Constipation is very common. It can mean opening your bowels less than three times a week, passing hard or lumpy stools, straining, or feeling that you have not emptied fully. When it lasts for three months or more, it is called chronic constipation.
Common causes
- Low fibre intake, not drinking enough, and little physical activity
- Ignoring the urge to go, or irregular routines and travel
- Medicines, such as strong painkillers, iron and calcium tablets, some antacids, and some medicines for mood, blood pressure or bladder control
- Medical conditions, such as an underactive thyroid, diabetes, high calcium, Parkinson’s disease, and pregnancy
- Irritable bowel syndrome with constipation, where pain and bloating are prominent
- Slow transit, where stool moves through the bowel slowly
- Pelvic floor dyssynergia, where the muscles of the back passage tighten instead of relaxing when you push. Typical signs are long, hard straining even with soft stools, and needing to press or use a finger to empty.
Warning signs that need prompt assessment
- A new change in bowel habit lasting more than a few weeks
- Blood in the stool
- Unintended weight loss
- Anaemia or low iron
- A family history of colorectal cancer
With any of these, or depending on your age, a colonoscopy is usually advised. See colorectal cancer screening.
Tests
- A careful history, including diet, medicines and toilet habits, and an examination, which may include a gentle examination of the back passage
- Blood tests, such as blood count, thyroid function and calcium
- A colonoscopy when there are warning signs or it is due for screening
- If simple treatment does not help, a transit study to check how fast the bowel moves
Treatment
- Diet and fluids: increase fibre gradually from vegetables, fruit, oats and whole grains, or take a fibre supplement such as psyllium, and drink enough water
- Toilet routine: try after breakfast, when the bowel is most active; do not ignore the urge; rest your feet on a small stool so your knees are above your hips
- Activity: regular walking or exercise
- Laxatives: osmotic laxatives such as macrogol (polyethylene glycol) or lactulose are often used regularly; stimulant laxatives such as senna or bisacodyl can be used when needed. Prescription medicines are available if these do not work.
- Reviewing medicines that may be contributing
- Biofeedback therapy for pelvic floor dyssynergia, where a therapist helps you retrain the muscles used to open your bowels
Seek urgent care at an emergency department if you cannot pass stool or wind and have vomiting or a swollen, painful abdomen, or if you have heavy bleeding.
General information only. Reviewed by Dr Chia Chung King, 2026-11-07. Book a consultation.