Constipation chronic in adults

Overview

Chronic constipation means having difficulty passing stools (poo) that lasts for several weeks or longer. You might go to the toilet less often than usual, have hard, dry stools, or feel like you cannot fully empty your bowels. It is a common digestive problem that can affect your daily life, but many things can help.

Yes, chronic constipation is very common. Many people experience it at some point, and it becomes more frequent with age.

It can affect anyone, but it is more common in older adults, people who do not eat enough fibre, those who are less active, and people taking certain medications. Women are also more likely to report it than men.

Symptoms

Common symptoms

• Fewer than three bowel movements per week
• Stools that are hard, dry, or lumpy and difficult or painful to pass
• Feeling like you have not completely emptied your bowels after going to the toilet
• Straining or spending a long time on the toilet
• Bloating, stomach pain, or feeling uncomfortably full
• Needing to use a finger to help pass stool (digital evacuation)

Symptoms in children

• Chronic constipation in children is common and symptoms include painful or hard poos, going less than three times a week, and soiling (leaking small amounts of liquid stool) between toilet visits.
• Children may also avoid the toilet, cross their legs, or show signs of stomach ache.
• Always speak to a doctor if you are worried about your child's bowel habits.

Symptoms in older adults

• Older adults may have more subtle symptoms, such as loss of appetite, confusion, or feeling generally unwell.
• They may also be at increased risk of faecal impaction (hard stool stuck in the back passage) and should not ignore a long period without a bowel movement.
• Some older people may not notice they are constipated, so carers and family should watch for changes.

Causes

Main causes

• Not enough fibre in the diet (such as fruits, vegetables, whole grains)
• Not drinking enough fluids (dehydration)
• Lack of physical activity or being sedentary for long periods
• Ignoring the urge to go to the toilet (habitual holding)
• Side effects of certain medications (like some painkillers, antidepressants, or blood pressure medicines)
• Changes in routine, such as travel or hospital stays
• Medical conditions affecting the digestive system, like irritable bowel syndrome (IBS), diabetes, or an underactive thyroid (hypothyroidism)
• Pelvic floor muscle problems or weakness, especially in older adults

Risk factors

• Age over 65 years
• Being female
• Low income or limited access to fresh food
• Taking multiple medications
• Having a neurological condition like Parkinson's disease or multiple sclerosis
• History of pelvic surgery or childbirth injuries
• Mental health conditions like depression or eating disorders

When to see a doctor

See a doctor urgently if:

• If you have severe stomach pain, blood in your stool, or you cannot pass gas or stool at all, seek medical help immediately.
• If you have vomiting with constipation, especially in an older adult or young child.
• If your constipation is causing intense pain or you feel very unwell.

Book a routine appointment if:

• See your doctor if constipation has lasted more than three weeks and does not improve with simple changes (more fibre, fluids, and exercise).
• If you notice a persistent change in bowel habit (more or less frequent, or different consistency) that lasts several weeks.
• If self-care measures have not helped and you are relying on laxatives regularly.
• If there is unexplained weight loss or blood in stool (even if small amounts).

Diagnosis

Your doctor will ask about your symptoms, medical history, diet, exercise, and medications. They may also do a physical exam, which might include checking your abdomen and a gentle internal (rectal) exam. Usually no tests are needed unless there are warning signs.

Tests that may be done

• Blood tests (to check for anaemia, thyroid function, or other causes)
• Stool test (to look for hidden blood or infection)
• Sigmoidoscopy or colonoscopy (a camera to look inside the lower bowel, if there are red flags like bleeding or weight loss)
• Bowel transit study (to see how quickly waste moves through your digestive system)
• Anorectal manometry (to test muscle function in the back passage)

What to expect at your appointment

You will be asked to keep a diary of your bowel movements, diet, and symptoms. Your doctor may recommend a trial of fibre supplements, more fluids, and increased physical activity before proceeding with tests. Most people get better with these simple steps, and only a small number need further investigations or specialist referral.

Treatment

Treatment for chronic constipation focuses on relieving symptoms and correcting the underlying causes. For most people, lifestyle changes are enough. If not, your doctor may suggest fibre supplements, stool softeners, or other medications to help you go more regularly. These are used for a short time and under medical advice.

Self-care at home

• Increase your fibre intake gradually – aim for 25–30g per day from fruits, vegetables, whole grains, nuts, and seeds.
• Drink plenty of water (6–8 glasses or 1.5–2 litres per day, unless your doctor advises otherwise).
• Get regular physical activity – even a daily 20-minute walk can help.
• Do not ignore the urge to have a bowel movement – go when you feel the need.
• Allow enough time for toilet visits, and try to sit comfortably with your feet on a small stool to mimic a squatting position.
• Review your medications with your doctor – some may be causing or worsening constipation.

Medical treatments

If self-care is not enough, your doctor may recommend over-the-counter or prescription treatments. These include fibre supplements (like psyllium husk), stool softeners (that draw water into the bowel), or stimulant laxatives (that encourage bowel movements). Osmotic laxatives (like lactulose or polyethylene glycol) are also commonly used. Always use these under medical guidance, as long-term use is not recommended. For severe cases, a specialist may prescribe newer medications that work on gut nerves or serotonin receptors.

When is surgery considered?

Surgery is rarely needed for chronic constipation. It might be considered if a specific structural problem is found (like a blockage, a weakness in the bowel wall, or a rectocele – a bulge of the rectum into the vagina). In very severe cases that do not respond to any other treatment, a subtotal colectomy (removing part of the colon) is sometimes done, but only after thorough evaluation and specialist discussion.

Living with this condition

Living with chronic constipation can be frustrating, but small changes can make a big difference. Keep a routine: eat meals at regular times, stay hydrated, and set aside a regular time for toilet visits each day. Listen to your body and be patient – it may take weeks for new habits to work.

Lifestyle tips

• Keep a food and symptom diary to identify triggers.
• Practice relaxation techniques like deep breathing – stress can worsen constipation.
• Limit caffeine and alcohol, which can cause dehydration.
• Avoid excessive use of laxatives without medical advice – they can make things worse over time.
• If you use opioid painkillers, talk to your doctor about managing constipation as a common side effect.

Diet and exercise

Aim for a balanced diet rich in fruits, vegetables, legumes, and whole grains. Prunes, pears, and kiwi fruit are natural stool softeners. Slowly increase fibre to avoid bloating. Drink plenty of fluids, especially water. Exercise helps move waste through your colon – even gentle activities like walking, yoga, or swimming are beneficial.

Mental health and emotional wellbeing

Chronic constipation can affect your quality of life, causing embarrassment, frustration, and anxiety. Some people avoid social situations or feel self-conscious. It can also interfere with sleep and relationships. If you feel worried or down about your symptoms, talk to your doctor. Sometimes, treating the emotional side helps the physical symptoms too.

Prevention

In many cases, chronic constipation can be prevented or improved by maintaining a healthy lifestyle. Eating plenty of fibre, staying hydrated, being active, and not ignoring the urge to go are the most important steps. For people at higher risk (older adults, those on certain medications), being proactive with these measures is especially helpful.

Screening programmes

There is no routine screening for constipation, but if you are over 60 and have a persistent change in bowel habit, your doctor may recommend bowel cancer screening (usually a stool test or colonoscopy) to rule out other causes.

Complications

If left untreated

• Faecal impaction – a large, hard stool stuck in the rectum that cannot be passed normally and may require medical removal.
• Haemorrhoids (swollen veins in the anus) from chronic straining.
• Anal fissures – small tears in the skin around the anus that can cause bleeding and pain.
• Rectal prolapse – part of the rectum pushes out through the anus.
• Urinary problems – pressure from a full colon can affect bladder function.
• In rare cases, untreated severe constipation can lead to bowel obstruction or reduced quality of life due to ongoing pain and discomfort.

Long-term outlook

The outlook for most people with chronic constipation is very good. With simple lifestyle changes and, if needed, medical help, symptoms can be managed effectively. Many people find that their symptoms improve significantly once they find the right combination of diet, hydration, activity, and (if necessary) medication. It may take time and patience, but you can usually achieve comfortable, regular bowel movements without surgery or long-term reliance on laxatives. Stay hopeful and keep communicating with your healthcare team.

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