Constipation is a reduction in the number of defecations (bowel movements), accompanied by hard, dry, small stools, relative to the norm for the individual. Normal frequency varies from three bowel movements per day to three per week. There is a wide normal range, a thing many people, especially the elderly and young mothers do not understand. Hard, uncomfortable stools are a better indication when deciding that a person is constipated. Any sudden change in bowel habit that has lasted for 2 weeks or more should not be treated lightly.


Abdominal discomfort, bloating and nausea often accompany constipation. Bowel obstruction in severe constipation would show with colicky pain, a stretched abdomen and vomiting. Consult your pharmacist or GP if you see these symptoms.


If fresh blood is present or shows on the toilet paper, it could well be due to piles, which are often associated with constipation. These must also be treated. It is best in these complicated cases to talk to the pharmacist directly.


A common cause of constipation is insufficient dietary fibre, i.e. not enough wholemeal cereals, bread, and fresh vegetables. This should be investigated. A change in dietary habit can be due to a change in lifestyle e.g. job change, retirement, travel or sickness can all reduce fibre intake. Other causes are bowel disease, old age and lack of fluid intake.


Try to determine what exactly the bowel habit is NOW and how this differs form what is USUAL. Note the presence of any other symptoms (abdominal pain, nausea, vomiting, blood in stools) and discuss these with the pharmacist. Think about any recent diet change if in doubt about how to improve your diet, talk to a member of staff at your local pharmacy.


Constipation must be treated fairly early. Long-term constipation can lead to blockage of the gut or haemorrhoids (also known as piles) when trying to pass hard stools.


If you take laxatives already you should get advice from your local pharmacist. There are many laxatives available but they work in a variety of different ways. Not all laxatives are appropriate in different circumstances and therefore you should discuss your case with a healthcare advisor at your local pharmacy.


The common over the counter laxatives can be divided into three broad categories:


Stimulant laxatives: these medications (e.g. Senokot, Dulcolax) stimulate the colon and rectum to empty their contents. They both work after about 8 hours and so are usually best taken at night. They may cause abdominal cramps, especially Dulcolax which is the stronger of the two. They are ideal for short-term or occasional use as they are relatively gentle and quick acting, but may cause problems with long-term, regular use. Castor oil is a powerful stimulant laxative, but its use is no longer recommended.


Bulk forming laxatives: these laxatives (e.g. Fybogel, Normacol) increase the mass of the stool. This makes it easier to pass by telling the rectum that it is full. They may take a number of days to have their full effect. It is important to drink plenty of water while taking bulk forming laxatives.


Osmotic laxatives: These medicines (e.g. Duphalac) are solutions of sugars which are not broken down or absorbed by the body. This has the effect of drawing water into the bowel which makes the stool larger, softer and easier to pass. Like the bulk-forming laxatives, they are suitable for long-term use, but may take a number of days to take effect. It is also important to maintain a good fluid intake.


Many medicines can cause constipation so if you have started taking a new preparation ask your pharmacist for advice.


There are two essential principles when treating constipation:


  1. Relieve the constipation in the immediate and short term by using laxatives to start the large intestine working again.
  2. Re-educate the bowel to restore the rectal reflex (urge to defecate), so allowing normal emptying without need for laxatives. This can best be achieved by emptying the bowels whenever you feel the need to do so.