Constipation in adults: causes, self-care and when to see a doctor

Almost everyone has constipation at some point. It is usually short-lived and not serious ^[3]. This article explains what it is, why it happens and how to look after yourself, using information from the NHS, the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and MedlinePlus. It covers adults. Children need separate advice from a doctor.

1. Introduction

Constipation is a change in how you pass stool, such as going less often or finding it hard to go ^[1]. MedlinePlus defines it as passing stool fewer than three times a week, often with stool that is hard and dry and painful to pass ^[3]. NIDDK points out that constipation is not a disease in itself but can be a symptom of another health problem, and that what is normal differs from person to person ^[2].

It is common. In the United States about 16 in 100 adults have constipation symptoms, rising to about 33 in 100 adults aged 60 and over ^[2].

2. Signs and symptoms

The NHS lists these signs ^[1]:

• Fewer than three poos in the last week, or going less often than usual
• Poo that is large or small and dry, hard or lumpy
• Straining or pain when passing poo
• A feeling that your bowel has not fully emptied
• Tummy ache, bloating or feeling sick

In older people, or people with dementia or a learning disability, changes in behaviour such as confusion may signal pain or discomfort from constipation ^[1].

3. Causes and risk factors

The NHS says common causes include ^[1]:

• Too little fibre, which is found in fruit, vegetables and cereals
• Not drinking enough fluid
• Being inactive or sitting or lying down for long periods
• Often ignoring the urge to go
• Changes in diet or daily routine
• Side effects of some medicines
• Stress, anxiety or depression

Sometimes no clear cause is found. Constipation is more common during pregnancy, after giving birth and over the age of 65 ^[1]. NIDDK adds that women, people who eat little fibre and people taking certain medicines or supplements are more likely to be affected ^[2]. Medical causes such as diverticular disease or bowel cancer are rare ^[1].

4. Medicines and constipation

Some medicines can cause constipation, and the NHS names opioid (strong) painkillers as one example ^[1]. NIDDK says people who take certain medicines or supplements are more likely to be constipated ^[2]. MedlinePlus advises asking your health care provider whether any medicine you take could be a factor ^[3]. Do not stop a prescribed medicine without speaking to a doctor first ^[1]. If a medicine seems to be causing constipation, tell your doctor, who can advise you ^{[1, 3]}.

NIDDK also lists older adults, women and people with certain health problems, including functional gut disorders, as more likely to become constipated ^[2].

5. Treatment and self-care

Diet and fluids

The NHS advises ^[1]:

• Eat a balanced diet and increase fibre gradually. Oats, wheat bran or linseed can be added.
• Fruits rich in a natural sugar called sorbitol, such as apples, apricots, grapes, raisins, raspberries and strawberries, can be included.
• Drink plenty of water and other fluids, and limit alcohol.

MedlinePlus similarly suggests more fibre from fruits, vegetables and grains and plenty of liquids ^[3].

Activity and toilet habits

A daily walk or other regular activity can help, according to the NHS ^[1]. It also suggests keeping a regular time and place for the toilet, allowing enough time and not delaying when you feel the urge. Resting your feet on a low stool, so your knees are above your hips, can help ^[1]. Improvement may appear within a few days, but can take weeks ^[1].

Laxatives

If diet and lifestyle changes do not help, a pharmacist can suggest a suitable laxative. The NHS says most laxatives work within 3 days and should be used only for a short time ^[1]. MedlinePlus advises caution with non-prescription laxatives and says to use them only if a health care provider recommends them ^[3].

Long-term constipation

If constipation lasts a long time, hard stool can build up in the rectum, the end part of the bowel. This is called faecal impaction. The main sign is watery stool leaking around the hard stool. A doctor may prescribe stronger laxatives, suppositories or mini enemas, or a healthcare professional may remove the stool, and you should not try to remove it yourself ^[1].

6. Special groups

Pregnancy and the weeks after birth make constipation more likely, and the NHS says the self-care steps above are considered safe to try in pregnancy ^[1]. Older adults are more often affected ^{[1, 2]}. In older people, people with dementia or people with a learning disability, the NHS says changes in behaviour such as confusion may signal pain or discomfort from constipation ^[1]. Constipation in children needs its own advice, so speak to a doctor.

7. When to see a doctor

The NHS advises seeing a doctor if you ^[1]:

• Are not improving with treatment, or are constipated regularly
• Are regularly bloated
• See blood in your poo
• Have lost weight without trying
• Feel tired all the time
• Take a medicine that causes constipation, such as opioid painkillers
• Notice a sudden change in your bowel habits
• Have tummy pain

MedlinePlus also advises checking with a provider if your bowel habits change ^[3]. MedlinePlus adds that taking time to have a bowel movement when you need to and getting enough exercise can help prevent constipation ^[3].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Constipation is common and usually not serious. Gradual fibre, fluids, activity and regular toilet habits are the main self-care steps, and a pharmacist can advise if they are not enough. A lasting change, blood in the stool, unexplained weight loss or ongoing pain should always be checked by a doctor.