Constipation

Constipation | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Constipation Constipation About constipation Symptoms of constipation Causes of constipation Diagnosing constipation Treating constipation Complications of constipation Preventing constipation About constipation Constipation is a common condition that affects people of all ages. It can mean that youre not passing stools regularly or youre unable to completely empty your bowel. Constipation can also cause your stools to be hard and lumpy, as well asunusually large or small. The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life. Read more about the symptoms of constipation . What causes constipation? Its often difficult to identify the exact cause of constipation.However, there are a number of things thatcontribute to the condition, including: not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits ignoring the urge to pass stools side effects of certain medications not drinking enough fluids anxiety or depression In children, poor diet, fear about using the toilet and problems toilet trainingcan allleadto constipation. Read more about the causes of constipation . Whos affected Constipation can occur in babies, children and adults. Its estimated that around 1in every 7adults and up to 1in every 3children in the UK has constipation at any one time. The condition affects twice as many women as men and is also more common in older adults and during pregnancy. When to get professional advice Pharmacy First Scotland: Constipation treatment from your pharmacy If you have constipation you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Constipation isnt usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required. Also speak to your pharmacist if you think your child might be constipated. Laxatives are often recommended for children alongside diet and lifestyle changes. You may be able to treat constipation yourself by making simple changes to your diet and lifestyle (see below). If these changes dont help and the problem continues, you should see your pharmacist. However, you should see your GP for advice if: you notice any rectal bleeding you notice any unexplained weight loss you have persistent tiredness yourconstipation lasts longer than 14 days without improvement Treating constipation Diet and lifestyle changes are usually recommended as the first treatment for constipation. This includes gradually increasing your daily intake of fibre, making sure you drink plenty of fluids, and trying to get more exercise. If these arent effective, yourpharmacist may recommend an orallaxative medicationthat canhelp you empty your bowels. Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established. Read more about treating constipation . Preventing constipation Making the diet and lifestyle changes mentioned above can alsohelp to reduce your risk of developing constipation in the first place. Giving yourself enough time and privacy to pass stools comfortably may also help, and you should try not toignore the urge to go to the toilet. Read more about preventing constipation . Complications For most people constipation rarely causes complications, but people withlong-term constipation can develop: haemorrhoids (piles) faecal impaction (where dry, hard stools collect in the rectum) bowel incontinence (the leakage of liquid stools) Read more about the complications of constipation . Symptoms of constipation When youre constipated, passing stools becomes more difficult and less frequent than usual. Normal bowel habits vary from person to person. Some adults go to the toilet more than once a day, whereas others may only go every 3or 4days. Similarly, some infants pass stools several times a day, while others only pass them a few times a week. If you or your child pass stools less than usual, it could be a sign of constipation. It may also be more difficult to pass stools and you may feel unable to empty your bowelcompletely. Your stools may appear dry, hard and lumpy, as well as abnormally large or small. Other symptoms of constipation can include: stomach ache and cramps feeling bloated feelingsick loss of appetite Constipation in children As well as infrequent or irregular bowel movements, a child with constipation may also have any of the following symptoms: loss of appetite a lack of energy being irritable, angry or unhappy foul-smelling wind and stools stomachpain and discomfort soiling their clothes generally feeling unwell Causes of constipation Constipation usually occurs when stools remain in the colon (large intestine) for too long, and the colon absorbs too much water from the stools, causing them to become hard and dry. Most cases of constipation arent caused by a specific condition and it may be difficult to identify the exact cause. However, several factors can increase your chances of having constipation, including: not eating enough fibre, such as fruit, vegetables and cereals a change in your routine or lifestyle, such as a change in your eating habits having limited privacy when using the toilet ignoring the urge to pass stools immobility or lack of exercise not drinking enough fluids having a high temperature (fever) being underweight or overweight anxiety or depression psychiatric problems, such as those brought on by sexual abuse, violence or trauma Medication Constipation may sometimes be a side effect of a medicine youre taking. Common types of medication that can cause constipation include: aluminiumantacids (medicine to treat indigestion ) antidepressants antiepileptics (medicine to treat epilepsy ) antipsychotics (medicine to treat schizophrenia and other mental health conditions) calciumsupplements opiate painkillers, such as codeine and morphine diuretics (water tablets) ironsupplements If constipation is caused by medication, the condition will usually ease once you stop taking the medicine. However, you shouldnt stop taking any prescribed medication unless your GP advises you to. Speak to your pharmacist if you have constipation thats caused bya medicine. They may be able toadvise you on how to treat the problem, or they might recommend you see your GP for an alternative medicine if appropriate. Pregnancy About 2in every 5women experience constipation during their pregnancy, mostly during the early stages. Constipation occurs during pregnancy because your body produces more of the female hormone progesterone, which acts as a muscle relaxant. The bowel normally moves stools and waste products to the anus by a process known as peristalsis. This is when the muscles lining the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along. If youre pregnant, there are ways to safely treat constipation without harming you or your baby. Read more about treating constipation . Other conditions In rare cases, constipation can be a sign of an underlying condition, such as: irritable bowel syndrome (IBS) diabetes hypercalcaemia  where theres too much calcium in the bloodstream underactive thyroid gland (hypothyroidism) muscular dystrophy a genetic condition that causes muscle wasting multiple sclerosis  a condition that affects the nervous system Parkinsons disease where part of the brain becomes progressively damaged, affecting the co-ordination of body movements spinal cord injury anal fissure a small tear or ulcerin the skinjust inside the anus inflammatory bowel disease a condition that causes the intestines to become inflamed (irritated and swollen) bowel cancer Babies and children Constipation in babies and children is quite common. Its estimated that up to 1in every 3children in the UK has constipation at any time. Poor diet, fear about using the toilet and poor toilet trainingcan all be responsible. Poor diet Children who are over-fed are more likely to have constipation, as are those who dont get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, its very important that your child has enough fibre in their diet. Toilet training Its important that you dont make your child feel stressed or pressured about using the toilet. Its also important to let your children try things by themselves (when appropriate). Constantly intervening when theyre using the toilet may make them feel anxious and may contribute to constipation. Toilet habits Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel they are unable to use the toilets at school. This fear may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, if they do this, their condition will only get worse. Other conditions In rare cases, constipation in babies and children can be a sign of an underlying condition, such as: Hirschsprungs disease  which affects the bowel, making it difficult to pass stools anorectal malformation  where the babys anus and rectum dont form properly spinal cord abnormalities  including rare conditions such as spina bifida and cerebral palsy cystic fibrosis  a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation Diagnosing constipation Constipation is a very common condition. Your pharmacist wont usually need to carry out any tests or procedures, but will confirm a diagnosis based on your symptoms and medical history. Your pharmacist will ask you some questions about your bowel habits. Dont feel embarrassed about discussing this with your pharmacist. Its important theyre aware of all of your symptoms, so they can make the correct diagnosis. Your pharmacist may also ask questions about your diet, level of exercise and whether there have been any recent changes to your routines. Constipation can be defined in a number of ways: opening the bowels less than 3times a week needing to strain to open your bowels on more than a quarter of occasions passing a hard or pellet-like stool on more than a quarter of occasions Physical examination If your pharmacist thinks you may have faecal impaction (when dry, hard stools collect in your rectum), they may advise you to contact your GP for a physical examination. Read complications of constipation for more information about faecal impaction. A typical examination will begin with you lying on your back, while the GP feels your abdomen (tummy). Youll then lie on your side while your GP carries out a rectal examination using a lubricated, gloved finger. Your GP will be able to feel for any stools that may have collected. An internal physical examination rarely needs to be carried out on a child. Instead, the diagnosis can usually be made by feeling the childs tummy. Further tests If youre experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions. Other tests you may have include: an abdominal X-ray  where X-rayradiation is used to produce images of the inside of your abdomen transit study examination  where you take a short course of special capsules that show up on X-rays; one or more X-rays are taken later on to see how long it takes for the capsules to pass through your digestive system anorectal manometry  where a small device with a balloon at one end is inserted into your rectum andattached to a machine that measures pressure readings from the balloon as you squeeze, relax and push your rectum muscles; this gives an idea of how well the muscles and nerves in and around your rectum are working As theres an increased risk of bowel cancer in older adults, your doctor may also request tests to rule out a diagnosis of cancer, including a computerised tomography (CT) scan or colonoscopy. Treating constipation Treatment for constipation depends on the cause, how long youve had it and how severe your symptoms are. In many cases, its possible to relieve the symptoms by making dietary and lifestyle changes. Lifestyle advice Changes to diet and lifestyle are often recommended as the first treatment for constipation. In many cases,this will improve the conditionwithout the need for medication. Some self-help methods of treating constipation are: increase your daily intake of fibre (you should eat at least 18 to 30g of fibre a day) add some bulking agents, such as wheat bran, to your diet to help make your stools softer and easier to pass avoid dehydration by drinking plenty of water exercise more regularly for example,by going for a daily walk or run if constipation is causing pain or discomfort, you may want to take a painkiller, such as paracetamol  always follow the dosage instructions carefully; children under 16 shouldnt take aspirin keep to a routine (a place and time of day) when youre able to spend time on the toilet and respond to your bowels natural pattern: when you feel the urge, dont delay try resting your feet on a low stool while going to the toilet, so that your knees are above your hips; this can make passing stools easier if medication youre takingcould be causing constipation, your GP may be able to prescribe an alternative Read about preventing constipation for more ways to change your diet and lifestyle. Your pharmacist may recommend an oral laxative if diet and lifestyle changes dont help. Laxatives Laxatives are a type of medicine that help you pass stools. There are several different types of laxative and each one has a different effect on your digestive system. Bulk-forming laxatives Your pharmacist will usually startyou ona bulk-forming laxative. These work by helping your stools to retain fluid. This means theyre less likely to dry out, which can lead to faecal impaction. Bulk-forming laxatives also make your stools softer, which means they should be easier to pass. Commonly prescribed bulk-forming laxatives include ispaghula husk,methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids, and dont take them before going to bed. It will usually be 2to 3days before you feel the effects of a bulk-forming laxative. Osmotic laxatives If your stools remain hard after youve taken a bulk-forming laxative, your pharmacist may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. Thissoftens your stools and stimulates your body to pass them. Commonly prescribed osmotic laxatives includelactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be 2to 3days before you feel the effect of the laxative. Stimulant laxatives If your stools are soft, but you still have difficulty passing them, your pharmacist may recommend a stimulant laxative. This type of laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus. The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they start to work within 6 to 12 hours. According to your individual preference andhow quicklyyou needrelief, your pharmacist may decide to combine different laxatives. How long will I need to take laxatives for? If youve had constipation for a short time, your pharmacist will usually advise you to stop taking the laxative once your stools are soft and easily passed. However, if your constipationis caused byan underlying medical condition or a medicine youre taking,your GP may advise you to take laxatives for much longer, possibly many months oreven years. If youve been taking laxatives for some time, you may have to gradually reduce your dose, rather than coming off them straight away. If you have been prescribed a combination of laxatives, youll normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months. Your GP will advise you about when its best to stop taking long-term laxatives. Treating faecal impaction Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along. Sometimes as a result of impaction, overflow diarrhoea may occur (where loose stools leak around the obstruction). You may have difficulty controlling this. If you have faecal impaction, youll initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using macrogol, you may also have to start taking a stimulant laxative. If you dont respond to these laxatives, and/or if you have overflow diarrhoea, you may need one of the following medications. Suppository  this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl is an example of a medication that can be given in suppository form. Mini enema  where a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way. Pregnancy or breastfeeding If youre pregnant, there are ways for you to safely treat constipation without harming you or your baby. Your pharmacist will first advise you to change your diet by increasing fibre and fluid intake. Youll also be advised to do gentle exercise. If dietary and lifestyle changes dont work, you may be prescribed a laxative to help you pass stools more regularly. Lots of laxatives are safe for pregnant women to use because most arent absorbed by the digestive system. This means that your baby wont feel the effects of the laxative. Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these dont work, your pharmacist may recommend taking a small dose of bisacodyl or senna (stimulant laxatives). However, senna may not be suitable if youre in your third trimester of pregnancy, because its partially absorbed by your digestive system. Read more about constipation and other common pregnancy problems . Babieswho havent been weaned If your baby is constipated but hasnt started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If youre using formula milk, make the formula as directed by the manufacturer and dont dilute the mixture. You may want to try gently moving your babys legs in a bicycling motion or carefully massaging their tummy to help stimulate their bowels. Babies who are eating solids If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pured or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are: apples apricots grapes peaches pears plums prunes raspberries strawberries Never force your baby to eat food if they dont want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience. If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives arent suitable for babies, so theyll usually be given an osmotic laxative. However, if this doesnt work, they can be prescribed a stimulant laxative. Children Forchildren, laxatives are often recommended alongside changes to diet. Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary. As well as eating fruit, older children should have a healthy, balanced diet , which also contains vegetables and wholegrain foods, such as wholemeal bread and pasta. Try to minimise stress or conflict associated with meal times orusing the toilet. Its important to be positive and encouraging when it comes to establishing a toilet routine. Allow your childat least 10 minutes on the toilet, to make sure theyve passed as many stools as possible. To encourage a positive toilet routine, try making a diary of your childs bowel movements linked to a reward system. This can help them focus on using the toilet successfully. Complications of constipation Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if its started promptly. However, if you have long-term (chronic) constipation, you may be more at risk of experiencing complications. Rectal bleeding Continually straining to pass stools can cause pain, discomfort and rectal bleeding. In some cases, bleeding is the result of a small tear around the anus (anal fissure), but its more often caused by haemorrhoids (piles) . Piles are swollen blood vessels that form in the lower rectum and anus. As well as bleeding, piles can also cause pain, itching around the anus, and swelling of the anus. The symptoms of piles often settle down after a few days without treatment. However, creams and ointments are available to reduce any itching or discomfort. See your pharmacist as soon as possible if you experience any rectal bleeding. Faecal impaction Long-term constipation can increase the risk of faecal impaction, whichis where dried, hard stools collect in your rectum and anus. Once you have faecal impaction, its very unlikely that youll be able to get rid of the stools naturally. Faecal impaction makes constipation worse because its harder for stools and waste products to pass out of your anus, as the path is obstructed. Faecal impaction can sometimes lead to a number of other complications, including: swelling of the rectum a loss of sensation in and around your anus bowelincontinence bleeding from your anus rectal prolapse  where part of your lower intestine falls out of place and protrudes from your anus (this can also occuras a result ofrepeated straining in people withchronic constipation) Faecal impaction is usually treated with laxative medication, although suppositories (medication inserted into the anus) andmini enemas (where medicine in fluid form is injected through your anus) may sometimes be used. Preventing constipation There are a number of things you can do to prevent constipation, including making diet and lifestyle changes. Fibre Includingenough fibre in your diet can significantly reduce your chances of developing constipation. Most adults dont eat enough fibre. You should aim to have about 30g of fibre a day. You can increase your fibre intake by eating more: fruit and vegetables wholegrain rice wholewheat pasta wholemeal bread seeds and oats Eating more fibre will keep your bowel movements regular, because it helps food pass through your digestive system more easily. Foods high in fibre also make you feel fuller for longer. Its important to increase your fibre intake gradually, because a sudden increase may make you feel bloated. Suddenly increasing your intake of fibre may also cause you to produce more wind( flatulence ) and experience stomach cramps. Read more abouthow to increase your intake of fibre and eating a healthy, balanced diet . Fluids Make sure you drink plenty of fluids to avoid dehydration , and steadily increase your intake when exercising or when its hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks you consume. Toilet habits Never ignore the urge to go to the toilet, because it can significantly increase your chances of having constipation. When going to the toilet, make sure you have enough time and privacy to pass stools comfortably. Exercise Keeping active andmobile will greatly reduce your risk of getting constipation. You should do at least 150 minutes of physical activity every week. As well as regular exercise reducing your risk of becoming constipated, it will also leave you feeling healthier and improve your mood, energy levels and general fitness. Read more about health and fitness and physical activity guidelines for adults . Source: NHS 24 - Opens in new browser window Last updated: 12 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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