Constipation is a topic that few of us like to talk about, even though it is one of the most common medical complaints in Australia. It affects more women than men and it increases with advancing age in both sexes. Approximately 1 in 5 middle aged women suffer from constipation and it also affects around 1 in 10 children.
Constipation occurs when your bowel movements become difficult to pass or when they happen less frequently than usual.
Normal stools should be soft, formed and passed without straining but the frequency of bowel movements is different for everyone. For some, it is normal to have a movement once or twice a day, but others only have a few movements each week – all are considered normal if it is the regular routine. Only you can determine what is normal for you.
The main symptom of constipation is a hard, dry stool that is infrequent or difficult to pass.
Other symptoms may include:
- Abdominal cramps
- Bloated abdomen
- Lack of energy
- Having to sit on the toilet for much longer than usual
- Sensation afterwards that the bowel hasn’t fully emptied
There are many causes of constipation, but the main cause is due to the slow movement of the stools through the bowel.
The large bowel absorbs water from the stools when they are not moved regularly and this can result in small or hard, dry stools that are difficult to pass. A number of factors can cause the passage of stools to slow down. The most common causes are:
Insufficient fluid intake
Water makes the bowel motion soft and easier to pass. With insufficient fluid intake, the stools become hard and dry which makes having a bowel movement difficult.
Inadequate amounts of fibre in the diet
Regular consumption of fibre rich foods like fruit and vegetables, cereals, bran and whole grain bread help to maintain a regular routine. The body does not absorb fibre so it travels through the system to the bowel, where it provides bulk for the bowel motion. Fibre also absorbs water, making the motion soft and easier to pass.
Ignoring the urge to have a bowel movement
This is especially common in children as they may be too busy playing to take the time to go to the toilet or accessing a toilet may be difficult. Busy schedules and racing to be ready for school or work can result in delaying a trip to the toilet.
Lack of physical activity
Exercise helps the muscles work to move the stools through the bowel.
Irritable bowel syndrome (IBS)
Click here for more information on IBS.
Change in lifestyle or routine
When the normal body clock is disrupted by travel, routine bowel habits can be upset and constipation may result.
Female hormones can affect the bowel habit and constipation is more common during pregnancy.
Certain medical conditions
Certain medical conditions may also cause or worsen constipation:
Endocrine disorders (diabetes, hypothyroidism, hyperparathyroidism),
Neurological conditions (MS, Parkinson’s disease, spinal cord injuries),
Gastrointestinal conditions (anal fissure, irritable bowel syndrome, psychogenic disorder).
Constipation can also be caused by some medications. Prescription medicines used to treat blood pressure, heart disease and depression can cause constipation. Some over the counter products such as analgesics that contain codeine as well as iron supplements and some antacids are also known to cause constipation. If you have any concerns you should talk to your doctor or pharmacist.
The Bristol Stool Form Chart is a medical aid designed to classify the form of stool (poo) categories. There are seven types of stools:
- Types 1 or 2 indicate constipation
- Types 3 or 4 are ideal stools as they are easier to pass
- Types 5, 6 or 7 may indicate diarrhoea and urgency
Bristol Stool Chart
Click here to download the PDF of Bristol Stool Chart.
Source: Heaton, K W & Lewis S J: Stool form scale as a useful guide to intestinal transit time. Scandinavian Journal of Gastroenterology 1997, 32 (9): 920-92.