Constipation - Treating constipation

Treatment for constipation depends on the cause, how long you have had the condition and how severe your symptoms are.

In many cases it is possible to relieve symptoms through dietary and lifestyle changes.

Lifestyle advice

Changes to your diet and lifestyle are often recommended as the first treatment for constipation and in many people this will improve the condition without needing medication.

Some ways you can help treat your constipation are listed below.

Increase your daily intake of fibre. You should eat at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables and cereals.
Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.
Avoid dehydration by drinking plenty of water.
Try to get more exercise, for example by going for a daily walk or run.
If your constipation is causing pain or discomfort, you may want to take a painkiller such as paracetamol. Make sure you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin.
Work out a routine of a place and a time of day when you are comfortably able to spend time on the toilet. Respond to your bowel's natural pattern: when you feel the urge, do not delay.
Try resting your feet on a low stool while going to the toilet, so that your knees are above your hips, as this can make it easier to pass stools.
If medication you are taking could be causing constipation, your GP may be able to prescribe an alternative.

Read about preventing constipation for more ways to change your diet and lifestyle.

If these diet and lifestyle changes do not help, your GP may prescribe an oral laxative.

Laxatives

Laxatives are a type of medicine that help you pass stools. There are several different types and each one has a different effect on your digestive system.

Bulk-forming laxatives

Your GP will normally start you on a bulk-forming laxative. These laxatives work by helping your stools to retain fluid. This means they are less likely to dry out, which can lead to faecal impaction (read about the complications of constipation for more information). Bulk-forming laxatives also make your stools softer, which means they should be easier to pass.

Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids. Also, do not take them before going to bed. It will usually be two to three days before you feel the effects of a bulk-forming laxative.

Osmotic laxatives

If your stools remain hard after you have taken a bulk-forming laxative, your GP may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. This helps to stimulate your body to pass stools and also softens stools.

Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be two to three days before you feel the effect of the laxative.

Stimulant laxatives

If your stools are soft but you still have difficulty passing them, your GP may prescribe a stimulant laxative. This laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus.

The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they will usually start to work within six to 12 hours.

According to your individual preference and the speed with which you require relief, your GP may decide to combine different laxatives.

How long will I take laxatives for?

If you have only experienced constipation for a short time, your GP will normally advise you to stop taking the laxative once your stools are soft and easily passed.

However, if you have constipation due to a medicine or an underlying medical condition, you may have to take laxatives for much longer, possibly many months or even years.

If you have been taking laxatives for some time, you may have to gradually reduce your dose rather than coming off them straight away. If you have been prescribed a combination of laxatives, you will normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.

Your GP will advise you when it is best to stop taking them.

Treating faecal impaction

Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.

If you have faecal impaction, you will initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative.

If you do not respond to these laxatives, you may need one of the medications described below.

Suppository – this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl is an example of a medication that can be given in suppository form.
Mini enema – this is when a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.

Pregnancy or breastfeeding

If you are pregnant, there are ways for you to safely treat constipation without harming you or your baby. Your GP will first advise you to change your diet by increasing fibre and fluid intake. You will also be advised to do gentle exercise.

If dietary and lifestyle changes do not work, you may be prescribed a laxative to help you pass stools more regularly.

Lots of laxatives are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.

Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these do not work, your GP may advise a small dose of bisacodyl or senna (stimulant laxatives).

However, senna may not be suitable if you are in your third trimester of pregnancy because this medicine is partially absorbed by your digestive system.

Babies who have not yet been weaned

If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make the formula as directed by the manufacturer and do not dilute the mixture.

You may want to try gently moving your baby's legs in a bicycling motion or carefully massaging their abdomen (tummy) to help stimulate their bowels.

Babies who are eating solids

If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pureed or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:

apples
apricots
grapes
peaches
pears
plums
prunes
raspberries
strawberries

Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience.

If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this does not work, they can be prescribed a stimulant laxative.

Children

For children, laxatives are often recommended alongside changes to diet. Osmotic laxatives are usually tried first, followed by a stimulant laxative if necessary.

As well as eating fruit, older children should have a well-balanced diet, which also contains vegetables and wholegrain foods such as wholemeal bread and pasta.

Try to minimise stress or conflict associated with using the toilet or meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet to make sure they have passed as many stools as possible.

To encourage a positive toilet routine, try making a diary of your child's bowel movements linked to a reward system. This can help them focus on using the toilet successfully.