What is constipation?
Constipation is one of the most common digestive complaints. It varies greatly between different people, as each person’s bowel movements differ. Most cases of constipation are caused by a low fibre diet or dehydration.
Constipation is most common in children and older people, and affects women more than men. One in 200 women have severe, continuous constipation and it is most common before a period and in pregnancy.
Symptoms of constipation
Normal bowel habits vary between people. Some people go more than once a day; other people may go every three days. If you experience a variation in your routine that means that you go to the toilet less often, this is constipation.
If you are going to the toilet as often as usual but you are having difficulty passing stools because they are hard and small, this is also constipation.
You may have to strain, which can be painful and cause bleeding or hemorrhoids around the anus.
If you are bleeding regularly it is important to make an appointment to see your GP.
When the stools are very small, the muscles around the anus cannot grip them properly to push them out. This means that the bowel muscles do not open and tell you that you need to go to the toilet. When this happens, the stools are ignored and dry up.
They go back up into the colon, dry out and shrink even more and block the passage, which means that the constipation continues.
The symptoms of constipation vary between people. They include:
- stomach ache and cramps,
- feeling bloated,
- feeling sick,
- change from usual pattern of bowel movements,
- not feeling empty, or a sense of fullness,
- furred tongue,
- loss of appetite,
- fatigue, and
Constipation may alternate with diarrhea; this may be an indication of another condition such as irritable bowel syndrome (IBS). Watery stools may be able to pass around a blockage of hard stools and be mistaken for diarrhea.
Constipation in children is fairly common and usually clears up within a few days.
Symptoms of persistent, severe constipation in children are:
- being irritable,
- loss of appetite,
- soiling their clothes,
- feeling sick, and
- stomach pains.
Causes of constipation
Often there is no identified cause of constipation, but it may be due to one or a number of the following factors:
- Not enough fluid (water) in the diet.
- Not enough fiber (fruit, vegetables, cereals) in the diet.
- Not being active enough – this could be due to a long-term condition or as a result of getting older.
- Drugs such as painkillers, antidepressants, and antacids, because they contain calcium or aluminum.
- Too much calcium in the diet.
- Too much iron in the diet.
- Drinking an excessive amount of strong tea or coffee (this increases urine production and so decreases the amount of fluid in the bowel).
- The bowel muscles not being strong enough to push. This is a common complaint in older people as their bowel muscles become weaker and they take a range of medication that affects the bowels.
- Recent abdominal surgery, hemorrhoids, or anal fissure can make it painful to defecate and lead to constipation.
- Anxiety – some people can become anxious that they are not passing stools once a day, but this should not be a problem as long as when you do go, your stools are soft and easy to pass.
The following conditions may also lead to constipation:
- Irritable bowel syndrome (IBS),
- Kidney failure,
- Colon/rectal cancer,
- Multiple Sclerosis (MS),
- Spinal injury, or
- Under-active thyroid gland.
Babies and Children
If there is not enough fiber in a child’s diet, or they are not getting enough fluids, they may develop constipation. Any illness with high fever and vomiting, can cause dehydration and lead to constipation. An allergy to cow’s milk or medicine may also be a cause.
Very rarely, in babies, constipation may be a sign of a disorder such as hyperthyroidism, Hirschsprung’s disease or anal stenosis, which means the bowel muscles are unable to relax. Constipation is also more common in children with Down’s syndrome, cerebral palsy and spina bifida.
In older children, constipation may be the result of fear or anxiety about going to the toilet or pain caused by an anal fissure (tearing). Holding their stools in means that the stools get harder and are more painful to pass, and so the problem persists.
Constipation when traveling
Constipation is often experienced by people when they are traveling or on holiday. This is because their normal routine is interrupted and the biological clock is disrupted. Unfamiliar surroundings, different toilets and change of diet are all contributing factors.
Constipation in children is fairly common. See your GP only if the constipation is persistent or causing distress to the child, or if they are passing blood.
In order to diagnose constipation, the GP will ask how long the symptoms have been occurring and if there is any rectal pain or bleeding. They will ask for information on the child’s toilet training and habits, diet and general health and may feel the child’s abdomen and perform a rectal examination.
Constipation is a very common digestive complaint. You will not usually need to see your GP unless the constipation lasts for over two weeks, or you are passing blood, particularly if you are over 50 years old.
Before going to your GP, keep a record of your bowel movements for two weeks (date, time, type of stool, how long you had to strain and if you have taken any medicines such as laxatives). For women, also note the date of your last menstrual period.
A typical examination will begin with you lying on your back while the GP feels your abdomen. You will then lie on your side while the GP performs a rectal examination with a lubricated, gloved finger.
If you have experienced bleeding from the anus, your GP will examine the anal canal and lower rectum using a small tube. They may take a sample of your faeces or refer you for more tests such as a colonoscopy or a contrast x-ray.
In most cases, constipation in children does not require medical treatment. See your GP if the constipation lasts longer than two weeks after you have tried measures such as:
- Increasing your child’s fluid intake.
- Increasing the amount of fiber in your child’s diet (plenty of fresh fruit and vegetables).
- Ensuring your child’s toilet routine is regular and relaxed. Do not put your child under any pressure, be patient and try giving rewards for going to the toilet.
- Using an anesthetic gel to relieve the pain of anal fissure (tearing).
Measures that you can take in order to relieve constipation include:
- Increasing your fiber intake to 20-30g a day. High fiber foods include fruit, vegetables and cereals.
- Add some bulking agents such as wheat bran to your diet. These will help make your stools soft and easy to pass.
- Make sure you increase your fluid intake as well.
- Try taking some laxatives to help the muscles of the bowel to constrict. These should only be used as a temporary measure. See your GP if you feel you have to take them for longer than two weeks.
- Try to get more exercise by going for a daily walk or run, for example.
- Use ointment, suppositories or painkillers to relieve a painful anus.
- Remember that everyone is different and not everyone passes stools every day.
- Talk to your GP about any medication you are currently taking, to find out if it may be causing constipation.
Your GP may suggest a short course of drugs (stool softeners and laxatives) to reduce the discomfort of going to the toilet. In some cases the bowel may need to be cleared out, this is called an enema. If constipation persists you may need to have an x-ray to try to discover the cause of the problem.
Chronic constipation can lead to hemorrhoid bleeding, rectal or womb prolapse (where a part of the body moves from its normal position), anal fissures, colon obstruction, ulcers, hernia, incontinence (from straining) or a build up of hard feces in the rectum leading to liquid feces (like diarrhea) leaking around the blockage.
Some women find that when they strain it does not reach as far as their pelvis. This is known as under-active bowels and may require the muscles to be retrained to work properly.
Some people find that they become dependent on laxatives and their colon may be unable to function without them. This is why laxatives should only be taken as a temporary measure.
How to prevent constipation
You can take a number of measures to avoid constipation:
- Eat plenty of fiber such as bran, wholemeal bread, cereals, fruit, leafy vegetables, potato skins, beans, dried peas.
- Have a regular routine in the morning and allow your bowels time to work. The best time to go is in the hour after breakfast.
- Reduce your intake of processed foods such as cheese and white bread.
- Drink more water and avoid caffeine, alcohol and fizzy drinks. Eat breakfast.
- Never ignore the urge to go to the toilet or the stools will just get drier and harder.
- Keep active by exercising regularly.
- When traveling, consider taking some bran supplements, only drink bottled water and avoid sitting still for too long.