Understanding Constipation: Causes, Symptoms, and Effective Relief

Constipation is a common digestive condition where you find it difficult to pass stools (poo) regularly or are unable to completely empty your bowels. In the UK, it is estimated that around 1 in 7 adults are affected by constipation at any given time. While it is rarely a sign of a serious underlying condition, it can cause significant discomfort and impact your quality of life.

The definition of 'normal' bowel habits varies significantly between individuals. Some people go several times a day, while others go only every other day. Medical professionals generally define constipation as having fewer than three bowel movements in a week, or when stools are unusually hard, large, or difficult to pass. You may also experience a sensation that you haven't fully emptied your bowels after using the toilet.

Beyond just a lower frequency of bowel movements, constipation often presents with a cluster of symptoms. These can include:

• Stomach aches and cramps
• Feeling bloated or excessively gassy
• Feeling sick (nausea)
• Straining to pass stools or feeling pain while doing so
• Stools that look like small stones or hard lumps
• A feeling of heaviness or pressure in the lower abdomen

In children, constipation can sometimes lead to 'soiling' (encopresis), where liquid stool leaks around the hard mass of stool and stains their underwear, which can often be mistaken for diarrhoea.

There are many lifestyle factors that contribute to slow bowel transit. Identifying the cause is the first step toward effective relief. Frequent causes include:

• Low Fibre Intake: A diet lacking in fible (found in wholegrains, fruits, and vegetables) is a primary cause. Fibre adds bulk to the stool and helps it move through the digestive system.
• Dehydration: Without enough water, the colon absorbs more fluid from food waste, resulting in hard, dry stools.
• Sedentary Lifestyle: Lack of physical activity can slow down the muscle contractions in the gut.
• Ignoring the Urge: Repeatedly delaying a bowel movement can lead to the stool becoming harder and more difficult to pass later.
• Medications: Certain prescription drugs, including opioid painkillers, some antidepressants, and calcium channel blockers (for high blood pressure), can cause constipation as a side effect.
• Anxiety and Depression: Mental health conditions can affect the digestive system's motility.
• Changes in Routine: Alterations in your daily schedule, such as travelling or changes in meal times, can disrupt bowel regularity.

For many, the first line of treatment involves simple lifestyle adjustments. Following NICE guidelines, we recommend the following steps:

1. Increase Dietary Fibre: Aim for 30g of fibre a day. Incorporate foods like oats, brown rice, wholemeal bread, lentils, beans, and plenty of leafy greens. Flaxseeds (linseeds) are also particularly effective when added to porridge or yoghurt.

2. Stay Hydrated: Drink plenty of fluids—ideally 6 to 8 glasses of water a day. Limit caffeine and alcohol, as these can contribute to dehydration.

3. Exercise Regularly: A daily 30-minute walk or light exercise can stimulate the bowels and keep things moving.

4. Toilet Routine: Try to establish a regular time and place to use the toilet where you feel comfortable and unhurried. Propping your feet up on a small stool while sitting on the toilet can help position your rectum more effectively for passing stool.

If lifestyle changes haven't helped after a week or two, a pharmacist may suggest a laxative. There are four main types available in the UK:

• Bulk-forming laxatives: These work like fibre, helping your stool retain water (e.g., Fybogel).
• Osmotic laxatives: These increase the amount of fluid in the bowels, softening the stool (e.g., Lactulose or Macrogol).
• Stimulant laxatives: These speed up the movement of the bowels by stimulating the nerves in the gut (e.g., Senna or Bisacodyl).
• Stool softeners: These help water to penetrate the stool, making it easier to pass.

Laxatives should generally only be used for a short period. If you find yourself relying on them regularly, you should speak with a GP.

While constipation is usually a temporary issue, it can sometimes indicate a more complex problem. You should book a consultation with an online GP if:

• You have tried lifestyle changes and over-the-counter treatments with no improvement.
• You are regularly constipated and it is affecting your daily life.
• You have persistent bloating or abdominal pain.
• You are taking medication that you suspect is causing your symptoms.

A GP can review your medical history, suggest prescription-strength treatments, or refer you for further investigations if needed. During a consultation, be prepared to discuss the frequency of your bowel movements and the appearance of your stools.