Constipation

Being constipated can make you feel bloated and uncomfortable and you may have to strain to pass a stool. It's a common problem affecting one in three children and one in seven adults.

Constipation is when you're not having regular bowel movements or experiencing problems either passing a stool or emptying your bowel completely. When it comes to frequency, the medical definition of constipation is passing stools less than three times a week.

There's a risk that if you repeatedly strain to pass a stool you may develop hemorrhoids (swollen veins inside and outside the anus), which can cause bleeding, itching and pain.

Causes

Not eating enough fibre and roughage including fruit, vegetables and whole grains is a common cause of constipation. 

However, between 15 and 30 per cent of people with constipation have slow transit constipation where the gut just doesn't move food and waste as fast as it should and eating too much fibre in these cases can make constipation worse.

Not drinking enough can cause constipation too. Your digestive system takes in water from the food you’ve eaten, as it travels through your colon. If the food your body is processing becomes hard and dry and difficult to move and pass out as waste. 

Some medicines, including antacids, strong painkillers (especially if they include codeine) some antidepressants and blood pressure medicines, as well as iron and calcium tablets can make you constipated.  

Not having enough exercise, feeling depressed, anxious and upset, using laxatives for long periods, and putting off going to the toilet to open your bowels, can all have constipating effects.   

Constipation can also be a symptom of irritable bowel syndrome (IBS) a collection of gut complaints which can also include diarrhoea, cramping, bloating and pain.

However, there isn't always an obvious cause of constipation. 

Symptoms 

Opening your bowels less than three times a week, and being unable to fully empty your bowel are symptoms of constipation. 

You may also find yourself straining to go to the toilet, and passing hard, small, lumps, rather like 'rabbit poo' pellets. 

Diagnosis

Your GP will ask you about your symptoms, how often you have bowel movements, and how uncomfortable they are to pass. 

They may also ask you to describe your stools – what size they are, whether they are hard or soft, etc. There's a diagnostic tool called the Bristol Stool Chart where you can point to a picture of what your stools look like.

Who gets constipation?

Anyone can develop constipation, but women suffer from constipation twice as much as men, and are even more likely to be constipated when they are pregnant. 

Getting older can also cause constipation. Older people and people who are immobile may become very bunged up (known as faecal impaction) and will need to be treated quickly, either by their GP or at hospital.  Taking opioid painkillers containing codeine can also make things worse.

Constipation is also very common in children.

Treatments

If you have moderate constipation, and it hasn’t been going on for too long, aim to eat a high fibre food at each meal and eat five portions of fruit or vegetables each day. Experts say soluble fibre from fruit and vegetables might be better tolerated than insoluble fibre from bran as it causes less bloating. More fluids may also help - aim to drink 10 cups a day.

Keeping physically active can also help prevent the bowel slowing down and becoming sluggish.

If this doesn’t help, or your constipation has been going on for some time, see your GP. They may prescribe laxatives including ispaghula husk (psyllium), senna, magnesium salts or suppositories to get things moving again.

Newer drugs include 5 HT4 receptor agonists (prucalopride), they work by stimulating serotonin receptors in the gut wall. 

You can also be referred to a specialist for a treatment called biofeedback, where you are taught a number of self help approaches, including neuromuscular training techniques.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn’t possible supplements can help. This article isn’t intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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