Chronic Constipation

Understanding and treating persistent constipation

What is chronic constipation?

Constipation means bowel motions that are infrequent (fewer than three per week), hard, difficult to pass, or feel incomplete. It is 'chronic' when it persists for three months or more. It is very common — affecting up to 1 in 4 adults at some stage — and is usually manageable with the right approach.

Common causes and contributors

• Low dietary fibre or fluid intake, and low physical activity

• Medications — including opioid painkillers, some antidepressants, iron tablets and certain blood pressure medications

• Slow transit — the bowel moves contents more slowly than normal

• Pelvic floor (defaecatory) dysfunction — the muscles used to empty the bowel don't coordinate properly

• Medical conditions such as an underactive thyroid or diabetes

• Ignoring the urge to go, often due to busy routines

Simple measures that help

• Aim for 25–30 g of fibre daily from vegetables, fruit, wholegrains, legumes, nuts and seeds — increase gradually to avoid bloating

• Drink adequate fluid, especially when increasing fibre

• A soluble fibre supplement such as psyllium (e.g. Metamucil) daily is safe long term

• Two kiwifruit or a serve of prunes daily has good evidence

• Don't ignore the urge — respond promptly, and allow unhurried time, ideally after breakfast when the bowel is most active

• Toilet position matters: place your feet on a small footstool, lean forward with elbows on knees, and avoid straining

• Regular exercise, even walking, stimulates the bowel

Laxatives — safe and effective when used correctly

Modern laxatives are safe for long-term use and the bowel does not become 'lazy' from osmotic laxatives. First choice is usually an osmotic laxative such as macrogol (e.g. Movicol, OsmoLax), which draws water into the bowel. Stimulant laxatives (e.g. senna, bisacodyl) are effective and can be used regularly if needed. If standard laxatives aren't working, prescription options and further testing are available — please tell us rather than putting up with symptoms.

When do we test further?

Most constipation does not need investigation. We consider colonoscopy if there are warning signs or if bowel cancer screening is due. For constipation that resists treatment, tests such as anorectal manometry (assessing pelvic floor coordination) or a colonic transit study can identify the cause — pelvic floor dysfunction, in particular, responds well to specialised physiotherapy (biofeedback) rather than more laxatives.

⚠ See a doctor promptly if you have Blood in the stoolUnintentional weight lossA sudden, persistent change in bowel habit — particularly after age 50Severe abdominal pain, vomiting, or inability to pass wind or stool (possible blockage — seek urgent care)A family history of bowel cancer — screening recommendations may differ for you

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This information is general and not a substitute for personalised medical advice. Please discuss any questions with your gastroenterologist or GP. If you develop severe symptoms, call 000 or go to your nearest emergency department.