Constipation: What it is and how to treat it

While it might not be a regular topic of conversation, constipation is more common than you’d think.

With an estimated one in seven adults and one in three children experiencing constipation at any time in the UK, constipation is a common condition that has several triggers, and can usually be treated by changes in diet and lifestyle.

In this article, we’ll be unpacking what constipation is, what causes constipation, and how it can be treated.

What is constipation?

Constipation is where you find it hard to poop, either by not pooping as often or not pooping at all.

Technically, constipation is defined as having less than three bowel movements a week, but bowel habits vary from person to person. What’s normal for you may not be normal for someone else, so while it’s normal for some people to poop several times a day, others may only open their bowels a few times a week.

If you’re constipated, you may open your bowels less often than usual, have hard, dry stools that are painful or difficult to pass, and experience other symptoms like abdominal pain or discomfort. On the Bristol Stool Chart, your poop will resemble Type 1, Type 2 or Type 3 stools.

Constipation can be acute or chronic. Acute constipation starts suddenly, is short-lived and is usually the result of something temporary like a change in diet, or a new medication. Chronic constipation often begins gradually and continues for months or years.

What causes constipation?

When you eat, food travels from your mouth to your stomach where it is mixed with digestive juices and turned into a substance called chyme before passing into your small intestine.

After your body absorbs the nutrients it needs, the remaining waste moves into your large intestine (colon), where excess water is absorbed before leaving your body as poo. 

If the waste moves too slowly through your colon, too much water is absorbed, resulting in hard, dry stools that are difficult to pass (constipation). 

Some common causes of constipation include:

• Lack of fibre such as whole grains, fruits and vegetables
• Not drinking enough water
• Lack of physical activity 
• Lifestyle changes such as changes to your diet, changes in your daily routine or travel
• Irritable bowel syndrome (IBS)
• Getting older — constipation becomes more common as we age 
• Ignoring the urge to have a bowel movement
• Certain medications including some pain medications, antidepressants and iron supplements
• Pregnancy
• Abusing laxatives
• Anxiety, stress or depression
• Some long-term medical conditions such as diabetes, thyroid problems and Parkinson’s disease 

Who can get constipation?

Anyone can get constipation, but some people may have an increased risk of developing the condition. Constipation affects twice as many women as men, and is more common in older adults and pregnant women.

How do I know if I have constipation?

Constipation symptoms can vary from person to person, but common symptoms of constipation include:

• A change in your bowel habits, such as having less than three bowel movements a week or moving your bowels less often than usual
• Pain or difficulty passing stool
• Hard, dry, or lumpy stools
• Straining when passing stool
• Feeling like you haven’t fully emptied your bowels
• Abdominal pain, cramping or discomfort
• Bloating
• Loss of appetite and resulting weight loss
• Nausea
• Feeling sluggish or lethargic

Is constipation dangerous?

Mild or acute constipation is usually treatable and doesn’t cause any long-term damage to your health. However, in some cases, untreated chronic constipation can lead to complications like rectal bleeding, faecal impaction and rectal prolapse.

Rectal bleeding

Constipation can result in hard, dry stools that are difficult to pass. If you frequently have to strain to pass stools it can result in rectal bleeding either from:

• Haemorrhoids (piles) — swollen blood vessels in your anus and lower rectum
• Anal fissure — a small tear in the tissue around the anus

Faecal impaction

Faecal impaction occurs when hard, dry stools build up in your colon and rectum as a result of long-term constipation. The most common symptom of faecal impaction is diarrhoea, where runny poop leaks through backed-up faeces. In most cases, you are unable to pass the impacted stools naturally and need medical treatment such as laxatives or an enema to treat faecal impaction.

Rectal prolapse

A rectal prolapse is where a part of your rectum (the last section of your colon) bulges out of your anus. It can occur due to long-term constipation, straining to pass stool or faecal impaction. A mild rectal prolapse may go back in on its own, but over time may become more severe and need surgery.

When should I see a consultant for constipation?

Occasional bouts of constipation can often be treated at home with diet and lifestyle changes, or with temporary over-the-counter medicines. If your constipation is severe or symptoms aren’t improving after a couple of weeks, you may need further investigation and treatment.

The symptoms of constipation may be similar to those of other health conditions which may require a medical diagnosis and treatment.

• Make an appointment with your consultant if:You have had symptoms of constipation for two weeks or more
• You are regularly constipated or bloated
• Your constipation is not getting better with diet and lifestyle changes or over-the-counter treatments
• You have a change in your bowel habits — such as the colour and consistency of your poop, how often you poop and how much control you have over your bowel movements
• You have abdominal pain
• You notice blood in your poo or on the toilet paper when you wipe
• You have lost weight without trying
• You are taking medicine that can cause constipation

How is constipation diagnosed?

Your consultant will start by asking about your symptoms, medical history, lifestyle, toilet habits and any medications you are taking, before performing a physical examination.

In this examination, you may have a digital rectal examination (DRE). This is a quick, painless test where your consultant inserts a gloved, lubricated finger into your rectum to check for any abnormalities. Having a DRE may be uncomfortable, but shouldn’t be painful. Tell your consultant if you experience any pain during your DRE.

Many people feel embarrassed or nervous about having a DRE. It’s important to remember that your consultant performs this test routinely and is used to people feeling uncomfortable about the procedure. Tell your consultant how you are feeling, as they’ll then take steps to help put you at ease.

Depending on your symptoms and the results of your physical examination, your consultant may order the following tests.

Blood, urine or stool tests

Testing your blood, urine or stool can detect any underlying medical conditions such as thyroid problems, anaemia, diabetes, or cancer that could be causing or worsening your constipation. They can also measure your hormone levels and check for any infection or inflammation.

Diagnostic imaging tests

Scans such as abdominal X-ray, computerised tomography (CT), or Magnetic Resonance Imaging (MRI) are non-invasive procedures that take detailed images of your bowel to allow your consultant to look for any abnormalities.

Colonoscopy or sigmoidoscopy

A colonoscopy or sigmoidoscopy involves inserting a flexible tube with a tiny camera into your rectum and examining your colon for any abnormalities.

Bowel function tests

Bowel function tests such as defecography, anorectal manometry, and colonic transit study, allow your consultant to see how well your colon is working and how stool moves through your colon.

How to relieve constipation

Mild constipation can often be treated with changes to your diet and lifestyle, but in some cases you might need to take an over-the-counter laxative for constipation relief. If your constipation is severe, long-lasting or has led to complications such as faecal impaction, you may need medical treatment.

Diet and lifestyle changes

Some things you can do to relieve constipation at home include:

• Drink more water by aiming to drink eight to ten glasses of water a day. Some people find warm drinks, such as tea and hot water with lemon, can stimulate the bowel and make stools easier to pass
• Increase your fibre intake by eating more fruits, vegetables, whole grains and other high-fibre foods
• Avoid drinks containing caffeine and alcohol which can cause dehydration
• Avoid sugary foods and drinks, processed meats, fried foods, and foods high in fat and refined carbohydrates such as white bread, pasta and potatoes
• Increase your physical activity
• Act on the urge to poop without delay
• Adjust your seating position on the toilet. You might find resting your feet on a low stool, leaning back, or squatting when using the toilet makes it easier to open your bowels

Laxatives

If changes to your diet and lifestyle haven’t helped to relieve your constipation, you may need to take a laxative. Laxatives should only be used to treat occasional constipation and should not be taken for more than a week at a time. If you still have symptoms of constipation after a week of using laxatives, make an appointment to see your consultant. Some laxatives are available over the counter, while others need a prescription.

Types of laxatives

There are four main types of laxatives that work in different ways to treat constipation.

• Bulk-forming laxatives — work by increasing the "bulk" of your stool, stimulating your bowel
• Stimulant laxatives — stimulate the muscles in your gut to help your stool move through your colon
• Osmotic laxatives — soften your stool and make it easier to pass by drawing water from the rest of the body into your bowels
• Stool-softener laxatives — increase the amount of water and fat absorbed by your stool, making it easier to pass

Which laxative should I use?

As different laxatives work in different ways, it can be difficult to know which laxative may work best for you. The most effective laxative will depend on your symptoms and the type of constipation you have. Your consultant or pharmacist will be able to advise on the most suitable laxative for you.

Medical treatment

In rare cases, you may need medical treatment to relieve complications of constipation. You may need prescription laxatives, a suppository or enema (medication put into your rectum to make you poop) or manual removal of faeces by a healthcare professional.

How can I prevent constipation?

To prevent constipation, aim to drink plenty of water, get enough fibre in your diet, cut back on processed foods, dairy and meats and be physically active.

Get help with Circle Health Group

At Circle Health Group we offer a range of services and treatment options, including specialist gastroenterology consultations.

If you would like to learn more about our treatment options, book your appointment online today or call a member of our team directly on 0808 189 4921.