Constipation

Constipation is a common digestive condition characterised by infrequent bowel movements, difficulty passing stools, or the sensation of incomplete evacuation. It occurs when the colon absorbs too much water from waste material, making the stool hard, dry, and difficult to pass. In some cases, constipation can also be caused by obstructions in the colon, which slow or block the movement of stool. This delayed transit allows even more water to be absorbed, further contributing to hard, compacted stools. Constipation can affect people of all ages and may be temporary or become a chronic issue that interferes with daily activities and quality of life.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS | MRCS (UK) | MMed (Surgery) | FRCS (UK)

Symptoms causes diagnosis treatments prevention FAQ

Symptoms of Constipation

Individuals with constipation typically experience a range of symptoms that can vary in severity and duration.

Infrequent bowel movements: Passing fewer than three stools per week indicates constipation, though normal frequency varies among individuals.
Hard or lumpy stools: The stool becomes dry, hard, and difficult to pass due to excessive water absorption in the colon.
Straining during bowel movements: Excessive effort may be required to expel stool, causing discomfort and sometimes pain.
Sensation of blockage: Patients often report feeling as if there is a blockage in their rectum, preventing complete evacuation.
Feeling of incomplete evacuation: Even after a bowel movement, there may be a sensation that not all stool has been passed.
Abdominal discomfort: Bloating, cramping, and general abdominal discomfort often accompany constipation due to the buildup of stool.

Causes and Risk Factors

Constipation can result from various factors that affect normal bowel function and movement through the digestive tract.

Dietary factors

Insufficient fibre intake and inadequate fluid consumption are primary causes of constipation, as both are needed for proper stool formation.
Physical inactivity

Lack of regular exercise slows intestinal movement, as physical activity helps stimulate the muscles in the digestive tract.
Medications

Certain medications, including opioid pain relievers, antidepressants, anticonvulsants, iron supplements, and some antacids, can cause constipation as a side effect.
Medical conditions

Neurological disorders, metabolic and endocrine conditions, and structural abnormalities of the digestive tract can lead to chronic constipation.
Ignoring the urge

Repeatedly delaying bowel movements when the urge arises can lead to constipation as the body begins to ignore the signals.
Pregnancy

Hormonal changes, pressure on the intestines from the growing foetus, and iron supplements can contribute to constipation during pregnancy.
Ageing

Older adults are more prone to constipation due to slower metabolism, decreased muscle tone in the digestive tract, and medication use.
Dehydration

Insufficient fluid intake reduces the water content in the intestines, making stool harder to pass.

Diagnostic Methods

Medical history assessment

Your doctor will conduct a detailed interview about your bowel habits, dietary patterns, physical activity levels, current medications, and family history of digestive disorders. This comprehensive evaluation helps pinpoint potential triggers and establishes a foundation for an effective treatment plan.

Physical examination

Includes a thorough abdominal examination to detect tenderness, unusual masses, or distension, and often a digital rectal examination to evaluate anal sphincter tone, assess for rectal abnormalities, and check for impacted stool that may be blocking regular bowel movements.

Blood tests

Commonly ordered to investigate underlying medical conditions that frequently cause constipation, such as hypothyroidism, diabetes, or electrolyte imbalances. These tests help distinguish between primary constipation and constipation as a symptom of another disorder.

Imaging studies

X-rays, CT scans, or other imaging techniques provide visualisation of the entire colon and surrounding structures, revealing stool accumulation, potential blockages, anatomical abnormalities, or unexpected masses that may be impeding normal bowel function.

Colonoscopy

Particularly for patients with warning signs such as rectal bleeding, unexplained weight loss, or those over 50 requiring colorectal cancer screening. This procedure allows direct examination of the colon’s interior using a flexible scope, enabling detection of polyps, inflammatory conditions, or structural issues affecting bowel movements.

Treatment Options

Constipation can be relieved through a variety of effective treatment approaches, ranging from simple lifestyle changes to medical interventions.

Dietary fibre increase

Adding more fibre to your diet through fruits, vegetables, whole grains, and legumes can help soften stool and promote regular bowel movements. Aim for 25-30 grams of fibre daily, but increase intake gradually to avoid bloating and gas.

Adequate hydration

Drinking plenty of water helps soften stools and supports the beneficial effects of dietary fibre. Most adults should aim for 6-8 glasses of water daily, with increased amounts during hot weather or physical activity.

Regular physical activity

Exercise stimulates intestinal muscle contractions and can significantly improve constipation symptoms. Even moderate activities like walking for 20-30 minutes daily can help maintain healthy bowel function and reduce the frequency of constipation episodes.

Over-the-counter laxatives

Various types of laxatives work in different ways, including bulking agents, stool softeners, osmotic laxatives, and stimulant laxatives. While effective for occasional constipation, most should not be used long-term without medical supervision, as dependency can develop.

Prescription medications

For chronic constipation that does not respond to lifestyle changes and over-the-counter options, doctors may prescribe medications that increase intestinal fluid secretion or enhance muscle contractions in the bowel. These prescription options are typically reserved for more severe or persistent cases when other treatments have failed.

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Prevention and Management

Preventing constipation focuses on developing habits that maintain digestive health before problems arise. Establishing consistent bathroom routines, particularly after meals when the colon is naturally more active, helps train your body for regularity. Responding promptly to bathroom urges rather than postponing them prevents stool from hardening in the colon. For those with stress-sensitive digestion, relaxation techniques like meditation or deep breathing can support gut function through the gut-brain connection. If you are taking medications known to cause constipation, proactively discussing preventive strategies or alternatives with your doctor can help maintain bowel regularity before problems develop.

Frequently Asked Questions (FAQ)

Can constipation cause complications if left untreated?

Chronic constipation can lead to several complications, including haemorrhoids, anal fissures (small tears in the anal tissue), and faecal impaction, where hardened stool becomes stuck in the rectum. Prolonged straining may cause rectal prolapse (where part of the rectum protrudes from the anus). It can contribute to the development of diverticular disease, in which small pouches form in the colon wall.

Can certain foods worsen constipation?

Foods low in fibre and high in fat or dairy can slow digestion and exacerbate constipation. Processed foods, cheese, white bread, and unripe bananas are common culprits that may contribute to firmer stools in susceptible individuals.

Can long-term constipation increase colon cancer risk?

While constipation itself does not directly cause colon cancer, the conditions sometimes share risk factors such as a low-fibre diet and a sedentary lifestyle. Chronic constipation may slightly increase risk by extending exposure time of potential carcinogens to colon tissues, though this connection is modest compared to other risk factors.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS|MRCS (UK)|MMed (Surgery)|FRCS (UK)

Expertise lies in managing colorectal diseases, particularly advanced colorectal cancer and inflammatory bowel disease.

Dr Chok graduated with degrees in Bachelor of Medicine and Surgery from the National University of Singapore. He was conferred the Master of Medicine (Surgery) in Edinburgh (UK) and a member of the Royal College of Surgeons, UK. He subsequently completed his specialist training in colorectal surgery and became a Fellow of the royal college of Surgeons in Edinburgh in 2016.
Dr Chok was awarded the Health Manpower Development Plan (HMDP) award in 2019 to further advance his colorectal training at Royal Marsden Hospital, one of the top 5 cancer centres in the world. While in London, Dr Chok trained with pioneers in the surgical management of advanced colorectal cancer and inflammatory bowel disease (IBD) and gained extensive experience while appraising the latest clinical and research evidence.

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