Top 10 Pages

1. Constipation and bloating
2. IBS Constipation
3. Health Assessment
4. High Fibre Diet Planner
5. Reasons to Treat Constipation
6. Digestive System Animations
7. Constipation Symptoms
8. Constipation during Pregnancy
9. What to expect from a treatment
10. Treatment Advisor

Constipation - Frequently Asked Questions - by Dr Mark Porter

1. Over the last few months I have found it increasingly difficult to go to the loo and think I am constipated. How can I be sure?

   There is no hard and fast definition of constipation but the two key symptoms are not opening your bowels regularly enough, and having to strain when you do.

   Try this simple questionnaire. Over the last three months

   • Have you had to strain at least a quarter of the time that you have been to the loo?
   • Have your stools been hard or lumpy at least a quarter of the time?
   • Have you been left with a feeling that your bowel is not completely empty at least a quarter of the times that you have been to the loo?
   • Have you averaged two or fewer bowel movements a week?

   Answering yes to two or more of the above suggests that you have a problem with constipation that needs addressing.

2. My 5 year old son has suffered from constipation ever since he started school. What can I do to help, and what remedy is best for a child of his age?

   Constipation is a common problem in children accounting for around 1 in 10 of all paediatric out-patient appointments in British hospitals. Any child can be affected but it is particularly common in infants, in toddlers around the time of potty training, and in children of your son's age.
   There could be a number of factors at play in your son's case but it's unlikely to be due to any underlying problem with his bowel, and much more likely to be due to his diet, and the disruption to his daily routine caused by starting school (a lot of children hold on because they don't like using the loos at school).
   Make sure he is eating a diet rich in fruit, vegetables and high fibre cereals and encourage him to drink fluids at break and lunchtime. Some laxatives are suitable for use in children - remedies to soften the stool and / or stimulate the bowel tend to work best - but children should always be assessed by a doctor first.
   The sooner you act the better, as young children tend to get into a vicious cycle - the more constipated they become, the more they dread going to the loo (it can sometimes be very painful), so the longer they hang on and the worse the constipation becomes.

3. Could my constipation be due to irritable bowel syndrome?

   Irritable bowel syndrome is an extremely common condition characterised by a collection of symptoms which include bloating, abdominal pain and altered bowel habit - typically loose frequent bowels but occasionally constipation.
   If you have the type of IBS where constipation is the predominant symptom then it is easily confused with straightforward constipation - and both often respond to a high fibre diet. But in practice most doctors can easily differentiate between the two. If in doubt, talk to your GP.

4. I frequently suffer from constipation - could this be a sign of something more serious?

   Constipation is rarely a sign of a serious underlying problem and, like most doctors, I actively encourage my patients to self-medicate with over-the-counter remedies in the first instance. But there are some exceptions to this - the following groups should seek medical advice from their GP before self-medicating.

   • Anyone over 50 where constipation is a new problem and where it has been going on for more than 4 - 6 weeks.
   • Any adult, of any age, who has a strong family history of bowel cancer (a brother, sister or parent with the condition) and who has developed constipation which has lasted for more than 4 - 6 weeks. Constipation is not a common symptom of bowel cancer but a prolonged change in bowel habit in someone with a family history of the disease needs to be taken seriously
   • All children
   • Anyone whose constipation is accompanied by pain in the tummy, or bleeding from the back passage (rectal bleeding)
5. I am constipated and probably need to take a laxative but am worried about side effects. Do laxatives give you diarrhoea?

   A lot of people are wary of taking constipation remedies because they think they will go from one extreme to the other and end up not being able to stray far from a loo! In reality most laxatives have a gentle action and as long as you select the right type, and follow the instructions, they shouldn't upset your tummy, but just return your bowels to normal. If in doubt, ask your pharmacist to point you in the right direction - a growing number of pharmacies now have private consultation areas where you can discuss your symptoms in confidence.

6. I am struggling with my weight at the moment but every time I go on a diet I suffer from constipation. Is there a link?

   It depends what sort of weight loss regime you are following. Cutting back on the amount you eat shouldn't, on its own, cause constipation although you may find you need to go to the loo less often.
   A lot of my patients have been trying low carbohydrate Atkins type diets recently and these can cause problems with your bowels. Cutting out high fibre foods like baked potatoes, bran based cereals and fruit and vegetables, and substituting high protein foods like meat, cheese and eggs can make the bowel sluggish.
   Another common problem in people trying to lose weight is that they take up a new exercise regime but don't take in enough fluids to compensate for the sweat they produce during their work-outs.

7. I have always been prone to constipation - is it likely to be due to the fact that I have a "lazy bowel", or my diet?

   Some people are undoubtedly more prone to constipation than others, and our bowels may become less efficient as we get older, but your constipation is much more likely to be due to your diet, than to anything fundamentally wrong with the way that your bowel works. And the most common problem with diet is too little fibre (the indigestible part of fruit, vegetables and cereals) and not enough fluid. To help your bowel work at peak efficiency you should try and eat a fibre rich diet and drink at least 2 litres of fluids a day (it doesn't have to be water, tea, coffee, juices and soft drinks all count).

8. Which laxative is right for me?

   There is now a wide range of different remedies available over-the-counter and you should ask your pharmacist to point you in the right direction. As a general rule fibre based remedies work best for people prone to passing small hard pellets, while remedies that stimulate the bowel wall (such as senna) work best in people who are prone to bloating, don't get the urge to go very often, and find it hard to, when they do. Suppositories, and other stool softeners, tend to be best for people who have the urge but find it difficult to empty themselves properly when they do go.
   But these are all generalisations based on my 20 years in practice and finding the right laxative often involves trial and error, and some people will need a combination of different approaches - such as boosting their fibre intake and taking something to stimulate the bowel wall.

9. Why do I get constipated every time I go away on holiday?

   It may be the change in your diet, a change in the make-up of the "healthy bacteria" that live in your bowel, or the result of dehydration from a combination of hot weather, and not drinking enough fluids. In my experience it is not a particularly common problem - travellers are more likely to get upset tummies than constipation.

10. My mother is prone to constipation which is relieved by laxatives, but as soon as she stops them, the problem just returns. Can she take constipation remedies on a regular basis?

    Constipation is more common in older people. While 1 in 10 of the British adult population suffers from regular constipation, in the elderly the proportion is more like 1 in 5. It also tends to be more common in women as their bowels naturally tend to work slightly slower.
    Older people tend to be less active which may also slow their bowels further, and they are often taking a range of drugs - from pills to cut high blood pressure to painkillers - which can cause constipation.
    My first approach would be to try and improve her diet, but if she is already eating a healthy high fibre diet, then I would be quite happy for her to take a regular laxative - as many people do - to keep her bowels working effectively.*

* Check with your doctor or pharmacist which laxatives are suitable to use long term.

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