What counts as constipation
Bowel habits vary a lot between healthy people. Some go twice a day, others once in two days. Doctors call it constipation when you pass stools fewer than three times a week, or when stools are hard, lumpy and difficult to pass, with straining or a feeling that the bowel is not fully empty.
Constipation is very common in children, pregnant women and older adults. It is usually short-term and harmless, and often improves within days once diet and routine are corrected. Long-term constipation, however, can cause piles, painful fissures, a bloated feeling and discomfort that affects work, sleep and appetite, so it is worth addressing early.
Common causes of constipation
The most common reasons are everyday habits. Modern diets with refined flour, polished rice, bakery foods and little fruit or vegetables give the bowel too little fibre. Not drinking enough water, especially in hot weather, makes stools dry and hard.
- Sitting for long hours and little physical activity
- Ignoring the urge to pass stools, often due to travel or unclean toilets
- Pregnancy hormones and iron tablets
- Medicines such as some painkillers, antacids with aluminium or calcium, and some BP or allergy medicines
- Health conditions such as an underactive thyroid, diabetes, irritable bowel syndrome and depression
Symptoms and complications
Besides infrequent or hard stools, people may feel bloating, lower belly discomfort, loss of appetite, a heavy feeling and sometimes mild nausea. Straining hard on the toilet can cause small painful cuts at the anus, called fissures, that bleed and sting. Repeated straining over months is also one of the main causes of piles.
In older or bedridden people, severe constipation can cause a hard mass of stool stuck in the rectum, which may paradoxically cause watery leakage that looks like diarrhoea. In children, fear of painful stools can make them hold back, which makes stools harder and the problem worse. Gentle, patient toilet training and more fibre help.
How it is checked
Most people do not need tests. The doctor will ask about your diet, water intake, medicines and how long the problem has lasted, and may examine your belly and back passage. If constipation is new after the age of 50, or there are warning signs, the doctor may advise blood tests such as thyroid function, blood sugar and a blood count.
A colonoscopy, a camera test of the large bowel, may be advised if there is bleeding, weight loss, anaemia or a family history of bowel cancer. For long-standing constipation that does not respond to treatment, specialists sometimes use tests of bowel movement or pelvic floor muscle function to find the cause.
Treatment options for constipation
The first step is always more fibre, more water and more movement. If these are not enough, a doctor or pharmacist may suggest a laxative. Bulk-forming fibre supplements and osmotic laxatives are generally gentle and suitable for many people. Stimulant laxatives work faster but are best for short-term use.
Do not use laxatives every day for long periods without medical advice, and avoid using strong laxatives to lose weight. Children, pregnant and breastfeeding women, older adults and people with kidney disease should ask a doctor or pharmacist before using any laxative, because some types are not suitable for them.
Everyday habits that help
Small changes, kept up every day, work better than occasional strong remedies. Increase fibre slowly over a couple of weeks, because a sudden jump can cause gas and bloating. Drink more water at the same time, since fibre needs water to soften stools. Children benefit from the same habits, with portions suited to their age.
- Eat whole grains such as ragi, jowar, brown rice and whole wheat chapati
- Add dal, rajma, chana and green leafy vegetables to daily meals
- Eat fruits such as guava, papaya, banana and oranges with their fibre
- Drink enough water through the day, more in summer
- Walk or exercise for at least 30 minutes most days
- Go to the toilet at a regular time, such as after breakfast, and do not rush
When to see a doctor for constipation
See a doctor if constipation lasts more than three weeks despite diet changes, keeps returning, or began after starting a new medicine. Do not stop a prescribed medicine on your own; ask the doctor about alternatives. A doctor or pharmacist can advise a suitable laxative, check your medicines and decide whether any tests are needed.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Bulk-forming laxatives such as ispaghula (psyllium) huskAdd soft bulk to stools so they pass more easily.Follow the label or your pharmacist's advice and drink plenty of water with it.
- Osmotic laxatives such as lactulose or polyethylene glycolDraw water into the bowel to soften stools.Follow the label or your pharmacist's advice; may cause bloating at first.
- Stimulant laxatives such as bisacodyl or sennaMake the bowel muscles contract to push stools out.Best for short-term use only; can cause cramps.
- Glycerin or other suppositoriesSoften and lubricate stool in the rectum for quick relief.Ask a doctor before using in children or during pregnancy.
See a doctor urgently if
- See a doctor urgently if you have severe belly pain with vomiting and cannot pass gas or stools.
- See a doctor soon if you see blood in your stools or they are black.
- See a doctor soon if you are losing weight without trying.
- See a doctor soon if your bowel habit has changed for more than a few weeks, especially after age 50.
- See a doctor if a child has constipation with poor growth, a swollen belly or vomiting.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.