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Constipation

An ESCP Guide for Patients

View our short printable guide

What is constipation?

Constipation happens when your bowel movements become less frequent or difficult to pass. There is no universally agreed definition of constipation. There is a wide range of normal bowel habits and it can mean different things to different people. Some may go several times a day, while others only go a few times a week.

If you feel like your stools are hard, painful, or incomplete, you might be constipated. It is common and usually easy to manage with simple lifestyle changes.

The term 'chronic constipation' means the problem has been present for at least 12 weeks in the past 6 months.
In some cases, if symptoms persist or severe changes occur, constipation may indicate an underlying health problem that will require the help of your medical provider to suggest additional tests, medical interventions or, rarely, surgery.

Symptoms of constipation

You may have constipation if you experience:

  • Fewer bowel movements than usual: The time between bowel movements increases compared to your usual pattern. There is a large range of normal bowel habits. Some people normally go to the toilet to pass stools 2-3 times per day, while others go to the toilet every 3 days. It is the change from a usual pattern that may mean that you are constipated.
  • Hard, dry, or lumpy stools
  • Straining or pain when passing stool
  • A feeling of incomplete emptying
  • Bloating or cramping
  • Feeling sick (in severe cases)

How is constipation diagnosed?

Clinical history and examination

Your doctor will ask questions about your bowel habits, diet, and lifestyle. They may check for:

  • Any changes in stool consistency or frequency
  • Red flags like blood in the stool, weight loss, or loss of appetite
  • Any family history of digestive issues
  • Physical exams, including checking your tummy for bloating or tenderness
  • A rectal exam if needed

Possible tests

If necessary, your doctor might suggest:

  • Colonoscopy: to rule out serious conditions like colorectal cancer
  • X-ray or CT scan: to check your intestines
  • Transit studies: to see how quickly food moves through your gut
  • Anorectal physiology tests: to check the function of nerves and muscles in the last part of the colon
  • Proctogram (also known as defecography): to get an image of the way stool is passed

Treatment options for constipation

Lifestyle and diet changes

Graphic showing the four ways to treat anal fissure through the lifestyle and diet changes: go to the toilet when you feel the need, stay well hydrated, exercise regularly, and have a diet rich in fibre

  1. Go when you feel the urge: do not hold it in!
  2. Drink more water: at least 6-8 glasses per day.
  3. Stay active: a 30-minute walk daily can help keep things moving
  4. Eat more fibre: aim for 30g daily (fruits, vegetables, whole grains)

The recommended daily intake of fibre is about 30 grams. Consuming a diet rich in whole grains, such as whole grain bread, cereals, and fibre-rich bars, along with plenty of fresh fruits and vegetables, can help improve bowel movements by adding bulk. Drinking six to eight glasses of water each day is also essential, by softening the stool it makes it easier to pass through the digestive tract. Finally, regular physical activity, even something as simple as a brisk 30-minute walk each day, can promote better digestion and improve bowel function.

Laxatives (use with caution)

If lifestyle changes do not help, laxatives can provide relief. There are several types of laxatives, including:

  • Stool softeners (e.g. docusate): make stool easier to pass
  • Bulking agents (e.g. psyllium): help add bulk and stimulate movement.
  • Osmotic laxatives (e.g. magnesium, lactulose): draw water into the bowel.
  • Stimulant laxatives (e.g. senna, bisacodyl): trigger bowel contractions.
    Stimulants are to be used with some caution and for short periods as they may exhaust the bowel after a while and make things worse.

Non-surgical procedures

If constipation persists, your doctor may suggest:

  • Pelvic floor exercises: strengthen muscles for better bowel control
  • Biofeedback therapy: uses sensors to help retrain bowel muscles
  • Enemas or irrigation: helps clear hard stools when needed by softening or flushing out the stools

Surgery (for severe cases only)

Surgery is rarely considered in the treatment of constipation. It may be an option for chronic constipation that doesn’t improve with other treatments It is used as a last resort and often only performed in specialised centres. Possible procedures include:

  • Removing part of the colon (colectomy): for slow bowel movement
  • Sacral neuromodulation: a small device to regulate bowel function
  • Stoma surgery: bringing the bowel through an opening on the abdomen for stool to pass outside the body in severe cases

When to see a doctor

See your doctor if you experience:

  • Constipation lasting more than 3 weeks
  • Severe pain or bloating
  • Blood in your stool
  • Unexplained weight loss
  • Loss of appetite

If you have any questions, speak with your doctor or colorectal surgeon for personalized advice.

Disclaimer

The information provided here is general and hopes to correctly inform the patient to the extent possible. However, this document cannot discuss all aspects of a specific condition or procedure, or of the individual patient.

The decision on which procedure will give you the best result is made by your doctor or colorectal surgeon during consultation and based on shared and informed decision-making with the patient.