Constipation Q & A

How do I know when I have constipation?

You don’t need to have a bowel movement every day, but having fewer than three bowel movements during a week means you have constipation. Other signs of constipation include:

  • Having a hard time passing stool
  • Experiencing pain when trying to have a bowel movement
  • Straining to have a bowel movement
  • Feeling like all the stool wasn’t eliminated
  • Feeling like your rectum is blocked

Many people with constipation also experience abdominal cramping, gas, and bloating.

This chart, called the Bristol Stool Chart, it is a way identifying constipation. If your poo is type 1 or type 2 on the chart, this is constipation. The poo is often hard and difficult to pass.

What causes constipation?

Medicines: Over the counter or prescription medicines (e.g. opioids, a type of pain relief drugs) often carry a side effect of constipation. If symptoms began (or got worse) after starting one of these drugs, ask your doctor to see if there are any alternatives.

Dehydration and Low-fibre diet: Eating less fibres and low fluid and water intake in diet is often commonest cause of Constipation.

Disturbed eating behaviour: eating disorders and sustained periods of erratic eating can result in constipation, even if eating behaviour returns to normal.

Ignoring the natural urges to open bowels: ignoring bowel urges because of an aversion to public toilets or time or social constraints can result in changes to both how the bowel muscles work and the pattern of bowel opening.

Excessive straining: this can be because of difficulty co-ordinating the muscles that empty the bowel.

Irregular mealtimes reduced liquid intake and reduced physical activity: these can all worsen symptoms in people with a tendency towards constipation.

Pain, or fear of pain, on passing stools.

Pelvic floor weakness: some women develop a weakness of the pelvic floor allowing the bowel to bulge abnormally during attempting rectal emptying (“rectocele”), further interfering with the emptying mechanism. This can be especially common in women who have had children often known as obstructed defaecation

Dilated bowel: this is a less common condition in which the bowel becomes abnormally large (dilated) creating a condition called megacolon or megarectum, which can cause constipation.

Slow transit constipation: one of the causes is where the muscles of the intestine and large bowel stop working properly; this results in slow movement of contents through the bowel down to the rectum (leading to a reduced urge to empty the bowel and hard stools).

Hypothyroidism: Thyroxine hormone is necessary for gut motility and low level can lead to constipation.

How is constipation diagnosed?

Constipation is bothersome but usually not serious. If the simple measures described later do not help and your symptoms persist, then you will need to consult your GP. Also, a sudden slowing up of your bowel, especially if you are aged over 40, should also be reported. Try not to take laxatives before seeing your doctor.

If you also experience any of the following symptoms, you should see you GP immediately:

  • Unexplained weight loss
  • Bleeding in the stool
  • or rectal pain

Your doctor will diagnose you according to the number or severity of symptoms as above. They may also want to examine your abdomen to check for any tenderness, swelling or blockageFurther investigation is usually unnecessary and will depend on your symptoms, age and possibly whether you have a history of bowel problems in your family. In rare cases the bowels may not be working properly because the bowel itself is diseased. If your doctor has any concerns, they may organise one or more of the following investigations:

  • Blood tests: these are usually to look for anaemia, thyroid hormone or metabolic problems.
  • Flexible sigmoidoscopy, colonoscopy, barium enema or CT scan: these are tests which allow doctors to examine the lining of your bowel and are routine procedures which are extremely safe. Bowel preparation is required prior to these procedures.
  • Transit studies: a simple test involving an X-ray which shows the speed of passage through the bowel. A highlighting substance is ingested which shows up on X-ray. Laxatives cannot be taken during the test. Please note that a simple abdominal Xray, without the highlighting substance, is rarely helpful in diagnosing constipation.
  • Anorectal physiology testing and proctography: rarely carried out, they indicate how the pelvic floor and the nerves and muscles around the back-passage work. No bowel preparation is required.

How can Constipation affect you?

Although people often worry about it, there is no reason to believe that constipation causes a ‘poisoning’ of the system. It can cause feelings of sluggishness and bloating, but there is no evidence that bugs or toxins leak from the bowel into any other part of the body.

It is important to remember that the vast majority of cases of constipation are easily resolved with simple diet, lifestyle or medication change. However, if constipation does not respond to different treatments there can be medium to long term effects including:

  • Haemorrhoids or fissures: bleeding from haemorrhoids, or more rarely a fissure (painful tear) at the anus, is the commonest complication of constipation.
  • Rectal prolapse: chronic straining can lead to the rectal wall protruding out through the anus.
  • Faecal impaction: elderly or immobile patients may get so badly constipated that they quite literally get bunged up and this will need prompt treatment by either the GP or hospital.
  • Diverticular disease: this is where small hard stools lead to increased intestinal contractions, creating pressure which causes the inner section of the intestine to bulge through the protective outer tube of muscle which surrounds it, creating a little pouch of intestine

How is constipation treated?

Most treatment is self-managed and based around dietary and lifestyle changes:

  • Dietary changes: Regular meals and an adequate fluid intake (approximately 8 cups a day) are the mainstays of treating and preventing constipation. Although drinking more than this is unlikely to make a difference.
  • A high fibre diet: this may help some patients with constipation. This should include a mixture of high fibre foods such as fruit, vegetables, nuts, wholemeal bread and pasta, wholegrain cereals and brown rice. The aim should be to include a high fibre food at each meal along with five portions of fruit or vegetables each day. Some people may find that it helps to eat more fruit and vegetables while others might prefer cereals and grains. Eating more fibre may lead to bloating and can worsen discomfort, so it is important to increase levels slowly. Fibre is most helpful for people with mild symptoms of constipation, however if the condition is severe then continuing to increase fibre may make symptoms worse.

If you are struggling with your diet, ask your GP for a referral to a dietitian.

  • Listening to your body: it is important to identify a routine of a place and time of day when you are comfortably able to spend time in the toilet. Respond to your bowel’s natural pattern so when you feel the urge, don’t delay. A warm drink with breakfast can help encourage the bowel into a pattern of regular working.
  • Exercise: keeping active and mobile may help some people whose bowel is sluggish.

If you remain troubled with constipation, you may need further treatment. These can include:

  • Laxatives: Regular use of over-the-counter laxatives is generally not encouraged but occasional use is not harmful. Long term use can lead to the bowel becoming progressively less responsive in some people, and in these individuals, it may be important to switch to a different agent.
  • Biofeedback: available in some centres, people are trained to co-ordinate rectal and abdominal muscles better in order to help the bowel empty rather more effectively.
  • Surgery: it is usually best to avoid surgery because many people do not have a successful outcome. Indeed, there are some people who develop new symptoms after an operation such as diarrhoea, bowel obstruction or incontinence. Pelvic floor surgery for conditions like rectocele and rectal prolapse (see above) may be a possibility but would need a specialist assessment to decide this.
  • Psychological treatments: These can be extremely helpful in reducing the symptom burden of some people who experience emotional influences on their constipation.

Pro Tip

You should visit a specialist for any new onset constipation before self-treating with laxatives… Piles Clinic UK

Don’t wait to get help for constipation. Call Piles clinic UK and book an appointment today.