Constipation

Constipation is a common condition which occurs when you are unable to pass stools, have difficulty going to the toilet and have to strain or feel like you have not emptied your bowels fully. Most people experience constipation at some point in their lives but some people suffer from chronic constipation, which can cause severe pain and discomfort.

Anyone can develop constipation but it is more common in babies and older people, and women are twice as likely to suffer from constipation as men. Pregnant women are also prone to constipation.

What causes constipation?

In most cases, constipation is not caused by a specific health condition and it can be difficult for doctors to identify a cause. However, several risk factors have been identified and these include:

• A low fibre diet.
• Changes in eating habits.
• Being underweight or overweight.
• Suffering from depression or anxiety.
• A lack of exercise.
• Being dehydrated and not taking in enough fluids.
• Being embarrassed about going to the toilet (this is common when people have the urge to go to the toilet when they are not at home).
• Taking certain types of medication, including diuretics, calcium supplements, antidepressants and aluminium antacids.
• Pregnancy: around 40 percent of pregnant women suffer from constipation.

Symptoms of constipation

Everyone is different when it comes to going to the toilet and symptoms may differ according to the individual. Some people pass stools more often than others and it is advisable to compare symptoms to your usual bowel habits. Common symptoms of constipation include:

• Difficulty passing stools: this may include going less frequently than normal, as well as experiencing difficulty in the physical movement of passing the stools. Going to the toilet may be painful as the stools are likely to be hard and dry.
• Abdominal pain and stomach cramps.
• Loss of appetite.
• Nausea.

In children, constipation causes many of the same symptoms as adults, but children often become irritable and emotional because they are experiencing pain. Additional symptoms include unpleasant smelling wind and a lack of energy.

When should I see my GP?

If you are experiencing constipation then eating high fibre foods, drinking fruit juices and taking in plenty of fluid should help, but if your symptoms persist or you are experiencing severe pain you should see your GP. If you notice sudden changes in your bowel habits, notice blood in your urine or stools, you should see your GP immediately. If your child has the symptoms listed above and you think they may have constipation, arrange to see your GP.

Diagnosing constipation

Doctors diagnose constipation based on the frequency you are passing stools (usually classified as fewer than 3 times per week) and whether you are having difficulty passing stools. Your GP will usually be able to diagnose constipation after talking about your symptoms, your medical history and feeling your tummy. If your doctor suspects that you have faecal impaction (when stools collect in the rectum), they will examine you. A physical examination involves feeling your abdomen and then you will be asked to lie on your side so that the doctor can examine the rectum, which involves them putting their finger up the back passage. This may be a little uncomfortable, but it is very quick and you should not experience any pain.

Treatment for constipation

The first stage of treatment is usually a change in lifestyle habits. Your GP will probably advise you to take the following steps:

• Increase your fibre intake: you should be aiming for between 18 and 30 grams of fibre per day; high fibre foods include fruit and vegetables, cereals and wholegrain foods.
• Increase your fluid intake.
• Add wheat bran to your daily diet (this will help to make the stools softer so that they are easier to pass).
• Increase the amount of exercise you do.
• Take painkillers if you are experiencing stomach pain.

If these changes do not work, your GP may suggest the following treatments:

• Laxatives: laxatives are a form of medication that helps you go to the toilet. GPs usually recommend bulk-forming laxatives first and, if the stools are still hard, they may recommend osmotic laxatives (osmotic laxatives increase the amount of fluid in the bowel, causing the body to pass the stool). If you are still having difficulty passing stools your GP may prescribe a stimulant laxative, which works by stimulating the muscles in the digestive tract.
• If you have faecal impaction (when the stools are dry and collect in the rectum), treatment usually involves a high dose of osmotic laxatives, which is normally followed by stimulant laxatives. If laxatives do not work, it may be necessary to use medication in the form of a suppository or an enema.

Preventing constipation

Constipation is a common condition and it may be impossible to prevent, but there are ways you can reduce the risk of developing constipation. These include:

• Eat plenty of fibre: good sources of fibre include wholegrain foods (such as brown bread, wholemeal pasta and brown rice) and fruit and vegetables.
• Drink plenty of fluids.
• Exercise on a regular basis (aim for at least 30 minutes of moderate exercise five times per week).
• Never ignore the urge to go to the toilet, as delaying it will only make you feel uncomfortable. Try not to feel embarrassed about using public toilets.
• See your GP if you are experiencing pain or difficulty going to the toilet.