Constipation

Constipation is when a person is not passing stools (poo) regularly, or cannot completely empty their bowels.
Constipation is common and affects around 1 in 7 adults and 1 in 3 children.
It is more common in older age and in pregnancy.

The digestive system
The digestive system is very efficient. In just a few hours it extracts nutrients from foods and drinks, processes them into the bloodstream, then gets ready for waste disposal through poo.
Material goes through around 6 metres of intestines before getting to the colon where water is removed. The rest usually leaves the body via the bowels after a day or two.

How often should I poo?
Most people have a poo or bowel movement somewhere between 3 times a day and 3 times a week.
A lot depends on diet, age and daily activity, but 'being regular', not getting constipated and not straining is the important thing.
The longer waste material stays in the colon, the harder the poo gets, making it difficult to pass.
Normal poo should not be either unusually hard or soft.

What causes constipation?
People's regular toilet habits can be affected by many things, including:

  • Busy lifestyles
  • Changes of routine, including holidays, starting school
  • Not eating enough fibre
  • Not drinking enough water or fluids
  • Not taking enough exercise, being sedentary
  • Ignoring natural urges to go to the toilet, sometimes due to not being near a toilet you are comfortable using
  • Emotional and psychological problems
  • Health conditions, including Parkinson's disease, an under-active thyroid gland and depression
  • Age and circumstances
  • Bottle-feeding for babies
  • Some medications, including narcotic-type pain killers such as codeine, iron supplements and some drugs used to control blood pressure.

What are the symptoms of constipation?
Constipation symptoms include:

  • Hard, compacted poo that is difficult or painful to pass
  • Straining during bowel movements
  • No bowel movements after 3 days
  • Stomach aches that are relieved by bowel movements
  • Bloody stools due to hard poo, piles (haemorrhoids) and anal fissures
  • Leaks of wet, almost diarrhoea-like poo between regular bowel movements
  • Complications of constipation
  • Complications of constipation include:
  • Dry, hard poo collecting in the rectum, called faecal impaction.
  • Leakage of liquid stools, called faecal incontinence.
  • Straining on the toilet and constipation leading to piles.

Seeking medical advice
Seek medical advice about constipation if:

  • Constipation is associated with a fever and lower abdominal pain, and your stools are thin or loose. This could be a sign of diverticulitis or other bowel conditions.
  • There is blood in poo. As well as being caused by anal fissures or piles, it is a possible symptom of bowel cancer.
  • Constipation begins after starting a new medication or supplement.
  • Constipation lasts 2 to 3 weeks, with abdominal pain. This could be a sign of lead poisoning or other serious problems.
  • You are elderly or disabled and have been constipated for a week or more, which may indicate an impacted stool.
  • There is unplanned weight loss
  • There is severe pain with bowel movements.

Diagnosing constipation
Because occasional constipation is so common, it does not usually need medical attention. However, if it is a recurring problem, seek medical advice.

Health professionals will ask about symptoms, medical history and will often examine your abdomen for any sign of a hardened mass and conduct a rectal examination with a lubricated gloved finger.
Further tests may be arranged, including blood tests or a colon examination.

What are the treatments for constipation?
Constipation 'lifestyle' treatments include:

  • Eating more fibre
  • Exercise

Laxatives, over-the-counter or through a GP, may be recommended for short-term use.
Bulk-forming laxatives make poo retain fluid.
Osmotic laxatives increase fluid in the bowel.
Stimulant laxatives encourage the digestive muscles to help move stools.

Make sure the doctor or pharmacist knows about other medications taken, or whether you may be pregnant, to make sure an appropriate laxative is selected.

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