I have constipation! What can I do about it?

Constipation is a common complaint. Technically it is defined by the presence of either straining with hard stools, or fewer than 3 bowel movements per week for at least 25% of the time. Patients usually complain of constipation when it is a relatively recent phenomenon which is a noticeable change from easier motions in the past. Or else they have symptoms of discomfort from constipation such abdominal bloatedness or pain. Such discomfort can even impair appetite.

Is constipation serious?

That depends on the cause. If you are young (less than say 45 years) then the likelihood of something serious like colon cancer is much less. If you are completely stopped up, passing nothing, not even gas for days and you have abdominal distention and pain, this may be due to intestinal obstruction (usually due to cancer but also post-surgical scarring of the tissues around your intestines – called “adhesions”) which is a medical emergency and you need to be quickly seen in a hospital and by a specialist.

What are the most common causes?

Most patients have “functional constipation” or “constipation predominant irritable bowel syndrome” which means that there is no specific disease causing it. The most consistent problem here is that material takes longer time to transit the small and large intestine. There is a mental overlay in that depression or anxiety are frequently associated with chronic constipation. Lack of fibre in the diet is seldom the cause.

If you have had diabetes mellitus for many years, then the effect of diabetes on the nerves controlling defaecation may be affected (autonomic neuropathy). Other possibilities include hormone imbalance, such as hypo-thyroidism. You should also tell your doctor all the medicines you take as some of them may cause constipation, such as anti-diarrhoea medicines like Imodium or Lomotil, some cough mixtures and aluminium based antacids.

Are there hints of more serious disease?

But if there are “alarm features”, and especially if the patient is more than 45 years old, then it is important to look harder for a serious disease such as cancer. Alarm featu