Written by: 
Dr Roger Henderson

What is constipation?

Constipation is the term used to describe difficulty opening the bowels. Strictly speaking, someone is medically defined as having constipation if they experience two or more of the following features for at least 3 months:

  • Straining to open the bowels at least a quarter of the time
  • A feeling of never having completely emptied the bowels at least a quarter of the time
  • Fewer than two bowel movements a week
  • Lumpy or hard stools at least a quarter of the time.

Many people suffer from constipation for short periods during their lives, but for some it becomes a chronicA disease of long duration generally involving slow changes. or recurrent problem; it is an extremely common reason for visiting the doctor.[1]

Most people open their bowels every 1 or 2 days, but a normal frequency may range from 3 times a day to once every 3 days.

Constipation by itself does not mean that anything serious is wrong, but it may accompany other problems in the bowels. The most important thing to look out for is a persistent change of bowel habit. If you notice this, it's advisable to seek the advice of your doctor.

Other potentially worrying symptoms that it's always wise to have investigated include bleeding from the back passage, unexplained weight loss and abdominal pain. These symptoms may indicate problems such as inflammationThe body’s response to injury. of the bowel or a potentially serious disorder such as a bowel tumour.

What are the usual causes of constipation?

A change of diet, dehydrationWater deficiency in the body. or even a change of daily schedule may all lead to constipation. Certain medications, especially some painkillers containing codeine or other opiates, as well as some iron supplementsDietary supplements used to treat anaemia., can also lead to problems. People who eat more fibre are less prone to various bowel problems.

How can I help prevent it?

In general, it's wise to take small meals often and to eat plenty of fresh fruit and vegetables, as well as having plenty to drink (1.5-3 litres of fluid daily). Eating foods containing fibre such as brown rice, wholemeal pasta, wholemeal bread and potatoes with their jackets on also helps to prevent constipation. It is also advisable to take regular exercise or at least to remain active.

Try not to get into the habit of putting off going to the bathroom, as this can make the body's natural functions more sluggish.

How is constipation treated?

Various medicines and tablets, called laxatives, are available to help constipation. Examples include fibre supplements, which come in powder form and are made up into small drinks, granules, tablets containing bran or indeed raw bran. Osmotic laxatives, which act by drawing more fluid into the bowel, can also be taken, as well as irritative preparations such as senna, which work by encouraging the bowel to contract.

Do any natural treatments help?

Keeping up your fluid intake is the most important action if you want to avoid constipation, but a gentle natural treatment is to add psyllium seeds (ispaghula) to your diet. These swell as they mop up fluid in the bowel and so add bulk to the stools. Try adding a spoonful a day to salads or cereals. Flaxseed oil taken daily can also help to prevent constipation naturally.

  1. 'Oxford Handbook of General Practice'. Oxford University Press. 2nd edition, 2002