What is constipation?
Constipation means passing stools less often than usual, or having difficulty passing them. There is no single 'normal' when it comes to bowel habits — some people go several times a day, others a few times a week — so constipation is really a change from your own usual pattern, or stools that are hard, lumpy, or difficult and uncomfortable to pass.
Common features of constipation include going to the toilet less than three times a week, straining, a feeling of not fully emptying the bowel, and hard or lumpy stools. It is extremely common, affects people of all ages, and is usually a temporary problem that responds well to simple measures. While uncomfortable, it is rarely a sign of anything serious.
Common causes
Constipation usually results from how the bowel is working and what passes through it, and is often linked to everyday factors that are within our control. Common causes include:
- •Not eating enough fibre
- •Not drinking enough fluids
- •Being inactive or spending long periods sitting
- •Ignoring or delaying the urge to go to the toilet
- •Changes in routine, diet or travel
- •Stress and anxiety
- •Some medications, including certain painkillers
- •Pregnancy, and certain medical conditions
How to relieve and prevent constipation
The good news is that most constipation responds well to simple diet and lifestyle changes, which also help prevent it returning. The three most effective measures work together:
- •Eat more fibre — wholegrains, fruit, vegetables, beans and pulses
- •Drink plenty of fluids, especially water, to keep stools soft
- •Stay physically active, as movement helps the bowel work
- •Do not ignore the urge to go — respond when you feel it
- •Establish a regular toilet routine, such as after breakfast
When simple measures are not enough
When diet and lifestyle changes alone do not relieve constipation, laxatives from a pharmacy can help in the short term, and a pharmacist can advise on which type suits your situation. These are intended for occasional or short-term use rather than long-term reliance, and it is best to address the underlying causes — fibre, fluids and activity — alongside them.
Increasing fibre is best done gradually and with plenty of fluids, as adding a lot of fibre too quickly can cause bloating and wind. If constipation is persistent, keeps coming back, or does not respond to these measures, it is worth seeing a doctor, who can check for any underlying cause and recommend the right approach. Persistent constipation, especially with other symptoms, should always be assessed.
Fibre, fluids and a healthy gut
Understanding why fibre and fluids matter so much helps explain the most effective approach to constipation. Fibre is the part of plant foods the body cannot fully digest, and it adds bulk to stools and helps them retain water, making them softer and easier to pass. There are two types — soluble fibre, which softens stools, and insoluble fibre, which adds bulk and helps move things along — and a varied diet provides both.
Good sources of fibre include wholegrain bread, brown rice, oats, fruit, vegetables, beans, lentils and pulses. Aiming to include a range of these across the day works better than a sudden large increase, which can cause bloating and wind. Fibre works hand in hand with fluids: without enough water, fibre cannot do its job and can even worsen constipation, so the two go together.
A healthy gut also benefits from regular physical activity, which stimulates the natural movement of the bowel, and from responding promptly to the urge to go. Together, a fibre-rich diet, good hydration, activity and good toilet habits keep the digestive system working smoothly and prevent most constipation from developing in the first place.
Constipation in pregnancy, children and older adults
Constipation is especially common in certain groups, and understanding why helps in managing it. In pregnancy, hormonal changes slow the bowel, and the growing womb adds pressure, making constipation very common. The same diet and lifestyle measures help, and a doctor or midwife can advise on what is safe to use if needed, as not all laxatives are suitable in pregnancy.
In children, constipation is common and can sometimes become a cycle where passing a hard, uncomfortable stool leads to holding back, which makes the problem worse. Encouraging fluids, fibre and regular toilet habits helps, and a doctor should be consulted for persistent constipation in a child, as early treatment prevents it becoming entrenched.
Older adults are also more prone to constipation, due to factors like reduced activity, lower food and fluid intake, medications, and other health conditions. The same principles apply, but because constipation in older adults can sometimes relate to underlying issues or medication, it is worth reviewing with a doctor if it is persistent or new.