Constipation

Reviewed by Dr Dan Rutherford, GP



What is constipation?

Although constipation is a common term, from a medical perspective it is hard to define precisely.

The dictionary definition is: 'A condition in which bowel emptying occurs infrequently or in which the stools are hard and small or where bowel movement causes difficulty or pain.'

But defining infrequent is difficult when some 90 per cent of people in Western countries have a bowel pattern that ranges from three bowel movements a day to three per week.

And it is possible to move your bowels every day and still be constipated if the stools are hard and difficult to pass. Equally, a daily bowel movement is by no means essential for, nor a sign of, good health.

Provided the bowels move regularly and without discomfort, it doesn't matter if your natural bowel frequency is once every two or three days.

How common is it?

Constipation is thought to affect a quarter of the population at some time.

Constipation is more common in the elderly because:

the power of the bowel muscles diminishes with age

they tend to take more medicines that have constipating side effects.

Bypass diarrhoea

This happens when a hard plug of stool in the lower bowel (faecal impaction) stops a proper evacuation.

Only the more liquid stool from higher up in the bowel can then be passed.

For this reason correct diagnosis is important.

Medicine to slow the bowel down will make the condition worse if a person is actually constipated.

What are the symptoms of constipation?

Tummy pain associated with bowel movements.

A feeling of incomplete emptying of the bowel.

A bloated feeling in the stomach region.

Diarrhoea: constipation is one of the most common causes of diarrhoea, especially in the elderly in care. Diarrhoea caused by constipation is known as bypass diarrhoea.

What causes constipation?

Poor general health.

Immobility or an inactive lifestyle.

Insufficient fluid intake.

A diet low in fibre. Fibre retains fluid and makes the stools light and soft.

Irritable bowel syndrome (IBS).

Inadequate toilet facilities.

An underactive thyroid gland.

Spinal injury.

Multiple sclerosis.

Colon or rectal cancer.

Kidney failure.

Too much calcium in the blood.

Tumours and other lesions of the bowel.

Certain medicines, eg codeine-containing painkillers (co-dydramol, co-proxamol), morphine-like painkillers, antidepressants, aluminium-containing antacids, iron supplements, and anticholinergics such as procyclidine (used in Parkinson's disease).

Constipation should not simply be accepted or ignored. Persistent constipation or any change in bowel habit (whether towards constipation or looseness) should be investigated, especially in adults over 40 years.

However, for most people with long-standing constipation there is no identifiable cause.

What can help prevent constipation?

A well-balanced diet high in fibre, including bran, fruits and vegetables, is often helpful.

Cutting down on white bread, cakes and sugar.

Drinking at least 8 to 10 glasses of water a day. Hot beverages, such as coffee, tea or hot water may stimulate bowel movements.

Prunes and plum juice can also be beneficial.

Regular exercise improves digestion and reduces stress.

A regular bowel habit. The best time is usually the first hour after breakfast. Don't hurry and sit for at least 10 minutes, regardless of whether you manage to pass a stool. Don't strain.

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