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Constipation

Written by Caidr's team of doctors and pharmacists based in UK | Updated: 07.09.2022 | 7 min read
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Constipation can happen to anyone from time to time. It’s when you have to strain to open your bowels or you go for a poo less often. This is usually less than three times a week, and stool can become hard and difficult to pass.

Other symptoms include:

  • bloating
  • tummy pain
  • nausea
  • loss of appetite

It's a very common problem and doesn’t usually point to a serious cause, although certain health conditions make you more prone. You can take action yourself to address diet and activity levels, or try some gentle medications to soften stool up and move it along.

Constipation can feel uncomfortable, and may cause complications such as:

  • haemorrhoids
  • anal fissures, which are small tears in the anus
  • faecal impaction, where hard dry stool collects in the rectum
  • overflow diarrhoea and possibly leakage

It’s important to address it early on before problems build up. We’ll talk you through likely triggers, how to address them, and medications and remedies you can try to get things moving along.

Causes & triggers

Diet

Diets high in processed foods and lacking high-fibre foods can lead to constipation. Lack of adequate fluid intake adds to the problem. Consider whether you’ve changed your diet or daily routine recently, which can change your bowel motions.

Activity

It helps the bowel to keep yourself fit and active. Your activity level may have dropped through illness or circumstance – you might be working longer hours or in a sedentary job, or you may have been in bed after surgery or a bout of flu, you may just have stopped going to the gym – all of this will have an impact on how quickly things move through your gut.

Medical conditions

Certain health conditions can slow down your gut musculature, such as diabetes, underactive thyroid disease (hypothyroidism), IBS (irritable bowel syndrome), diverticular disease, stroke or Parkinson’s disease.

Age

Those over 60 are more likely to get constipation through a combination of lifestyle factors and health conditions, and as the gut becomes less active as we age. We also worry about colorectal cancer in this age group particularly, and it’s important to look out for blood in the stool, weight loss or other changes and see a doctor urgently if these occur alongside constipation.

Constipation in children occurs frequently, and it's often due to poor diet, not drinking enough and lack of routine around toileting.

Pregnancy

Constipation in pregnancy is a common problem as rising hormone levels can slow down the bowel, and later in pregnancy, the bowel gets squeezed for space by the growing baby.

Mental health

At Caidr, we believe mind and body should be treated as one, and mental health conditions and your state of mind should not be overlooked in the effect on your gut. Depression can cause a slowing down throughout the body and you may feel more sluggish overall.

Stress and anxiety can cause you to be in a heightened state and this effectively prioritises the fight or flight response over day-to-day body maintenance, such as digestion and elimination. Feeling constipated can then add further to your anxiety and stress.

Treatment: home & drug-free

Hydration

Addressing your hydration is the easiest place to start: aim to drink 1.5 litres per day (that’s 6 to 8 cups or glasses) or more if it’s hot weather or you have been exercising. This means more water is absorbed into the gut, bulking out the waste as it passes through your intestine and softening it so it’s easier to eliminate.

High fibre diets

Picking foods rich in both soluble and insoluble fibre helps to bulk out stool and makes gut contractions more effective at moving waste along the pipeline and out. Think fresh plant-based foods, fresh fruit and vegetables, or foods where you can opt for a brown option over white, to maximise fibre intake.

High fibre foods include:

  • wholemeal bread
  • brown rice
  • pulses, oats, beans and lentils
  • green vegetables like spinach and broccoli
  • fresh fruit like apples, grapes, kiwis and raspberries
  • dried fruits like apricots and prunes

Exercise

Exercise works out the muscle you can see, but also ignites gut muscles, increasing the blood supply to bring oxygen and nutrients to the gut and it can also reduce stress levels, which have an effect on constipation. Aim for 150 minutes per week of physical activity that gets you out of breath, or at least half an hour, five times per week.

Finally, make sure you go when you feel the urge. Allow yourself enough time, in a place you feel is private and free from distractions and interruptions – this is not usually at work or public toilets. A routine may help, so aim for the same time every day, to retrain your bowel into a regular rhythm.

Treatment: products

Laxatives

Laxatives are a general term for constipation relief. They fall into different categories, depending on how they work. Let’s give you a rundown of each, and what to try first.

  • Bulk-forming laxatives act by adding soluble fibre to stool to give them volume, and are a good first option. They keep stools soft and loose, making them easier to pass. This helps prevent or ease haemorrhoids and fissures, and will help those who don’t get enough fibre. Fybogel satchets containing isphagula husk are one example - adults should take 1 sachet in a glass of water twice daily. Again, they are best used if you’ve had constipation for less than 3 days, and take 24 to 48 hours to take effect. Fybogel is mild enough to take routinely for a few weeks.

  • Osmotic laxatives work by osmosis and draw water with them as they move from the stomach and into the large bowel. They work best if constipation has been a problem for less than 3 days and they take about 2 to 3 days to get to work. They have a gentle action and are safe to use for a few weeks. Lactulose solution can be a good place to start – try taking 15ml twice a day with a glass of water. Movicol sachets containing macrogol powder are another option – dissolve one or two in a glass of water twice daily. You need to be drinking plenty of water to get the best out of osmotic laxatives.

  • Stimulant laxatives such as senna and bisacodyl tablets (found in brands such as Senokot or Dulcolax) work by forcing stools down and out. They work fairly quickly (within 8 to 12 hours), so they’re a good option to get you through the first couple of days and work well alongside a bulk-forming laxative, especially if stool has become soft but still difficult to pass. This combination is especially effective in opioid-induced constipation, when you’re taking codeine-based painkillers.

  • Stool softeners containing docusate sodium, such as DulcoEase, or arachis oil, make the stool looser by encouraging water in, making it easier to pass.

  • Suppositories such as glycerol are particularly effective when other treatments have failed or when stools remain difficult to pass. They work directly in the rectum, and results are usually seen within an hour, or up to 6 hours, and they can work well alongside other types of laxative.

For constipation in pregnancy some options should be avoided such as stimulant laxative and stool softeners, so it’s best to start with osmotic or bulk-forming laxatives, or discuss with your pharmacist or doctor.

For constipation in children we generally start with osmotic laxatives, but it’s worth discussing this with your pharmacist or doctor.

Many want to try natural or herbal remedies, and some may be effective. But some may not be safe in pregnancy, such as castor oil, and others may not have been through the rigorous testing that medications have, so make sure you check they are safe and evidence-based.

Can prebiotics and probiotics help constipation? Good question, but the evidence is split between these helping versus not helping. We haven’t seen evidence that they cause harm, so you can certainly try some supplements, live yoghurts or fermented foods, to see if they help. We’re learning more and more about how important it is to look after our gut microbiome, cultivating and encouraging good bacteria to protect us and keep our gut healthy and happy.

When should I see my doctor?

You should book to see your doctor if you have tried these lifestyle changes and over-the-counter treatment for a couple of weeks without improvement, or if medication could be causing your constipation. They can offer sound advice, change your laxatives and they may consider changing your other medications, if that’s a factor.

If you have constipation alongside weight loss, feeling very tired or breathless or you have noticed blood mixed in with the stool, you should book an urgent appointment. The doctor will ask you about your symptoms and will examine your tummy. With your consent, the doctor may examine your back passage (rectal examination) to rule out other causes. Depending on their assessment, they may recommend a laxative regime, advise on any possible causes, or they may refer you to a specialist team.

For some, a gentle intervention in their lifestyle and diet and short-term laxative use is enough to clear any blockage. Some people are particularly prone to constipation, and your doctor may suggest a maintenance regime of laxatives to keep it at bay, and a treatment regime for those episodes when it gets a bit worse. You will get to know what works best for you.

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