What is constipation?

Constipation is difficulty passing stools (pooing) or infrequent bowel movements. It's common in both adults and children.

Constipation can usually be treated by making simple lifestyle changes. However, in some cases there may be an underlying problem. So, see your doctor if your constipation is bad or not getting better.

What symptoms are related to constipation?

How often you have a bowel movement (poo) varies between people. For adults, the normal range is from 3 bowel movements per day to 3 bowel movements per week.

So, if you're not pooing every day, that doesn't necessarily mean there is a problem.

Constipation symptoms include:

• having trouble doing a bowel movement
• not having a bowel movement as often as usual
• passing hard, lumpy stools
• straining to have bowel movements
• passing only small amounts at a time
• feeling blocked, or as though you have not completely emptied your bowels

What causes constipation?

Constipation happens when your poo is hard and dry, making it difficult to pass. It's usually caused by:

• not eating enough fibre
• not drinking enough water
• not getting enough physical activity
• ignoring the urge to poo when you need to
• being stressed or having a change in your environment

You can also get constipation when you:

• are pregnant
• take certain medicines, such as some pain killers or iron tablets
• have a medical condition such as a thyroid problem, Parkinson's disease, multiple sclerosis or depression
• have a problem with your digestive tract, such as irritable bowel syndrome, coeliac disease or diverticulitis

How is the cause of constipation diagnosed?

To make a diagnosis, your doctor will ask you about:

• your symptoms
• your lifestyle
• any medical conditions you have
• any medicines you are taking (including prescription, over-the-counter and complementary medicines such as vitamins and supplements)

Your doctor may also do a physical examination. This may include:

• feeling your abdomen (tummy) area
• gently examining your anus and rectum (bottom) using a gloved finger

Tests

Tests can help detect underlying conditions that may be causing your constipation. Your doctor may recommend tests, particularly if your constipation is severe or you have other symptoms.

Tests your doctor might recommend include:

• blood tests
• an x-ray of your abdomen
• colonoscopy or flexible sigmoidoscopy — procedures that use a flexible telescope to examine the inside of your bowel
• specialised tests to see if there is a problem with the muscles used during a bowel movement

When should I see my doctor?

See your doctor if you have severe constipation or constipation that is not getting better with simple lifestyle changes.

When to seek urgent care

See your doctor urgently if you have any of these symptoms:

• recent change in your bowel habits
• weight loss
• bleeding from your rectum (bottom) or blood in stools
• abdominal (tummy) pain, cramping or bloating

You should also see your doctor if:

• you are over 50 years old
• your normal bowel habit changes suddenly
• you have a family history of bowel cancer

Occasionally, constipation can be a sign of an underlying condition such as bowel cancer.

How is constipation treated?

Treatment will depend on the cause of your constipation.

With constipation that has been present for more than 3 months, changes in your diet and lifestyle will usually help.

There are several things you can do at home to prevent constipation and treat it if it does occur. These are explained below.

Self-care at home

The following tips can help treat and prevent constipation.

• Eat more high fibre foods — increase the amount of fibre in your diet slowly, to help prevent bloating and wind.
• Drink plenty of water and other fluids.
• Get regular physical activity.
• Go to the toilet when you need to, without delaying.
• Learn and use relaxation techniques to manage stress.

If these measures don't work, ask your doctor or pharmacist for advice. They might need to check the medicines you take or recommend a laxative to get your bowel moving.

Medicines for constipation

Laxatives can be used to treat constipation. There are several different types. Your doctor or pharmacist will talk with you about which laxative may be best for your episode of constipation.

If you don't notice an improvement in your constipation, talk to your doctor about other possible treatments.

Sometimes, misusing stimulant laxatives can make it difficult to have a normal bowel pattern when you stop the laxatives. Always check with your doctor or pharmacist about how to take laxatives properly.

Other treatment options

There is a prescription medicine available to treat chronic (ongoing) constipation that has not responded to laxatives. This medicine is called prucalopride.

It is only available to people with constipation not caused by another illness or medicine side effect. Common side effects with this medicine include headache and diarrhoea.

Can constipation be prevented?

You can help prevent constipation by practising good toilet habits. These help to improve your bowel health.

Always go to the toilet when you get the urge to do a poo — don't ignore it or wait until later. And 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. You can support your feet with a footstool. This helps to fully relax your pelvic floor and muscles around your bottom (anus).

Complications of constipation

Being constipated can increase your chances of developing:

• haemorrhoids (piles)
• anal fissures (small splits in your anus that cause pain and bleeding)
• faecal impaction (your poo becomes stuck in your colon)
• faecal seepage (leaking stool or faecal incontinence)
• rectal ulcer syndrome (open sores in the lower part of your large bowel where the body stores poo)
• megarectum and megacolon (caused by a build-up of poo with a loss of feeling in your bowel)

Resources and support

If you speak a language other than English, you can find information on constipation and incontinence at Continence Health Australia.

For Aboriginal and/or Torres Strait Islander peoples living in rural and remote communities, a brochure on constipation is available. This explains:

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

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