constipation specialist tests overview

Overview

Constipation is when you have fewer than three bowel movements a week or have hard, dry stools that are difficult to pass. Specialist tests are used when constipation does not improve with simple changes, to find the underlying cause.

Yes, constipation is one of the most common digestive complaints. Many people experience it at some point in their lives.

Constipation can affect anyone, but it is more common in women, older adults, and during pregnancy.

Symptoms

Common symptoms

• Fewer than three bowel movements a week
• Straining during bowel movements
• Hard or lumpy stools
• Feeling as if you haven't completely emptied your bowels
• Bloating or discomfort in your abdomen

Symptoms in children

• Pain when passing stools
• Withholding stools (tightening the bottom to avoid going)
• Soiling or accidents in underwear
• Irritability and loss of appetite

Symptoms in older adults

• Confusion or agitation may be a sign of constipation in people with dementia
• Loss of appetite
• Leaking liquid stool (overflow diarrhoea)

Causes

Main causes

• A diet low in fibre (e.g. not enough fruits, vegetables, or whole grains)
• Not drinking enough water or fluids
• Lack of physical activity
• Ignoring the urge to go to the toilet
• Side effects of certain medications (e.g. some painkillers, antidepressants)
• Medical conditions such as irritable bowel syndrome (IBS), diabetes, or an underactive thyroid

Risk factors

• Being older than 65
• Being pregnant
• Taking medications that cause constipation
• Having a low-fibre diet or eating a lot of processed foods
• Not getting enough exercise
• Having a family history of constipation or bowel problems

When to see a doctor

See a doctor urgently if:

• Any sign of blood in your stool or on toilet paper
• Unexplained weight loss
• Severe abdominal pain that comes on suddenly or does not go away
• Constipation that started after you began a new medication

Book a routine appointment if:

• Constipation that lasts more than 3 weeks despite trying self-care measures
• If you need to use laxatives regularly for more than a few weeks
• If constipation is affecting your daily life or causing distress

Diagnosis

A doctor will start by asking about your symptoms, diet, and medical history. They may perform a physical exam, including a gentle rectal exam to check for blockages or muscle problems. If needed, they will refer you to a digestive specialist (gastroenterologist) for further tests.

Tests that may be done

• Colonoscopy – a thin, flexible tube with a camera checks the inside of your large bowel for problems like polyps or narrowings. You need to take laxatives the day before to empty your bowel.
• Anorectal manometry – a small, flexible tube is placed in your bottom to measure the pressure and coordination of the muscles that control bowel movements.
• Defecography – an X-ray or MRI while you pass a soft paste (like stool) to show how your muscles and organs work during a bowel movement.
• Colonic transit study – you swallow a capsule with small markers, and X-rays track how fast the markers move through your bowel over several days.
• Balloon expulsion test – a small balloon is inserted into your rectum and you are asked to push it out; this tests how well your muscles work.

What to expect at your appointment

Most of these tests are done in a hospital clinic or an outpatient department. Some require special preparation (like taking laxatives for a colonoscopy). The tests are usually not painful, though you may feel some discomfort. Your doctor will explain what to expect and how to prepare.

Treatment

Treatment for chronic constipation depends on the cause. It often starts with simple lifestyle changes. If these are not enough, your doctor may recommend different treatments or medicines to help.

Self-care at home

• Eat more fibre – aim for 25 to 30 grams a day from fruits, vegetables, beans, and whole grains.
• Drink plenty of water – at least 6 to 8 glasses a day, unless your doctor tells you otherwise.
• Get regular physical activity – even a daily 20-minute walk can help.
• Set aside time each day to try to use the toilet, especially after meals.
• Never ignore the urge to go – try to get to a toilet as soon as you feel the need.

Medical treatments

If self-care does not work, doctors may recommend over-the-counter remedies like fibre supplements (bulk-forming laxatives) or stool softeners. For more severe cases, prescription medications are available that work by pulling water into the bowel or by stimulating the bowel muscles. Your doctor will choose the safest option for you. Always talk to your pharmacist or doctor before taking any remedy for a long time.

When is surgery considered?

Surgery is rarely needed for constipation. It may be considered only if a specific problem is found, such as a narrow spot in the bowel, a rectocele (a weakening of the wall between the rectum and vagina), or a severe muscle coordination problem that does not respond to other treatments.

Living with this condition

Living with chronic constipation can be frustrating, but most people can manage it well with a plan. Try to use the toilet at the same time each day, especially after breakfast. Keep a diary of your symptoms and any triggers.

Lifestyle tips

• Stay active throughout the day – even small movements help.
• Practice relaxation techniques like deep breathing or yoga to reduce stress, which can affect digestion.
• If you need to strain, try putting your feet on a small stool while on the toilet (this changes the angle and makes it easier).

Diet and exercise

Eat a variety of high-fibre foods such as apples, pears, prunes, oats, and leafy greens. Drink enough water so your urine is light yellow. Aim for at least 30 minutes of moderate activity most days – walking, swimming, or cycling are great choices.

Mental health and emotional wellbeing

Chronic constipation can cause embarrassment, anxiety, and affect your social life. It may also contribute to low mood. Be open with your doctor about how it makes you feel – they can help with both physical and emotional aspects.

Prevention

In many cases, constipation can be prevented by eating a fibre-rich diet, drinking enough fluids, staying active, and responding promptly to the urge to have a bowel movement.

Complications

If left untreated

• Hemorrhoids (swollen veins in the bottom) from straining too hard
• Anal fissures (small tears in the skin around the anus)
• Fecal impaction (a large, hard mass of stool that gets stuck)
• Rectal prolapse (the rectum pushes out of the anus) – rare but possible
• Bowel obstruction – very rare but serious

Long-term outlook

The outlook for most people with constipation is very good. With the right lifestyle changes, medicines, and sometimes specialist help, the vast majority of people can improve their symptoms and lead a normal, active life.

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