Constipation is a very common condition that affects people of all ages. When you are constipated, you feel that you are not passing stools (faeces) as often as your normally do, or that you have to strain more than usual, or that you are unable to completely empty your bowels. Constipation can also cause your stools to be unusually hard, lumpy, large or small.

The severity of constipation can vary greatly. Many people only experience constipation for a short period of time with no lasting effects on their health. For others, constipation can be a chronic (long-term) condition which causes significant pain and discomfort. Chronic constipation can also lead to complications, such as faecal impaction (where dry, hard stools collect in your rectum) or faecal incontinence (where you involuntarily leak liquid stools around solid impacted stools).

The treatment for constipation is usually very effective, although in some cases it can take several months before a regular bowel pattern is re-established.

Constipation affects twice as many women than men, and is more common in the elderly. Approximately 40% of pregnant women experience constipation during their pregnancy.

Symptoms of constipation 

Everyone, whether young or old, has their own normal bowel habits, and these can be quite different from other people’s habits. For example, some adults normally go to the toilet more than once a day, whereas others may normally go only every three or four days. And, some infants may normally pass stool several times a day, while others may normally pass stool only a few times a week.

When you are constipated you feel that passing stools has become more difficult than it used to be. Passing stools may feel more difficult for a number of reasons reasons. For example, passing stools may have become significantly less frequent, or significantly less effective (you feel that you are unable to completely empty your bowel).

Passing stools may also seem more difficult because your stools are:

1. dry and hard,
2. hard and lumpy,
3. abnormally large, or
4. abnormally small.

As well as causing a change in your normal bowel habits, constipation can also cause the following symptoms:

1. stomach ache and cramps,
2. feeling bloated,
3. feeling nauseous, and loss of appetite.

Children

As well as infrequent, or irregular, bowel movements, a child with constipation may also display the following signs and symptoms:

1. loss of appetite,
2. lack of energy,
3. being irritable, angry, or unhappy,
4. foul smelling wind and stools,
5. abdominal pain and discomfort,
6. soiling their clothes, and
7. generally feeling unwell.

If your child is displaying these symptoms, or has spoken to you about having difficulty in passing stools, you should speak to your doctor.

Causes of constipation 

Most cases of constipation are not caused by a specific condition, and it may be difficult to identify the exact cause of your constipation. However, there are several factors which can increase your chances of having constipation. These include the following:

1. not eating enough fibre, such as fruit, vegetables and cereals,
2. a change in your routine, or lifestyle, such as a change in your eating habits,
3. having limited privacy when using the toilet,
4. ignoring the urge to pass stools,
5. immobility, lack of exercise,
6. not drinking enough fluids,
7. being under, or overweight,
8. anxiety, or
9. depression.

Medication

Sometimes, constipation may be a side effect of a medicine that you are taking. Some of the most common types of medication which can cause constipation include:

1. aluminium antacids (medicine to treat indigestion),
2. antidepressants,
3. antiepileptics (medicine to treat epilepsy)
4. antipsychotics (medicine to treat schizophrenia, manic conditions and anxiety)
5. calcium supplements,
6. diuretics (water tablets), and
7. iron supplements.

If your constipation is being caused by medication, you will usually find that the condition eases once you stop taking the medicine. However, under no circumstances should you stop taking your medication unless your doctor specifically advises you to.

Speak to your doctor if you are experiencing constipation due to a medicine, because they may be able to prescribe an alternative medication for you.

Pregnancy

Constipation during pregnancy is very common. About 40% of women will experience some form of constipation during their pregnancy. Most pregnant women tend to be affected during the early stages of their pregnancy.

Constipation occurs during pregnancy as a result of the hormonal changes in your body. During pregnancy, your body produces more of the female hormone called progesterone. This hormone acts as a muscle relaxant.

Your bowel normally moves stools and waste products along to the anus by a process known as peristalsis. This is when the muscles which line the bowel contract and relax, in a rippling, wave-like motion. An increase in progesterone means that the bowel muscles find it more difficult to contract, making it harder to move waste products along.

If you are pregnant, there are ways that you can safely treat constipation which will not cause harm to you or your baby. See the ‘treatment’ section for more information about this.

Other conditions

The majority of constipation cases are not caused by a particular medical condition. However, constipation can very rarely be a sign of an underlying condition. In adults such conditions include:

1. colon or rectal cancer,
2. diabetes,
3. hypercalcaemia – when there is too much calcium in your bloodstream,
4. underactive thyroid,
5. muscular dystrophy – a genetic condition which causes muscle wasting,
6. multiple sclerosis – a condition which affects your nervous system),
7. Parkinson’s disease – a brain condition that affects the coordination of body movements, such as walking, talking and writing,
8. spinal cord injury,
9. anal fissures – a small tear of the skin just inside your anus,
10. inflammatory bowel disease – a condition that causes the intestines to become inflamed, and
11. irritable bowel syndrome (IBS).

Babies and Children

Constipation in babies and children is quite common. For example, poor diet, fear about using the toilet and poor toilet training can all cause constipation in babies and children.

Poor diet

Children who are overfed are more likely to have constipation, as are those who do not get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, it is very important that your child has enough fibre in their diet.

Toilet training

Make sure that you do not make your child feel stressed, or pressured, about using the toilet. It is also important to let your children try things by themselves (when appropriate). Constantly intervening when they are using the toilet may make them feel anxious.

Toilet habits

Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel that they are unable to use the toilets at school. This fear or phobia may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them, for fear of experiencing pain and discomfort. However, this will mean that their condition only worsens.

Medication

Constipation in children can sometimes be a side-effect of medicines such as:

1. antiepileptics – medicines to treat epilepsy,
2. sedating antihistamines – medicine to relive the symptoms of allergies, such as itching and inflammation, and
3. opioids – a type of painkilling medicine.

Other conditions

The majority of constipation cases are not caused by a particular medical condition. However, constipation can rarely be a sign of an underlying condition. In children such conditions include:

1. Hirschprung’s disease – a condition that affects the large intestine, making it difficult to pass stools),
2. anorectal malformation – a condition where the baby’s anus and rectum do not form properly,
3. spinal cord abnormalities – for example, rare conditions such as spina bifida, and cerebral palsy, and
4. cystic fibrosis – a genetic condition that causes the body to produce thick and sticky bodily substances which, in the digestive system, which can lead to constipation.

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