helps soften stools and promotes regular bowel movements

• Regular physical activity – Exercise improves bowel function

 

Fibre supplements such as psyllium husk or wheat bran can be helpful, but they may take a few weeks to show results. Always increase fluid intake alongside fibre to prevent bloating or discomfort.

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Medications for constipation

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If lifestyle changes are not enough, your doctor may recommend:

• Laxatives – Short-term use of bulk-forming, stimulant, or osmotic laxatives

• Suppositories or enemas – Used for immediate relief in some cases

• Prescription medications – If you have chronic constipation, medications like Prucalopride or Linaclotide may improve colonic motility

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Surgical treatment

Surgery for constipation is rare but may be considered for obstructed defaecation syndrome or structural issues affecting bowel movement.