What is constipation?

Constipation is when you have difficulty passing bowel movements (pooing) or less frequent bowel movements than normal.

Constipation is common in both adults and children.

The information in this article relates to constipation in adults and children over 12 years of age. If you are caring for a child with constipation, see Constipation in children.

What are the symptoms of constipation?

Symptoms of constipation include:

• having trouble passing bowel movements
• having bowel movements less often than usual
• passing hard, lumpy stools (poo)
• straining (pushing hard) during bowel movements
• passing only small amounts of stool at a time
• feeling like you have not completely emptied your bowels after a bowel movement
• pain or discomfort in your stomach

Bowel movement frequency is different for everyone. For adults, normal bowel frequency ranges from 3 bowel movements per day to 1 bowel movement every 3 days.

If you don't have a bowel movement every day, that doesn't mean you are constipated.

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What causes constipation?

Constipation can happen when your stool is hard and dry, making it difficult to have a normal bowel movement. This is usually caused by:

• not eating enough fibre
• having a high fat diet
• not drinking enough water
• not getting enough physical activity
• a change in daily routine
• being stressed or anxious

You can also become constipated if you:

• are pregnant
• take certain medicines, such as strong pain-relief medicines or antidepressants
• have certain medical conditions, such as a thyroid problem, Parkinson's disease or diabetes
• have a problem with your digestive system, such as irritable bowel syndrome, bowel obstruction or diverticulitis

Constipation can also occur without any known cause.

How is constipation diagnosed?

Your doctor can diagnose constipation. Your doctor will ask about:

• your symptoms
• your normal bowel habits
• any medical conditions you have
• any medicines you are taking, including prescription, over-the-counter medicines and supplements

Your doctor might also examine you. This may include:

• feeling your abdomen (tummy)
• a digital rectal exam (gently examining your anus and bottom using a gloved finger)

Tests

Your doctor may recommend further tests if your constipation is severe or you have other symptoms.

Further tests your doctor might recommend include:

• blood tests
• an x-ray of your abdomen
• colonoscopy (a flexible tube with a camera on one end to examine the inside of your bowel)
• magnetic resonance imaging (MRI) of your abdomen

When should I see my doctor?

See your doctor if you:

• have severe constipation. This might mean 3 or more days between bowel movements, tummy pain, straining for a long period or feeling that there is a 'ball', blocking your rectum.
• have constipation that is not getting better with simple lifestyle changes
• are worried about your symptoms

You should also see your doctor if you have constipation and you:

• are over 50 years old
• have a family history of bowel cancer

When to seek urgent care

Get urgent care if you have constipation as well as:

• unexplained weight loss
• bleeding from your rectum (bottom) or blood in your stool
• severe abdominal (tummy) pain, cramping or bloating
• vomiting

Sometimes constipation can be a sign of a serious condition such as bowel obstruction or bowel cancer.

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How is constipation treated?

The treatment of constipation will depend on the cause.

Self-care at home

The following lifestyle measures can help you manage constipation at home:

• Eat more high-fibre foods, such as fruits and vegetables.
• Drink plenty of water and other fluids.
• Do regular physical activity.
• Use relaxation techniques to help manage stress or anxiety.

If these lifestyle measures don't work, ask your doctor or pharmacist for advice.

Medicines for constipation

Laxatives can be used to treat constipation. There are several different types. Ask your doctor or pharmacist which laxative may be best for you.

Laxative type	Examples	Note
Bulk-forming laxatives (fibre supplements)	psyllium, ispaghula and sterculia	These work by increasing the amount of water absorbed into your bowel. This means your stool is softer and easier to pass. It’s important to drink lots of fluids when taking these laxatives. Side effects can include bloating and flatulence (wind). They usually work within 24 hours, but they may need to be used for 2 to 3 days.
Osmotic laxatives	lactulose, macrogol and magnesium salts	These work by keeping water in the bowel and softening your stool. Side effects include bloating and abdominal discomfort. They usually work within 1 to 3 days.
Stimulant laxatives	senna and bisacodyl	These make your bowel movement quicker. Side effects can include stomach cramps. They usually work within 6 to 12 hours.
Stool softeners	docusate	These work by making your stool softer and easier to pass. They are often used with a stimulant laxative. They usually work within 12 to 72 hours.

If you don't notice an improvement in your symptoms after using laxatives, talk to your doctor about other treatments.

Using laxatives incorrectly can make it hard to have a normal bowel pattern after you stop using laxatives. Ask your doctor or pharmacist about how to take laxatives properly.

Other treatment options

There is a prescription medicine available to treat chronic (long-term) constipation that has not responded to laxatives. This medicine is called prucalopride. Common side effects of prucalopride include:

• headache
• nausea
• abdominal pain

If your constipation is caused by a problem in part of your bowel, such as a bowel obstruction, blockage or growth, you may need surgery. A surgeon may need to remove the affected section of bowel. Your doctor will refer you to a colorectal surgeon if this applies to you.

If a problem with your sphincter muscles (muscles around your rectum) is causing your constipation, you may need to retrain these muscles. A physiotherapist can show you which pelvic floor exercises are right for you.

What are the complications of constipation?

Being constipated can increase your chances of developing:

• haemorrhoids — swollen or inflamed veins in your anus and rectum
• anal fissures — small splits in your anus that cause pain and bleeding
• faecal impaction — when stool becomes stuck in your colon
• faecal incontinence — leaking of stool between bowel movements
• rectocele — a bulge in your rectal wall caused by excessive pushing over long periods of time
• megarectum and megacolon — when your colon and rectum become abnormally stretched

Can constipation be prevented?

You can help prevent constipation by having good toilet habits. Here are some tips that can help:

• Always go to the toilet when you get the urge to do a poo — don't ignore it or wait until later.
• Don't go to the toilet 'just in case' — only go when you need to.
• Make sure that you use the correct sitting position when you're on the toilet. Sit on the toilet, place your elbows on your knees and lean forward.
• Support your feet with a footstool. This helps to fully relax your pelvic floor and muscles around your bottom.

Eat foods that are high in fibre to help prevent constipation, including:

• wholegrain bread
• cereals
• fruit
• vegetables
• nuts

Talk to your pharmacist about:

• using a fibre supplement to increase your fibre intake
• having your medicines reviewed, to see if they might be causing constipation

Resources and support

Learn more about the signs of constipation on the Department of Health, Disability and Ageing page.

The Colorectal Surgical Society of Australia and New Zealand offers information on various bowel conditions, including constipation.

Read more about how to manage constipation at home on the Western Australia Department of Health page.

Languages other than English

You can find information on constipation and incontinence at Continence Health Australia in multiple languages.

Health Translations Victoria offers a fact sheet on constipation in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

For Aboriginal and/or Torres Strait Islander peoples living in rural and remote communities, Continence Health Australia offers a brochure on constipation. This explains:

• what constipation is
• why it can cause urinary incontinence and faecal incontinence
• how to prevent it

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.