There are four main ways of dealing with constipation:

  • change your diet
  • avoid dehydration
  • take more exercise
  • use a laxative.

Change Your Diet

Diet is very individual and what works for one person may not work for another. There is no one diet that suits everyone and it is not uncommon for people to find that they cannot tolerate certain foods. This does not often amount to an allergy but rather an intolerance. Keeping a food diary can sometimes help.
Increasing your fibre intake can sometimes (but not always) be effective in constipation. Fibre is not digested and absorbed in the intestines, so the stools are softer and more bulky, and it is easier for the bowel muscles to push them along. There are two kinds of fibre: soluble and insoluble. Soluble fibre, as its name suggests, dissolves in water; insoluble fibre does not. Soluble fibre forms a gel whilst insoluble fibres absorb water and form bulk. Both forms of fibre ferment and produce gas, which can cause bloating and/or pain. Insoluble fibre is found in whole wheat, whole grains, wheat bran, corn bran, seeds, nuts, barley, couscous, brown rice, bulgur, courgettes, celery, broccoli, cabbage, onions, tomatoes, carrots, cucumbers, green beans, dark leafy vegetables, raisins, grapes, fruit, and root vegetable skins. Soluble fibre is found in oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flax seeds, beans, dried peas, blueberries, psyllium, cucumbers, celery and carrots.
Aim for at least 30 grams of fibre a day, which really means eating one fibre-rich food at every meal. If you suddenly increase the amount of fibre you eat, you may notice wind and bloating, so increase the amount slowly, over several weeks, to allow your gut to adjust to the new diet. Some people find increasing their fibre causes more tummy pain, bloating and wind.

A simple way of increasing fibre in your diet is to:

  • change to wholemeal bread, and eat 2–4 extra slices a day
  • eat 2–3 extra helpings of fruit and vegetables a day
  • change to a wholewheat cereal (the packet will tell you)
  • add some raw bran to your cereal or yoghurt.

 

Fibre checklist

Fibre foodsFibre content (in grams)
High-fibre foods
Bowl of All Bran9.8 
Bowl of muesli6.2 
Bowl of Bran Flakes5.2 
2 slices of wholemeal bread4.1 
1/2 large can of red kidney beans12.4 
1/2 large can of baked beans7.6 
Medium jacket potato4.2 
4 tablespoons of peas4.1 
5 dried apricots5.8 
5 prunes4.9 
100 g of Quorn4.8 
Medium-fibre foods
2 Weetabix3.9 
Bowl of Fruit’n Fibre2.8 
2 slices of ordinary brown bread2.5 
2 slices of white bread1.1 
3 tablespoons of cooked sprouts3.1 
2 tablespoons of cooked broccoli2.3 
3 tablespoons of cooked carrots1.9 
1/2 avocado3.4 
Apple (with skin)3.1 
Orange2.7 
Banana2.2 
1 tablespoon of peanuts1.6 
1 tablespoon of mixed nuts and raisins1.1 

Sources: MeRec Bulletin 1999;10 (No 9); https://www.bda.uk.com/resource/fibre.html
Increase the amount of fibre gradually. A high-fibre diet is healthy for most people, but if you are elderly and not very mobile it can make the constipation worse. So check with your doctor. Some people find that high-fibre worsens bloating without improving constipation.

Avoid Dehydration

Increasing your fluid intake will not always improve constipation. In the past, doctors advised drinking lots of water to help constipation. Research has now shown this will not help (Prescriber 2010;21:24–29). Also, if you have a medical condition, such as heart failure, it may not be advisable to take too much fluid. Check with your doctor.

Think about Your Lifestyle

Inactivity can make the bowels sluggish, and doing more exercise can help to relieve constipation, especially if you are elderly. Changing patterns of shift work can upset the rhythm of your bowels. Similarly, it is quite common to be constipated at the beginning of a foreign holiday, especially if you have crossed time zones and are also eating foods that are different from your normal diet.

Toilet Training (for Adults)

The problem with ignoring the urge to defecate is that, after a while, you stop feeling the urge. So don’t ignore it when your body tells you that you’re due to have your bowels open. And give yourself enough time for an undisturbed visit to the lavatory, preferably half an hour after breakfast.

Humans are probably meant to have our bowels open in a squatting posture – sitting on a lavatory is not the optimum posture. So, when you sit on the lavatory, prop your feet up on a footstool.

Don’t push and strain to have a poo. This increases the likelihood of piles or painful anal cracks (anal fissure), and can be dangerous if you have high blood pressure. If nothing has happened after 10 or 15 minutes, go away and do something else, and try again later.

Do You Need a Laxative?

Laxatives should be a last resort and are often not necessary, as most episodes of constipation are short lived and will resolve on their own. Dozens of laxatives are available from pharmacies without a prescription, so if you have tried changing your diet and it hasn’t worked you may be tempted to try one. Before doing so, see your doctor.

You may find that a laxative becomes less effective the longer you use it, so if you really need a laxative it is best to find two or three different ones that work for you, and rotate them. Keep the dosage to the minimum that is effective.

If your doctor decides there is nothing seriously wrong, a laxative might be appropriate, particularly if:

  • you have piles, and they bleed if you strain to have a poo
  • you are elderly, and your tummy and pelvic muscles are weak, so passing poo is difficult.

Types of Laxative

Bulk laxatives (such as psyllium husk from health-food stores, bran, ispaghula husk, methylcellulose, sterculia) provide fibre in a concentrated form. They have to be taken with plenty of water, and it can be several days before they have an effect. They are the best type of laxative for long-term use.
Osmotic laxatives retain fluid in the bowel, which then softens the poo. They may take several days to work. Examples of this type of laxative are: milk of magnesia, which is magnesium hydroxide; Epsom salts or Andrews Liver salts, which are magnesium sulphate; and laxatives containing polyethylene glycol. If you have kidney or heart failure problems talk to your doctor before taking this type of laxative, as they may not be suitable.
Stimulant laxatives (such as senna, bisacodyl) work by increasing contractions of the bowel, and so they can cause tummy cramps. The effect occurs within a few hours, so they are taken at night to produce a morning bowel action. Some experts think that if you use these regularly for years, the contractions of the large bowel (colon) may eventually become weakened, making the problem much worse than before, so this type of laxative is inadvisable for long-term use. Glycerol suppositories that you insert into the back passage (rectum) act as a stimulant because they are slightly irritant to the bowel.

Lactulose and lactitol are types of sugars that the body cannot digest, so they remain in the bowel where they act partly like fibre and partly like an osmotic laxative. They often cause bloating, wind and tummy cramps and have to be taken regularly for up to 3 days before having an effect.

Faecal softeners, such as sodium ducosate or ‘liquid paraffin’ from a pharmacy, lubricate and soften the poo. Sodium ducosate encourages water into the poo, whereas liquid paraffin probably acts by lining the bowel with a film of oil that stops water being absorbed into the body from the poo. Liquid paraffin is also a mild stimulant. Faecal incontinence (soiling) can occur with this type of laxative. These laxatives are not suitable for long-term use.

If Laxatives Don’t Work

If laxatives do not relieve the constipation, your doctor may consider other treatments. Biofeedback is one possibility. Some people, most often young women, have a problem coordinating the muscles of the bowel, anus and pelvic floor. For example, when they are trying to have a poo, they contract the anus muscle instead of relaxing it. Special feedback training can overcome the problem. This treatment is available in only a few specialist hospitals, and is reserved for people with a severe constipation problem.

Your doctor may suggest a medication called prucalopride. This is not a laxative but works by increasing the muscle contractions of the bowel and decreasing the time it takes for poo to move along the colon. It is licensed only for use in women in whom laxatives have not worked. It is normally only suggested for use by a hospital specialist for severe cases of constipation. It can have side effects – headache (in 11%), nausea (in 95%), tummy pain (in 7%) and diarrhoea (in 6%), although these often settle down during the first few weeks of use (Prescriber 2010;21:24–29).

 

First published on: embarrassingproblems.com
Reviewed and edited by: Dr Kevin Barrett
Last updated: October 2020

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