Constipation affects around 10% of the global population, with women 2-3 times more likely to suffer than men. In addition, a third of the elderly population and around 40% of pregnant women are affected.

What is constipation?

• You poo less than three times a week

• Your poo is often large, hard, dry or lumpy

• You often strain or have pain on the toilet

• Feelings of incomplete evacuation

• You also have a sore stomach, feel bloated, sick or have a loss of appetite

You may suffer chronic constipation if you have these symptoms for at least three months.

Constipation can also present as hard stools (poo), which are difficult to pass, followed by loose stools. This pattern of loose bowel movements could signify what is known as overflow diarrhoea. Faecal impaction, where water stool forms above hard stools and can leak around the hard stool. When the hard stool eventually passes, a large amount of the soft stool can follow. In this instance, look for the treatment of constipation, not diarrhoea.

Red flags

Speak to your GP if: you have sudden changes in bowel habits (going to the toilet more or less than usual or changes in the consistency of poo), bleeding from your bottom or blood in your poo. If you have abdominal pain (which might feel like stomach pain) or have been diagnosed with iron deficiency anaemia, this could be a sign of something more serious. Always discuss this with a healthcare professional.

Once you have checked that you don’t have any red flags, you can try to treat constipation. Can you identify any underlying causes? Are you taking any medication which may affect your bowels, or would you benefit from diet and lifestyle changes? For example, include more fibre in your diet or increase daily physical activity.

Risk factors

Some risk factors include a low-fibre or low-calorie diet and lack of physical activity. Lack of access or privacy when using the toilet, incorrect positioning on the toilet or changes in lifestyle or routine may also increase your risk of constipation. Other factors may be psychological (depression or anxiety), family history, age, gender or pregnancy.

Complications

It is important to treat chronic constipation, not only for an improvement in quality of life but also to reduce complications. Untreated constipation can lead to severe complications, for example, faecal loading and impaction, retention and haemorrhoids or anal fissures. This can then progress and cause the colon to expand (megacolon), leading to bowel obstruction, perforation, ulcer, urinary tract infection, rectal bleeding or prolapse.

Laxatives explained

Different types of laxatives have other mechanisms of work, so it is essential to know which ones to use.

• Bulk-forming laxatives (these are the first-line approach), e.g. Ispaghula/psyllium

• Osmotic or stool-softening laxatives (these are ones to try next or in addition to bulk-forming laxatives) e.g. lactulose, Movicol

• Stimulant laxatives (this is the last approach), e.g. Senna

Always speak to your GP and who will advise the best option for you. Once constipation is treated, a combination of diet and lifestyle changes can help keep you regular and avoid chronic constipation.

Fibre and Fluid

Fibre is the part of plant foods which passes through the body undigested. It plays an important role in keeping us regular. Effectively, this adds ‘bulk’ to our stool. If you increase the fibre in your diet, do this gradually over time while increasing the amount of fluid you drink. If there isn’t adequate fluid, you may increase your risk of an intestinal blockage.

There are two main types of fibre, soluble and insoluble fibre.

• Soluble fibre absorbs water in the bowel, making the stool softer, larger, and easier to pass. E.g. Oats, root vegetables, apples, bananas, beans, peas and lentils

• Insoluble fibre encourages water to be reabsorbed from the body into the bowel while also stimulating mucous secretion, which helps speed up the bowel movement and passing of stool. E.g. ‘rougher’ fibre like wholegrain cereal, nuts, fruit skins and seeds, leafy vegetables, green beans, potato skins and beans

Activity

Physical activity doesn’t have to mean exercise. It can be fun - playing in the garden or the park.

Aim to walk in the park three times a week, walk to the shops or school instead of taking the bus or get off the bus two stops before you usually would and walk the rest etc.

Stress and Anxiety

Explore ways to manage stress or anxiety.

• MIND peer support

• NHS Mental Wellbeing audio guide

• Headspace breathing exercises

Routine and seating position

• Aim for three meals and snacks at regular times of the day

• Try to eat at a table (i.e. not on the couch while watching tv)

• Relax when you are on the toilet

• Put your feet on a low stool and lean forward

If you’re looking for tips to improve your bowels, look at this.