What is constipation?

Constipation can be embarrassing to talk about, so here’s all the info you need. Find out what’s normal, what’s not – and when to seek help

Written by Madeleine Bailey on March 1, 2019 Reviewed by Dr Rob Hicks on March 13, 2019

Many of us have been constipated at some point, but if you get constipation on a regular basis – or it lasts more than a few days – there may be a medical reason that needs addressing.

What is constipation?

Constipation is when you’re unable to empty your bowels properly or you don’t pass stools regularly.¹ Not everyone has a bowel movement every day, but constipation means going less often than is usual for you. Medical guidelines define constipation as having three or fewer bowel movements a week.² Other constipation symptoms may include:³

• dry, hard, lumpy stools
• unusually small or large stools
• bloating
• stomach ache
• nausea
• loss of appetite

Constipation can last for a couple of days, which is usually nothing to worry about, but some people can go several weeks without emptying their bowels. This is classed as chronic constipation.⁴ If left untreated, chronic constipation can lead to:⁵

• piles – caused by straining
• impaction – when hardened stools get stuck in your intestines
• small tears around your rectum – due to hard or very large stools
• prolapsed rectum – triggered by severe straining

What causes constipation?

Stools are usually in the large intestine for an average of 40 hours,⁶ but if they remain in the bowel for too long, too much water is absorbed from food in the colon which makes stools hard, dry, and difficult to pass. Causes of constipation include:^7-12

Diet and lifestyle – not eating enough fibre such as wholegrains and fruit and vegetables, a low fluid intake, and not getting enough exercise, can all contribute to a sluggish bowel.

Changes to your routine – a new diet, a change in sleep routine, or going on holiday can disrupt your bowel habits, while a new job may mean you have less time to go to the loo and so ignore the urge to empty your bowels.

Stress – stress can affect the hormonal activity in your gut, slowing down digestion. You may not be eating properly or drinking enough water too, which can also lead to constipation.

Hormones – during pregnancy and before your period, there’s an increase in the hormone progesterone that relaxes your muscles and can make bowel movements more difficult.

Medication – some drugs, such as codeine, antidepressants and indigestion tables, have side-effects that include constipation, while overusing laxatives means your body may no long respond to them effectively.

Certain medical conditions may lead to constipation too, such as:^13,14

• nervous system disorders like multiple sclerosis (MS) or Parkinson’s disease
• irritable bowel syndrome (IBS)
• hypothyroidism
• depression

Who gets constipation?

Around one in seven adults and up to one in three children have constipation at any time,¹⁵ but it’s more common in women, pregnant woman, young children and older adults. Getting older can make constipation more likely because your metabolism tends to slow down as you age, and you may not be as active.¹⁶

Four easy ways to ease constipation

1. Aim to eat 30g of fibre a day to keep things moving, but increase the amount of fibre gradually so your gut can adapt.
2. Limit fatty, low-fibre foods such as deep-fried fast foods, which can slow down digestion.¹⁷
3. Don’t ignore the urge to go to the loo. Raising your knees above your hips by putting your feet on a footstool can also make it easier to empty your bowels.¹⁸
4. Drink plenty of fluid to help prevent stools hardening, but not alcohol or caffeine, which can be dehydrating.¹⁹

If your constipation doesn’t improve after trying the tips above, or you are concerned, see your GP. You should make an urgent appointment if you also experience bloody stools or notice blood on the toilet paper, you’re always tired, or you’ve lost your appetite or a lot of weight for no obvious reason.²⁰  Advice is for information only and should not replace medical care. Please check with your GP before trying any remedies.

Sources

1. NHS Inform. Constipation

2. Nature. Constipation. Available from: https://www.nature.com/subjects/constipation

3. NHS Inform. Symptoms of constipation 4. Mayo Clinic. Constipation

5. As above

6. Mayo Clinic. Digestion: How long does it take? 7. Christian Nordqvist. Medical News Today. What to know about constipation 8. NHS. Constipation 9. Gov.uk. Guidance. Constipation: making reasonable adjustments 10. Cory Whelan. Healthline. Is stress causing my constipation? 11. NCT. Constipation in pregnancy, haemorrhoids and anal fissures 12. NHS Inform. Causes of constipation

13. As above
14. As Source 7
15. As Source 1

16. Manini TM. Energy Expenditure and Aging 17. Alina Petre. Healthline. 8 foods that can cause constipation

18. As Source 12
19. As Source 7

20. As Source 8