What is constipation?

Constipation is the term used to describe difficulty going to the toilet or opening the bowels (passing motions less often than you usually do). We probably all suffer from this for short periods during our lives, but for some people it becomes a chronic or recurrent problem. There is no such thing as a ‘normal’ number of times we should go to open our bowels – for some people it is two to three times a day, while for others normal would be two to three times a week – but the majority of people open their bowels every one or two days.

What are the usual causes?

There are many possible causes of constipation but the usual reasons are a change in the normal diet, dehydration (not drinking enough fluid) or even a change of daily routine. Certain medicines, such as some pain killers, can also lead to problems with opening your bowels. It is also true that people who eat more fibre as part of their diet are less likely to develop constipation.

What are the symptoms of constipation?

The usual symptoms are of passing a motion (a stool) less often than usual, having to strain to open the bowels or passing motions that are dry and hard, like rabbit pellets. It may also hurt when trying to go to the toilet and sometimes straining to go may not work, and no motion is passed. People with constipation often feel full and bloated when eating too, and there may be some abdominal pains.

How can I help prevent it?

In general, try to eat small meals often and include lots of fresh fruit and vegetables. Always have plenty of water to drink – try to drink between one and a half to three litres of fluid daily, drinking more if necessary in hot weather. Try to eat foods that are high in fibre such as wholemeal pasta, brown rice, wholemeal or brown bread, and potatoes in their jackets. It is also important to take regular exercise and remain as active as possible as this helps work the muscles that open the bowels. Never put off going to the toilet if you feel you need to go, as this can make the body's natural ways of working more sluggish. Find a routine of a place and a time of day when you are comfortably able to spend time in the toilet, and respond to your bowel's natural pattern: when you feel the urge to go, go! The best time for you to pass stools is first thing in the morning, or about 30 minutes after a meal.

Try to keep stress to a minimum. It can also help if you add natural treatments such as psyllium seed or flaxseeds into the diet – often into salads or cereals - that help add bulk to the motions and so prevent constipation.

What treatments are available?

If simple measures of prevention do not work then you may need to take a laxative from your pharmacist or doctor. The type usually given first is a bulk-forming laxative. These work by making your stools heavier yet softer, which means they should be easier to pass.  When taking this type of laxative, you should drink plenty of fluids, and it is usually two to three days before you feel the benefits of taking it. If you are still constipated after you have taken a bulk-forming laxative, your doctor may prescribe you an osmotic laxative, which helps to stimulate your body to pass stools while making them softer. As with bulk-forming laxatives, make sure you drink lots of fluids. Finally, you may be prescribed a stimulant laxative. This type of laxative stimulates the muscles that line your bowels, helping them to move stools and waste products along them.  These laxatives are usually only used on a short-term basis, and they will usually start to work within 6 to 12 hours.

If you have only experienced constipation for a short time, your doctor will normally advise you to stop taking the laxative once your stools are soft and easily passed. However, if you have constipation due to a medicine or an underlying medical condition, you may have to take laxatives for much longer.

Always seek medical advice if your constipation is associated with severe abdominal pain, vomiting or passing blood or mucus in the motions, and if your usual bowel habit suddenly changes or you start losing weight for no obvious reason.