Constipation

Constipation is a common condition, and it can affect people of any age. You may not be passing stools regularly, or you may feel you can't empty your bowel completely.

Your stools can also turn hard and lumpy, and they may be unusually large or small.

How bad it gets differs from one person to the next. Many people have constipation only for a short time. For others it becomes a long-term (chronic) problem that causes a lot of pain and discomfort and affects their quality of life.

Read more about the symptoms of constipation.

It's often hard to pinpoint the exact cause of constipation. Still, several things can contribute to it, including:

• not eating enough fibre, such as fruit, vegetables and cereals
• a change in your routine or lifestyle, such as a change in your eating habits
• ignoring the urge to pass stools
• side effects of certain medicines
• not drinking enough fluids
• anxiety or depression

In children, poor diet, fear about using the toilet and problems with toilet training can all lead to constipation.

Constipation can happen to babies, children and adults. In the UK, around 1 in every 7 adults and up to 1 in every 3 children are estimated to have it at any one time.

Twice as many women as men are affected. It's also more common in older adults and during pregnancy.

Constipation isn't usually serious, and a pharmacist can often treat it. If needed, your pharmacist may suggest that you see a doctor.

Speak to your pharmacist too if you think your child might be constipated. Laxatives are often recommended for children, alongside changes to diet and lifestyle.

You may be able to deal with constipation yourself by making simple changes to what you eat and how you live (see below). If these changes don't help and the problem carries on, you should see your pharmacist.

However, you should see a doctor for advice if:

• you notice any rectal bleeding
• you notice any unexplained weight loss
• you have persistent tiredness
• your constipation lasts longer than 14 days without improvement

Doctors usually recommend changes to your diet and daily habits as the first treatment for constipation. That means slowly increasing the fibre you eat each day, drinking plenty of fluids, and trying to get more exercise.

If these changes don't work, your pharmacist may suggest an oral laxative medicine to help you empty your bowels.

Constipation can be treated effectively, though in some cases it takes several months before your bowel habits settle into a regular pattern again.

The diet and lifestyle changes mentioned above can also lower your risk of getting constipation in the first place.

It may help to give yourself enough time and privacy to pass stools comfortably. Try not to ignore the urge when you feel you need to go to the toilet.

Most people find that constipation rarely causes complications. But if you have long-term constipation, you can develop:

• haemorrhoids (piles)
• faecal impaction (where dry, hard stools collect in the rectum)
• bowel incontinence (the leakage of liquid stools)

When you're constipated, passing stools gets harder and happens less often than usual.

What counts as normal differs from one person to the next. Some adults go to the toilet more than once a day, while others only go every 3 or 4 days. Babies are the same. Some pass stools several times a day, and others only a few times a week.

So if you or your child pass stools less often than usual, it could be constipation.

You may also find it harder to pass stools, and feel you can't empty your bowel completely. The stools can look dry, hard and lumpy, and they may be unusually large or small.

Other symptoms of constipation can include:

• stomach ache and cramps
• feeling bloated
• feeling sick
• loss of appetite

A child with constipation may have other symptoms besides infrequent or irregular bowel movements. These can include any of the following:

• loss of appetite
• a lack of energy
• being irritable, angry or unhappy
• foul-smelling wind and stools
• stomach pain and discomfort
• soiling their clothes
• generally feeling unwell

Constipation usually happens when stools stay in the colon (the large intestine) for too long. The colon then absorbs too much water from them, and the stools turn hard and dry.

Most cases of constipation aren't caused by a specific condition, and it can be hard to pin down the exact cause. Still, several things can make it more likely, including:

• not eating enough fibre, such as fruit, vegetables and cereals
• a change in your routine or lifestyle, such as a change in your eating habits
• having limited privacy when using the toilet
• ignoring the urge to pass stools
• immobility or lack of exercise
• not drinking enough fluids
• having a high temperature (fever)
• being underweight or overweight
• anxiety or depression
• psychiatric problems, such as those brought on by sexual abuse, violence or trauma

Sometimes constipation is a side effect of a medicine you're taking. These are the common types of medicine that can cause it:

• aluminium antacids (medicine to treat indigestion)
• antidepressants
• antiepileptics (medicine to treat epilepsy)
• antipsychotics (medicine to treat schizophrenia and other mental health conditions)
• calcium supplements
• opiate painkillers, such as codeine and morphine
• diuretics (water tablets)
• iron supplements

If medicine is the cause, the constipation will usually ease once you stop taking it. But don't stop any prescribed medicine unless your doctor tells you to.

Speak to your pharmacist if a medicine is causing your constipation. They may be able to advise you on how to treat the problem, or they might suggest you see your doctor for an alternative medicine if that's appropriate.

About 2 in every 5 women get constipation during pregnancy, and it's most common in the early stages.

The reason is hormonal. In pregnancy your body makes more of the female hormone progesterone, which works as a muscle relaxant.

Normally the bowel pushes stools and waste along towards the anus by a process called peristalsis. The muscles lining the bowel contract and relax in a rippling, wave-like motion. When progesterone rises, those muscles find it harder to contract, so waste moves along more slowly.

If you're pregnant, there are safe ways to treat constipation that won't harm you or your baby.

In rare cases, constipation can be a sign of an underlying condition, such as:

• irritable bowel syndrome (IBS)
• diabetes
• hypercalcaemia, where there's too much calcium in the bloodstream
• underactive thyroid gland (hypothyroidism)
• muscular dystrophy, a genetic condition that causes muscle wasting
• multiple sclerosis, a condition that affects the nervous system
• Parkinson's disease, where part of the brain becomes progressively damaged, affecting the co-ordination of body movements
• spinal cord injury
• anal fissure, a small tear or ulcer in the skin just inside the anus
• inflammatory bowel disease, a condition that causes the intestines to become inflamed (irritated and swollen)
• bowel cancer

Constipation is quite common in babies and children. It's estimated that up to 1 in every 3 children in the UK has constipation at any time. Poor diet, fear about using the toilet and poor toilet training can all be the cause.

Children who are over-fed are more likely to get constipation, and so are children who don't get enough fluids. Babies who have too much milk can also become constipated. Just as with adults, your child needs enough fibre in their diet, and this matters a great deal.

Try not to make your child feel stressed or pressured about using the toilet. Let your children try things by themselves too, when that's appropriate. If you keep stepping in while they're on the toilet, they may become anxious, and that can contribute to constipation.

Some children feel stressed or anxious about using the toilet. They may have a real fear of it, or feel they simply can't use the toilets at school.

Often this fear starts because your child has felt pain when passing stools. Children then pick up poor bowel habits. They ignore the urge to go and hold their stools in, afraid the pain and discomfort will come back. But if they keep doing this, the constipation will only get worse.

In rare cases, constipation in babies and children can be a sign of an underlying condition. These include:

• Hirschsprung's disease, which affects the bowel and makes it difficult to pass stools
• anorectal malformation, where the baby's anus and rectum don't form properly
• spinal cord abnormalities, including rare conditions such as spina bifida and cerebral palsy
• cystic fibrosis, a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation

Constipation is very common. Your pharmacist usually won't need to do any tests or procedures, and will confirm the diagnosis from your symptoms and your medical history.

They will ask you some questions about your bowel habits. Try not to feel embarrassed talking about this. It's important that they know all of your symptoms, so they can make the correct diagnosis.

Your pharmacist may also ask about your diet, how much exercise you take, and whether anything in your routine has changed recently.

Constipation can be defined in a number of ways:

• opening the bowels less than 3 times a week
• needing to strain to open your bowels on more than a quarter of occasions
• passing a hard or pellet-like stool on more than a quarter of occasions

If your pharmacist thinks you may have faecal impaction (when dry, hard stools collect in your rectum), they may advise you to see a doctor for a physical examination. Read complications of constipation for more information about faecal impaction.

The examination usually starts with you lying on your back, while the doctor feels your abdomen (tummy). You'll then lie on your side, and the doctor will do a rectal examination using a lubricated, gloved finger. This lets the doctor feel for any stools that may have collected.

A child rarely needs an internal physical examination. The diagnosis can usually be made by feeling the child's tummy.

If your constipation is severe, your doctor may ask for more tests, such as blood tests or thyroid tests, to find out what's causing it or to rule out other conditions.

Other tests you may have include:

• an abdominal X-ray, which uses X-ray radiation to make pictures of the inside of your abdomen
• a transit study examination, where you take a short course of special capsules that show up on X-rays. One or more X-rays are taken later to see how long the capsules take to pass through your digestive system
• anorectal manometry, where a small device with a balloon at one end is put into your rectum and connected to a machine. The machine measures the pressure in the balloon as you squeeze, relax and push your rectum muscles. This gives an idea of how well the muscles and nerves in and around your rectum are working

Bowel cancer is more likely in older adults, so your doctor may also ask for tests to rule it out, including a computerised tomography (CT) scan or a colonoscopy.

How you treat constipation depends on what's causing it, how long you've had it and how bad your symptoms are. In many cases, you can ease the symptoms by changing what you eat and how you live day to day.

Doctors often suggest changes to diet and lifestyle as the first treatment for constipation. In many cases, these changes improve the condition without any need for medicine.

Here are some things you can do yourself:

• eat more fibre every day (you should have at least 18 to 30g a day)
• add some bulking agents, such as wheat bran, to your food, which helps make your stools softer and easier to pass
• drink plenty of water so you don't become dehydrated
• exercise more regularly, for example by going for a daily walk or run
• if constipation is causing pain or discomfort, you may want to take a painkiller such as paracetamol, but always follow the dosage instructions carefully (children under 16 shouldn't take aspirin)
• keep to a routine, with a place and time of day when you can spend time on the toilet and respond to your bowel's natural pattern. When you feel the urge, don't delay
• try resting your feet on a low stool while going to the toilet, so that your knees are above your hips, as this can make passing stools easier
• if a medicine you're taking could be causing constipation, your doctor may be able to prescribe an alternative

There are more ways to change your diet and lifestyle in the information on preventing constipation.

Your pharmacist may recommend an oral laxative if diet and lifestyle changes don't help.

Laxatives are medicines that help you pass stools. There are several types, and each one works on your digestive system in a different way.

Your pharmacist will usually start you on a bulk-forming laxative. It helps your stools hold on to fluid, so they're less likely to dry out, and dry stools can lead to faecal impaction. These laxatives also make your stools softer, so they should be easier to pass.

Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. While you're taking this type of laxative, you must drink plenty of fluids, and you shouldn't take it just before going to bed. You will usually have to wait 2 to 3 days before you feel the effects.

If your stools are still hard after you've taken a bulk-forming laxative, your pharmacist may prescribe an osmotic laxative instead. Osmotic laxatives work by increasing the amount of fluid in your bowels. This softens the stools and prods your body to pass them.

Lactulose and macrogols are the osmotic laxatives most often prescribed. Just as with bulk-forming laxatives, make sure you drink enough fluids. You will usually have to wait 2 to 3 days before you feel the effect of the laxative.

If you have constipation and your stools are soft but still hard to pass, your pharmacist may suggest a stimulant laxative. This kind of laxative stimulates the muscles that line your digestive tract. That helps them move stools and waste products along your large intestine to your anus.

The stimulant laxatives prescribed most often are senna, bisacodyl and sodium picosulphate. They are usually used only for a short time, and they start to work within 6 to 12 hours.

Depending on what you prefer and how quickly you need relief, your pharmacist may decide to combine different laxatives.

If you've had constipation for only a short time, the pharmacist will usually tell you to stop the laxative once your stools are soft and easy to pass.

It's different if your constipation comes from an underlying medical condition or from a medicine you're taking. In that case your doctor may advise you to keep taking laxatives for much longer, possibly many months or even years.

If you've been on laxatives for some time, you may need to cut down the dose gradually rather than stop all at once. And if you've been prescribed a combination of laxatives, you'll normally reduce the dose of each one, one at a time, before you can stop taking them. This can take several months.

Your doctor will tell you when it's best to stop long-term laxatives.

Faecal impaction happens when your stools turn hard and dry and collect in the rectum. This blocks the rectum and makes it harder for stools to pass along.

Sometimes impaction leads to overflow diarrhoea, where loose stools leak around the blockage. You may find this hard to control.

If you have faecal impaction, you'll first be given a high dose of macrogol, which is an osmotic laxative. After a few days on macrogol, you may also need to start a stimulant laxative.

If these laxatives don't work, and/or if you have overflow diarrhoea, you may need one of the following medicines.

Suppository: this medicine is put into your anus. It dissolves slowly at body temperature and is then absorbed into your bloodstream. Bisacodyl is one medicine that can be given as a suppository.

Mini enema: here the medicine is in liquid form and is injected through your anus into your large bowel. Docusate and sodium citrate can be given this way.

If you're pregnant, there are safe ways to treat constipation without harming you or your baby. A pharmacist will usually start by advising you to change your diet, eating more fibre and drinking more fluid. You'll also be advised to do some gentle exercise.

If these changes to your diet and daily habits don't work, you may be prescribed a laxative to help you pass stools more regularly.

Lots of laxatives are safe to use in pregnancy, because most of them aren't absorbed by the digestive system. This means your baby won't feel the effects of the laxative.

The osmotic laxatives lactulose and macrogols are safe to use during pregnancy. If they don't work, your pharmacist may recommend a small dose of bisacodyl or senna (both stimulant laxatives).

However, senna may not be suitable if you're in the third trimester of pregnancy, because your digestive system partly absorbs it.

Read more about constipation and other common pregnancy problems.

If your baby has constipation but hasn't started eating solid foods yet, the first thing to try is giving extra water between their normal feeds. If you use formula milk, make it exactly as the manufacturer directs and don't dilute the mixture.

You can also try gently moving your baby's legs in a bicycling motion, or carefully massaging their tummy, to help get the bowels moving.

If your baby is already eating solid foods, give them plenty of water or diluted fruit juice. Encourage them to eat fruit too. You can purée it or chop it, depending on how well they can chew. These are the best fruits for a baby with constipation:

• apples
• apricots
• grapes
• peaches
• pears
• plums
• prunes
• raspberries
• strawberries

Never force your baby to eat if they don't want to. Doing that can turn mealtimes into a battle, and your child may start to see eating as a negative and stressful experience.

If your baby is still constipated after a change in diet, a doctor may need to prescribe a laxative. Bulk-forming laxatives aren't suitable for babies, so they'll usually be given an osmotic laxative. If that doesn't work, they can be prescribed a stimulant laxative.

Children with constipation are often given laxatives as well as changes to their diet. Doctors usually start with an osmotic laxative, and if that isn't enough, they move on to a stimulant laxative.

Older children should eat fruit, but they also need a healthy, balanced diet that includes vegetables and wholegrain foods, such as wholemeal bread and pasta.

Try to keep stress and arguments away from meal times and from using the toilet. Be positive and encouraging as you build a toilet routine. Let your child sit on the toilet for at least 10 minutes, so they pass as many stools as possible.

A diary of your child's bowel movements, linked to a reward system, can help the routine along. It gives them something to focus on, and that helps them use the toilet successfully.

Constipation rarely causes complications or long-term health problems. Treatment usually works well, especially if you start it early.

But if you have long-term (chronic) constipation, you may be more likely to run into complications.

Straining again and again to pass stools can cause pain, discomfort and rectal bleeding.

Sometimes the bleeding comes from a small tear around the anus (anal fissure). More often, though, haemorrhoids (piles) are the cause. Piles are swollen blood vessels that form in the lower rectum and anus.

Besides bleeding, piles can cause pain, itching around the anus, and swelling of the anus.

The symptoms of piles often settle down after a few days without treatment. Creams and ointments are available, though, to reduce any itching or discomfort.

See your pharmacist as soon as possible if you have any rectal bleeding.

If you have constipation for a long time, you are more likely to develop faecal impaction. This is when dried, hard stools collect in your rectum and anus. Once that happens, it's very unlikely you'll be able to get rid of the stools naturally.

Faecal impaction also makes the constipation worse. The path is blocked, so it's harder for stools and waste products to pass out of your anus.

Faecal impaction can sometimes lead to other complications, including:

• swelling of the rectum
• a loss of sensation in and around your anus
• bowel incontinence
• bleeding from your anus
• rectal prolapse, where part of your lower intestine falls out of place and protrudes from your anus (this can also occur as a result of repeated straining in people with chronic constipation)

Faecal impaction is usually treated with laxative medicine. Sometimes suppositories (medicine inserted into the anus) and mini enemas (where medicine in fluid form is injected through your anus) may be used instead.

There are several things you can do to prevent constipation, and changes to your diet and daily habits are part of that.

Eating enough fibre can cut your chances of getting constipation by a good deal. Most adults don't eat enough of it.

Try to have about 30g of fibre a day. You can raise your intake by eating more:

• fruit and vegetables
• wholegrain rice
• wholewheat pasta
• wholemeal bread
• seeds and oats

Fibre keeps your bowel movements regular because it helps food pass through your digestive system more easily. Foods high in fibre also keep you feeling full for longer.

Increase your fibre slowly. A sudden jump may leave you feeling bloated, and it can also give you more wind (flatulence) and stomach cramps.

Drink plenty of fluids so you don't become dehydrated, and take more of them, a little at a time, when you exercise or when the weather is hot. Try to cut back on caffeine, alcohol and fizzy drinks too.

Don't ignore the urge to go to the toilet. Holding it in can make constipation much more likely. When you do go, make sure you have enough time and some privacy, so you can pass stools comfortably.

Keeping active and mobile will greatly reduce your risk of getting constipation. You should do at least 150 minutes of physical activity every week.

Regular exercise lowers your chance of becoming constipated, and it also leaves you feeling healthier. Your mood, energy levels and general fitness will improve too.