Constipation
Constipation is not a one-line diagnosis but a change in the way your bowel normally works: you go less often, the stool becomes hard, and passing it takes…
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Medicines commonly prescribed for Constipation
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: RECTAL LIQUID, 450 mg / 45 mgActive substance: sodium lauryl sulfoacetate, incl. combinationsManufacturer: Lainco S.A.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 0.67 g lactulose/mlActive substance: lactuloseManufacturer: Lainco S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 0.67 g lactulose/mlActive substance: lactuloseManufacturer: Lainco S.A.Prescription required
Constipation is not a one-line diagnosis but a change in the way your bowel normally works: you go less often, the stool becomes hard, and passing it takes effort. Everyone has their own rhythm. Opening your bowels twice a day is normal, and so is doing it every three days. What matters is not an average figure but the shift away from what used to be usual for you. Almost everyone runs into it at some point, and in most cases it settles with simple changes to food and routine.
What counts as constipation
Constipation is likely when several of these apply:
- fewer than three bowel movements a week, or noticeably fewer than you are used to;
- stools that are dry and hard, pellet-like or unusually large;
- straining for a long time to pass them, sometimes painfully;
- a lingering sense that the bowel has not emptied completely.
Bloating, heaviness, a dull ache in the abdomen, poor appetite and nausea often come with it. Older people and people living with dementia deserve a separate mention: they frequently do not put the problem into words. Restlessness, refusing food or unusual confusion are worth noticing, because sometimes that is the only way a person signals pain or discomfort.
Why the bowel slows down
A clear cause is not always found. Most often it is a combination of circumstances:
- too little plant food: vegetables, fruit, pulses, wholegrains;
- too little to drink, especially in hot weather or with a fever;
- days without movement: desk work, bed rest, long journeys;
- the habit of holding on and putting the toilet off;
- an abrupt change of diet or schedule: moving house, a holiday, night shifts;
- side effects of medicines: opioid painkillers, iron tablets, some blood pressure drugs, antidepressants;
- stress, anxiety or low mood.
Constipation is more common in pregnancy, after childbirth and over the age of sixty-five. Sometimes another condition sits behind it: an underactive thyroid, diabetes, a high calcium level, diverticular disease or a neurological disorder. Rarely, but seriously, bowel cancer. That is why persistent constipation appearing for the first time in an adult should not simply be put down to something you ate.
What actually helps
The first steps are much the same for everyone and are safe in pregnancy too.
Food. Add fibre gradually, over two or three weeks, or the bloating will only get worse: vegetables, fruit, bran, oats, linseed. Fruits rich in sorbitol are useful too, such as plums and prunes, dried apricots, pears and apples.
Fluid. Fibre only works alongside water; without it, fibre makes the stool harder rather than softer. Alcohol dehydrates, so it is worth cutting back.
Movement. A brisk daily walk changes more than you would expect, because the bowel responds to the body being active in general.
Toilet routine. Go at roughly the same time each day, ideally twenty to thirty minutes after breakfast, when the bowel is at its most active. Never ignore the urge. Do not rush, but do not sit there with your phone either. Position matters: a low footstool, knees above hips and the upper body tilted slightly forward straighten the rectum and cut down the straining.
The first improvement is usually noticeable within days, though the bowel sometimes takes a couple of weeks to resettle.
Laxatives and how they differ
If diet and routine are not enough, it is worth talking to a pharmacist or a doctor. A laxative is not one product but several groups that work in different ways.
- Bulk-forming (ispaghula husk, methylcellulose) hold water and increase the volume of the stool. Gentle and suitable for longer use, but they require plenty of fluid.
- Osmotic (macrogol, lactulose) draw water into the bowel. Not instant, but predictable; macrogol is usually the first choice for hard stools.
- Stool softeners ease the passage and are often used after childbirth or perineal surgery.
- Stimulants (senna, bisacodyl) prompt the bowel to contract. They act quickly, but these are precisely the ones not to take week after week.
- Suppositories and micro-enemas help when the stool has already reached the rectum and become stuck there.
Most laxatives work within three days. The course should be short and is best tapered off rather than stopped abruptly. The choice is tailored to the situation, particularly in pregnancy, in children and in people with kidney or heart disease.
Who finds it hardest
Pregnancy and the first weeks after birth. Hormones slow the bowel, the growing womb presses on it and iron supplements make things worse. Start with food and fluid; medicines should be chosen by a doctor, as not all of them are suitable.
Older age. Less movement, less fluid and more medicines taken at once. This is where faecal impaction most often develops: a hard mass that gets stuck in the rectum. The sign is misleading, because what you see is diarrhoea, liquid leaking around the blockage. That false diarrhoea must not be treated with anti-diarrhoeal medicines; a health professional needs to clear the mass.
Treatment with opioid painkillers. Constipation is almost inevitable here, so a laxative is prescribed from the start alongside the painkiller, rather than once the problem has taken hold.
People with dementia or a learning disability. Constipation is easily missed, and a simple record of bowel movements is worth more than guesswork.
When to see a doctor, and when it cannot wait
Call emergency services straight away if constipation comes with:
- severe and worsening abdominal pain;
- vomiting together with no wind being passed at all;
- a suddenly swollen, hard abdomen.
These can be signs of bowel obstruction, which is treated in hospital.
Book an appointment within the next few days if:
- there is blood in the stool or on the paper, or the stool has turned black;
- you are losing weight without trying to;
- your usual bowel pattern has changed abruptly and has not returned to normal for several weeks;
- constipation keeps coming back or does not respond to home measures;
- you feel constantly tired or anaemia has been found;
- it began after starting a new medicine. Do not stop it yourself; the dose or the drug is changed by the doctor.
Online consultation
Constipation is exactly the kind of problem you can start sorting out remotely. The doctor does not need to examine you so much as to hear the detail: how long, how often, what the stool is like, what you take, what you have already tried, whether there is pain or blood. In a video appointment they can go through your medicine list with you, help you rebuild your eating and toilet routine, and explain which group of laxatives fits your case and for how long.
The second job of a remote appointment is to separate ordinary constipation from the kind that needs attention. If the doctor hears something that calls for examination or tests, they will say plainly which specialist to see and which tests to arrange, instead of leaving you to guess. With the symptoms listed above as urgent there is no reason to wait for any appointment at all: call emergency services.
This material is for information only and does not replace medical advice.
Consult with a doctor about Constipation
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Constipation
Discuss your symptoms and possible next steps for Constipation with a doctor online.
