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Constipation

Published by Bupa's health information team, July 2008.

This factsheet is for people who have constipation, or who would like information about it.

Constipation is different for everyone but is usually thought of as difficulty in having a bowel movement. It can occur for many reasons, and may also be a symptom of an underlying condition. It's more common in certain groups of people, such as young women and the elderly. There are a number of treatment options for constipation.

About constipation

If you have constipation, there are two main ways in which you may be affected. These are described here.

  • It may be that you are able to have regular bowel movements, but it's uncomfortable and you have to strain to go.
  • You don't have bowel movements as often as you would expect.

Constipation is a very common reason for people going to see their GP - about three million people a year go to their GP about this.

Symptoms of constipation

It's very difficult to define constipation as everyone's pattern of bowel movements varies. In general, constipation is when this changes from what you are used to, either because you have bowel movements less often than usual, or because it's difficult or painful to have a bowel movement.

The main symptoms of constipation include:

  • straining when trying to have a bowel movement
  • feeling as though you haven't fully emptied your bowels
  • faeces that are hard and/or lumpy
  • fewer than two bowel movements a week

If you have these symptoms you should see your GP. It's also important to see your GP if you notice a change in your usual pattern of bowel movements or it's difficult to have a bowel movement.

Other symptoms include:

  • pain or discomfort in your abdomen (tummy)
  • bloating
  • feeling sick

Complications of constipation

Untreated constipation can cause complications. These may include:

  • haemorrhoids
  • anal fissures - these may develop as a result of damage to your anus as hard faeces pass through it
  • faecal impaction - hard faeces may collect in your rectum and may also lead to overflow incontinence
  • overflow (spurious) diarrhoea
  • psychological problems, especially in children, such as holding in faeces because passing them has been painful in the past

Causes of constipation

There are a number of reasons why you may develop constipation. These include:

  • not eating enough fibre
  • not drinking enough fluid
  • taking certain medicines, such as some antidepressants
  • being inactive
  • fear about using the toilet
  • Parkinson's disease
  • irritable bowel syndrome (IBS)
  • stress or depression

Young women and the elderly are more at risk of getting constipation. Some women find they are more likely to get constipated at certain points during their menstrual cycle. In addition, women who are pregnant often have constipation.

If you have constipation, it's possible that it's a symptom of another medical condition. If you are over 40 and develop constipation or notice a change in how often you are having bowel movements, it's very important that you see your GP.

Diagnosis of constipation

Your GP will ask about your symptoms and examine you - this may include an examination of your rectum. He or she may also ask about your medical history. You may also need to have a blood test to see if your constipation is caused by another medical condition.

It's possible that your GP will refer you for further tests such as a flexible sigmoidoscopy, colonoscopy or a barium enema.

  • A sigmoidoscopy is a procedure used to look inside the rectum and lower part of the bowel using a narrow, flexible, tube-like telescope called a sigmoidoscope. It's routinely done as an out-patient procedure and you won't need an anaesthetic or sedative.
  • A colonoscopy is a test that allows your doctor to look inside your large bowel. The test is done using a narrow, flexible, tube-like telescopic camera called a colonoscope.
  • A barium enema involves placing a fluid containing barium (a substance which shows up on X-ray images) into your bowel via the rectum. X-ray images of your abdomen then show the inside of your bowel more clearly.

Treatment of constipation

Many people who have mild symptoms of constipation won't need treatment with medicines. There are a number of things you can do to help relieve your symptoms.

Self-help

It's important that you include plenty of fibre in your diet as this can help to prevent constipation, as well as many other conditions. Most people in the UK don't eat enough fibre. Fibre absorbs water and increases the bulk of waste matter in your bowel. This helps to move digested food through your bowel more easily.

Only food that comes originally from plants contains fibre. Good sources of fibre include:

  • fruit
  • vegetables
  • wholegrain breakfast cereals
  • wholegrain bread
  • brown rice
  • oats
  • beans and pulses

The UK Department of Health recommends that everyone eats five portions of fruit and vegetables a day. This can go a long way towards increasing the amount of fibre in your diet, which will improve symptoms of constipation. It also helps to protect you against other health conditions such as some cancers. Sprinkling bran onto your food is another easy way to eat more fibre.

If you don't currently eat much fibre, increase the amount in your diet slowly, otherwise you may get bloating and wind. It's important to continue with a high-fibre diet even if your symptoms don't immediately improve as it may take several weeks to have an effect. About half of all people with symptoms of constipation find they are helped by eating more fibre.

You may also need to increase the volume of fluid that you drink. Speak to your GP before making any changes to your diet or the amounts that you eat and drink.

It's likely that increasing the amount of exercise you do will help to ease constipation.

Medicines

If making lifestyle changes doesn't help to relieve constipation, you may be prescribed a laxative. Usually, you won't be prescribed laxatives unless straining to have a bowel movement is likely to worsen a medical condition or cause bleeding. If you take laxatives long-term, it can lead to your bowel not working properly on its own.

There are a number of types of laxative that work in different ways. There isn't much evidence to show which sort works best, so your GP will prescribe you one according to the symptoms of your constipation. It's important to be aware that laxatives affect everyone differently. Generally, you should only use laxatives occasionally. Once your bowel movements are back to usual, you can try to keep them this way by eating a balanced diet with plenty of fluids and fibre.

Bulk-forming laxatives

These medicines work by increasing the amount of faeces in your bowel. As this builds up, it stimulates your bowel muscles to move and push the faeces out. It may take a few days for bulk-forming laxatives to have a full effect. Examples of this type of laxative include bran and ispaghula husk (eg Fybogel). It's important to drink plenty of water if you take a bulk-forming laxative.

Osmotic laxatives

Osmotic laxatives increase the amount of water in your bowel. These also take several days to have an effect so they won't give immediate relief. It's important to drink water when you are taking this type of medicine. Examples of osmotic laxatives include lactulose and macrogols (eg Idrolax).

Stimulant laxatives

Stimulant laxatives increase movement in your bowel. They work more quickly than other types of laxative - if you take them at night you are likely to have a bowel movement in the morning. Stimulant laxatives can cause abdominal pain. Examples of this medicine include bisacodyl and senna (eg Senokot).

You can buy each type of laxative over the counter from a pharmacist without a prescription. However, it's a good idea to see your GP before trying laxatives as he or she may be able to give you advice on how to relieve your symptoms without needing to use medicines. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Physiological therapies

There is some evidence that you may be able to train the muscles in your pelvic floor to contract fully and enable you to have a bowel movement. This is called biofeedback.

Very occasionally, you may need to have faeces removed by hand.

Prevention of constipation

You can try to prevent constipation by eating a balanced diet with lots of fibre. Drinking plenty of water and taking regular exercise will also help to reduce the chance of you getting constipated.

Further information

 

Related topics

Sources

  • Constipation in adults. Clinical Evidence. http://clinicalevidence.bmj.com, accessed 9 June 2008
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:472-473
  • Constipation in adults. CORE. www.corecharity.org.uk, accessed 9 June 2008
  • Jewell DJ, Young G. Interventions for treating constipation in pregnancy. Cochrane Database of Systematic Reviews 1998, Issue 3. Art. No: CD001142
  • Dietary fibre. British Nutrition Foundation. www.nutrition.org.uk, accessed 10 June 2008
  • 5 a day. Department of Health. www.dh.gov.uk, accessed 10 June 2008
  • National Prescribing Centre. The management of constipation. MeReC Bulletin 2004, 14(6)
  • Joint Formulary Committee, British National Formulary. 55 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
  • Constipation. Bandolier. www.jr2.ox.ac.uk/bandolier, accessed 10 June 2008
  • Bloom S, Webster G. Oxford Handbook of Gastroenterology and Hepatology. Oxford: Oxford University Press, 2006:53

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr WH Simpson, MBBS, General Practitioner, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2008.

 

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