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A Doctor’s Guide to Constipation: Common Causes and Effective Solutions

Written By TheCRCS
January 20, 2025
Constipation, when accompanied by severe abdominal pain, blood in the stool, unexplained weight loss, or sudden changes in bowel habits, may warrant a visit to the doctor.

Posted by Dr. Ronnie Mathew, 

Senior Consultant Surgeon, Colorectal Care Specialists (CRCS)

Constipation is a common problem that affects people of all ages. It can mean that you’re not passing stools regularly or you’re unable to completely empty your bowel. Constipation in adults can affect the quality of life. It also may be associated with haemorrhoids, anal fissures, and serious underlying causes, such as colorectal cancer. There is some evidence that constipation may be associated with a modest reduction in survival.

Constipation is a common condition where bowel movements become infrequent or difficult, often caused by diet, lifestyle, or underlying health issues.

What is Constipation?

Constipation is common and can occur at any age. The word may mean different things to different people, as bowel habits (and the words they use to describe them) differ greatly between people. For some, it might mean not going to the toilet as often as usual; for others, it means their stools are very hard or painful to pass. This might mean people strain to force the stool out. For others, it might feel like they haven't emptied completely, and for some people, they only believe they are constipated when they have several of these symptoms at the same time. Sometimes, it occurs because of your body’s condition: Your large intestine might be sluggish and need help expelling waste, or perhaps the bowel muscles don't work effectively. Otherwise, it occurs because of another medical condition or medicines that you are taking. 

A commonly used medical definition of constipation is having fewer than three spontaneous bowel movements per week. 

Symptoms of Constipation

The severity of constipation varies from person to person. Many people experience it only for a short time, but for others, it can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life. Chronic constipation means the problem has been present for at least 12 weeks out of the past 6 months. 

If you are constipated, it may cause one or more of the following: 

  • Stools (faeces) become hard and difficult or painful to pass.

  • The time between each bowel motion increases compared with your usual pattern. There is a large range of normal bowel habits. Some people usually go to the toilet to pass stools 2-3 times daily. For others, 2-3 times per week is normal. It is a change from your usual pattern that may mean you are constipated. Passing a soft stool at least three times a week is considered normal.

  • Sometimes, crampy pains occur in the lower part of your tummy (abdomen). You may also feel bloated and feel sick if you have severe constipation.

  • It does not feel like you have emptied your bowels or 'finished' after going to the toilet to pass a stool. 

What are the causes of Constipation?

Some causes are known to lead to constipation, including the following: 

  • Not eating enough fibre (roughage) can lead to constipation. Fibre is the part of plant food that is not digested. It remains in your gut. It adds bulk to the stools (faeces) and helps your bowels to work well. Foods high in fibre include fruit, vegetables, bran cereals, whole-meal bread, oats, etc.  A daily intake of 30 g of fibre per day is recommended. However, you should consider your medical history and how well you can tolerate fibre.

  • Not drinking enough may lead to or worsen constipation. If you eat enough fibre and drink enough fluid, your stool is usually soft and easily passed. However, some people need more fluids than others to avoid constipation. For example, if you live in a hot country, spend most of your time outdoors, or exercise a lot, you may need more fluids.

  • Being less active for various reasons, for example:
    • Illness or injury. 
    • Disability.
    • Frailty, or old age. 
    • Depression.
    • Work patterns. 
    • Obesity.

  • Some medicines can cause constipation as a side effect. Examples are painkillers (particularly those with codeine/morphine based), some antacids, some antidepressants (including amitriptyline), and iron tablets. These are only a few examples, and there are many others. If in doubt, check the medication label and its side effects.

  • Various medical conditions can cause constipation. For example: An
  • Pregnancy. About one in five pregnant women will become constipated. This is due to the hormonal changes that slow down gut movements during pregnancy. In later pregnancy, it can simply be due to the baby taking up a lot of room in the tummy and pushing the bowels to one side.

  • Unknown cause (idiopathic) Some people can get constipated despite having a good diet, drinking a lot of fluids, not having a disease, and not taking any medication that can cause constipation. Their bowels are said to be underactive. This is quite common and is sometimes called functional constipation or primary constipation. Most cases occur in women. This condition starts in childhood or early adulthood and persists throughout life.

  • Personal Toileting habits might also predispose to constipation. For example, people may develop the long-term habit of withholding or ignoring the urge to defecate. This can be due to a lack of access to the toilet at home or work or an avoidance of using public toilets. Issues of cleanliness and lack of privacy can also lead to these. People may also feel hurried or disturbed when trying to defecate.

  • Anxiety, depression, cognitive impairment, or an eating disorder. There are multiple causes of constipation, including over 30 factors. Sometimes, it can be a combination of these. This blog is unable to cover them all. If you need to seek a healthcare specialist assessment for personal health reasons, it is recommended that you seek one.

Can you improve your Constipation on your own?

There are several things that can be done to improve constipation symptoms. 

  • Adequate dietary fibre: This includes fruits and vegetables. Certain fruits may especially help, but this can vary from person to person. Some of these fruits are prunes, kiwi fruit, papaya, pineapple, dragon fruit, and banana. You may need to adjust according to the seasons. Prunes, for example, don’t go out of season, as they are dried and usually available all year round.

  • Stay hydrated: Drink at least 8-10 glasses of liquids daily. This is even more important when you take fibre, as it needs liquid to help it bulk up and become soft. Otherwise, it can become hard. This is especially true in hot climates, if you exercise more, etc.

  • Stay active. Regular exercise and staying active are important to avoid constipation.

  • Probiotics. There is evidence that probiotics may help with reducing the risk of constipation.

  • Maintain good toilet habits: Go to the toilet when you need to, without delay. Some people also find the correct position helps while you are on the toilet.

  • Manage any stress, anxiety, or eating disorders. Learn and use relaxation techniques to manage stress. Seek expert help as required, including for eating disorders.

When should you seek expert professional help and treatment for Constipation?

It is not possible to be certain when to seek a review from a healthcare expert. Below are some of the general considerations when it is important to seek a health review for constipation: 

  • Your constipation lasts longer than 14 days without improvement
  • You have a sudden change in your bowel habits
  • A feeling of incomplete bowel evacuation (you feel you have not passed all the stool even though you have gone to the toilet to do so)
  • You have blood in your stool or black stools
  • You have unexplained weight loss
  • You are over 40 years old
  • You have a family history of colon cancer
  • You have persistent tiredness
  • It makes it difficult to do everyday activities
  • You have stomach pain that doesn't stop
  • You have abdominal (tummy) bloating
  • You're vomiting stool or bile
  • You're taking medicine that's causing constipation

Important: Irrespective of the above general factors, seeking professional help is good practice when unsure or worried.

What are the possible investigations and treatment options for Constipation?

The list of investigations and management options is too vast and detailed to be included in this blog. This also considers the multiple causes of constipation, including over 30 factors. Sometimes, it can be a combination of these. It is enough to mention that some may need lifestyle changes, while others require more detailed investigations and treatment. The direction of the management approach is based on the likely causative factors. What is important is that you seek help from a specialist healthcare provider. 

If you have any questions regarding constipation or what to do about it, then do get in touch with us today to have them answered. 

Important Disclaimer: The information provided here is not specific and is meant for general information only. It does not constitute guidance for managing or treating any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.

Acknowledgments and References, for further reading: 

  • patient.info/digestive-health/constipation 
  • Attaluri A, Donahoe R, Valestin J, et al; Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011 Apr;33(7):822-8. doi:
  • A Guide to Refractory Constipation: Diagnosis and Evidence-Based Management; British Society of Gastroenterology, 2020 - updated November 2021 
  • Diaz S, Bittar K, Mendez MD; Constipation
  • Constipation; NICE CKS, January 2024 
  • Cho YS, Lee YJ, Shin JE, et al; 2022 Seoul Consensus on Clinical Practice

Guidelines for Functional Constipation. J Neurogastroenterol Motil. 2023 Jul 30;29(3):271-305. doi: 10.5056/jnm23066.

  • Ford AC, Talley NJ; Laxatives for chronic constipation in adults. BMJ. 2012 Oct 1;345:e6168. doi: 10.1136/bmj.e6168. 
  • Krogh K, Chiarioni G, Whitehead W; Management of chronic constipation in adults. United European Gastroenterol J. 2017 Jun;5(4):465-472. doi: 10.1177/2050640616663439. Epub 2016 Aug 2. 
  • Lacy BE, Levenick JM, Crowell M; Chronic constipation: new diagnostic and treatment approaches. Therap Adv Gastroenterol. 2012 Jul;5(4):233-47. doi: 10.1177/1756283X12443093. 

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