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Health condition · Clinically reviewed

Chronic constipation, fibre, macrogol, prucalopride and specialist care.

One in seven UK adults is affected. A stepped plan - lifestyle, laxatives, prokinetics and, when needed, specialist assessment - almost always improves things.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CKS, BSG and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including macrogol laxatives, prucalopride, linaclotide and biofeedback for pelvic floor dyssynergia.

Key facts

Chronic constipation at a glance.

The essentials, in plain English - what it is, who it affects, how it is defined and how it is treated in the UK today.

  • What it is

    Persistent difficulty with bowel opening defined by the Rome IV criteria - straining, hard stool, incomplete emptying or fewer than three bowel motions a week for at least three months.

  • How common

    Around one in seven UK adults - about 14% of the population - is affected, and it is more common in women and in older adults.

  • Types

    Normal-transit (most common), slow-transit, evacuation disorder (pelvic floor dyssynergia) and secondary constipation - each with a different treatment emphasis.

  • First-line therapy

    Fibre, fluid, movement and macrogol (Movicol or Laxido) - effective and safe for long-term use.

  • Refractory options

    Prucalopride, linaclotide (for IBS-C), pelvic floor biofeedback and, rarely, sacral nerve stimulation or surgery.

  • When to worry

    New symptoms after 50, weight loss, rectal bleeding, anaemia, a family history of bowel cancer or a positive FIT test - all warrant urgent referral.

Why this guide matters

A stepped plan, not a bottle of the wrong laxative.

Constipation has many causes and treatments - the trick is matching the plan to the type. Three points shape everything else on this page.

  • Rule out serious causes

    Red flags such as new symptoms over 50, bleeding, weight loss or a positive FIT test always come first - a colonoscopy protects patients.

  • Start with the safe basics

    Fibre, fluid, movement, toileting habit and macrogol solve most cases and can be used together, safely, long-term.

  • Escalate when it is not enough

    Prucalopride, linaclotide, biofeedback and specialist tests exist for a reason - a referral is not a defeat.

How the diagnosis is made

From first appointment to a clear plan.

The steps a UK GP or gastroenterologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and Rome IV screen

    A careful account of stool form, straining, incomplete emptying, duration and any red-flag features - plus a medication review.

  2. 02

    Assessing

    Diet, fluid and lifestyle review

    Fibre intake, fluid volume, activity level, toileting habits and any recent changes such as travel, opioids or a new medicine.

  3. 03

    Assessing

    Examination and PR

    Abdominal palpation, rectal examination and assessment of anal tone, squeeze and the anal wink reflex.

  4. 04

    Confirming

    Baseline bloods and FIT

    FBC, TSH, calcium, glucose, coeliac serology and a faecal immunochemical test to screen for bowel cancer where appropriate.

  5. 05

    Confirming

    Colonoscopy for red flags

    A colonoscopy is arranged if there are alarm features, a positive FIT or a persistent change in bowel habit that needs a clear look inside.

  6. 06

    Specialist

    Specialist physiology testing

    Anorectal manometry, balloon expulsion, defecating proctography or a colonic transit study when a functional cause is suspected.

  7. 07

    Specialist

    MDT referral

    Gastroenterology, colorectal surgery, pelvic-floor physiotherapy and dietetics - a joined-up plan for the more complex cases.

Typical timeline: a first appointment to a working plan in a few weeks, with specialist tests reserved for the more complex cases.

Symptoms

What chronic constipation actually feels like.

The core Rome IV features, the everyday impact - and the red-flag symptoms that mean it is time to see a doctor sooner rather than later.

  • Fewer than three motions a week

    The classic frequency threshold - and one of the Rome IV criteria for chronic constipation.

  • Hard or lumpy stool

    Bristol type 1 or type 2 stool for a quarter or more of bowel motions - the commonest clue on history.

  • Straining

    A feeling of having to strain excessively to pass stool - often present most days.

  • Incomplete emptying

    A sense that the bowel has not fully emptied after a motion - typical of both slow-transit and evacuation disorders.

  • Anorectal obstruction

    A blockage sensation at the anus or rectum - a pointer towards pelvic floor dyssynergia or a rectocele.

  • Manual manoeuvres

    Digital support of the perineum or vagina to help defecation - a strong sign of an evacuation disorder.

  • Bloating and discomfort

    Abdominal distension and cramping - often prominent when constipation overlaps with IBS-C.

  • Red flag - bleeding or weight loss

    New symptoms after 50, unintentional weight loss, rectal bleeding or a positive FIT test need urgent investigation.

Treatment

How chronic constipation is treated in the UK.

Lifestyle first, laxatives titrated to comfort, prokinetics and secretagogues for refractory disease - and specialist care where an evacuation disorder or structural cause is in play.

  • Fibre, fluid and movement

    Build fibre gradually to 25 to 30 g a day, drink 1.5 to 2 litres of fluid and keep moving - the foundation of every treatment plan.

  • Toileting habit

    Use the gastrocolic reflex after breakfast, sit with knees higher than hips (a footstool helps) and never defer the urge to open the bowel.

  • Bulk-forming laxative

    Ispaghula husk (Fybogel), methylcellulose or sterculia - a first-line option when dietary fibre alone is not enough.

  • Macrogol (Movicol or Laxido)

    An osmotic laxative that is effective, safe for long-term use and the most widely used option in UK primary care.

  • Stimulant laxative

    Senna, bisacodyl (Dulcolax) or sodium picosulphate - useful short-term or as an as-needed rescue when osmotic laxatives are not enough on their own.

  • Prucalopride (Resolor)

    A 5-HT4 agonist prokinetic licensed for chronic idiopathic constipation when laxatives have failed - dose 1 to 2 mg once daily.

  • Linaclotide (Constella)

    A guanylate cyclase-C agonist secretagogue at 290 micrograms daily - the specific option for IBS with constipation.

  • Opioid-induced constipation therapy

    Naloxegol (Moventig), methylnaltrexone or oral naloxone - PAMORA drugs that reverse gut opioid effects without touching pain relief.

  • Rescue for faecal impaction

    High-dose macrogol, glycerol or docusate suppositories, phosphate enemas and, occasionally, digital evacuation under specialist care.

  • Pelvic floor biofeedback

    Specialist physiotherapy retrains the pelvic floor to relax on defecation - the best-evidenced treatment for dyssynergic defecation.

  • Rectal irrigation (Peristeen)

    Trans-anal irrigation for selected refractory cases - particularly useful when neurogenic causes are in play.

  • Sacral nerve stimulation and surgery

    Reserved for refractory disease - sacral nerve stimulation, laparoscopic ventral mesh rectopexy or, very rarely, subtotal colectomy in specialist centres.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gastroenterologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE Clinical Knowledge Summary. Constipation in adults.

  • British Society of Gastroenterology (BSG). Guidelines on the management of chronic constipation in adults.

  • Rome Foundation. Rome IV diagnostic criteria for functional gastrointestinal disorders.

  • NICE. Prucalopride for the treatment of chronic constipation in women (TA211).

  • NICE. Linaclotide for treating moderate to severe irritable bowel syndrome with constipation (ES4).

Red flags

When constipation needs urgent attention.

Most chronic constipation is safely managed in primary care. These are the features that lower the threshold for referral and investigation.

  • New onset after age 50

    A persistent change in bowel habit in an adult over 50 needs urgent investigation to rule out colorectal cancer.

  • Rectal bleeding

    Fresh or altered blood on the paper or in the pan warrants a two-week-wait referral - do not attribute it to piles without a proper look.

  • Unintentional weight loss

    Losing weight without trying, alongside a change in bowel habit, is a red flag for a serious underlying cause.

  • Iron-deficiency anaemia

    Low haemoglobin with a low ferritin in an adult with new bowel symptoms needs a colonoscopy to look for a bleeding source.

  • Positive FIT test

    A positive faecal immunochemical test is a strong signal for colorectal investigation, regardless of overt bleeding.

  • Family history of bowel cancer

    A first-degree relative with bowel cancer, especially at a young age, lowers the threshold for referral and earlier investigation.

  • Palpable abdominal or rectal mass

    A mass on examination is an urgent referral, even in a patient whose only symptom is constipation.

  • Faecal impaction with overflow

    Overflow diarrhoea in an older or immobile adult can mask severe impaction - a clinical review and disimpaction plan are needed.

  • Acute severe pain or obstruction

    Absolute constipation with abdominal distension, vomiting or severe pain suggests obstruction - a same-day surgical assessment is required.

Living with it

A treatable condition, with a clear ladder.

Four things make the biggest difference day to day - the basics, a bit of patience, sensible laxative use and knowing when to ask for more.

A quiet reminder

Small, steady changes beat heroic one-week plans.

Bowel habits shift slowly. A little more fibre, a little more water and a proper morning window on the toilet - kept up for weeks - tend to work.

  1. 01 Routine

    Build the basics

    Fibre in small daily upgrades, fluids you enjoy, movement most days and a proper morning window for the toilet - these do most of the work.

  2. 02 Patience

    Give any plan four to six weeks

    Bowel habits shift slowly. Judge a plan at six weeks, not six days, and keep a simple stool-form diary while you wait.

  3. 03 Meds

    Use laxatives without fear

    Macrogol is safe long-term. Titrate the dose to soft, easy stool and step down gradually rather than stopping suddenly.

  4. 04 Escalate

    Ask about specialist options

    If laxatives, diet and toileting habits are not enough, prucalopride, linaclotide, biofeedback and specialist tests can transform outcomes.

Frequently asked

Everything we get asked about chronic constipation.

Quick answers on Rome IV, medications, macrogol, prucalopride, pelvic floor dyssynergia and when a colonoscopy is needed.

  • What counts as chronic constipation?

    Rome IV defines chronic constipation as at least two of the following for a quarter of bowel motions over three months or more - straining, hard or lumpy stool, incomplete emptying, a sensation of anorectal blockage, using manual manoeuvres, or fewer than three bowel motions a week - with symptoms starting at least six months earlier.

  • Which medicines commonly cause constipation?

    Opioids are the biggest culprit but the list is long - tricyclic antidepressants, iron, calcium supplements, some antihistamines and antipsychotics, calcium channel blockers such as verapamil, diuretics, some antiepileptics and 5-HT3 antagonists like ondansetron. A medication review is often the single most useful thing your GP will do.

  • Is macrogol safe to take long-term?

    Yes. Macrogol (Movicol, Laxido) is one of the best-studied laxatives, works by drawing water into the stool and is safe for long-term daily use. Titrate the dose to a comfortable, soft stool rather than aiming for any particular sachet number.

  • When should I ask about prucalopride or linaclotide?

    Prucalopride is licensed for chronic idiopathic constipation when at least two laxatives from different classes, at optimal doses over at least six months, have not worked. Linaclotide is used specifically for IBS with constipation. Both need a proper trial of first-line treatment first and are usually initiated after a specialist review.

  • What is pelvic floor dyssynergia?

    It is an evacuation disorder where the pelvic floor and anal sphincter fail to relax - or paradoxically contract - during defecation. Laxatives alone rarely fix it. The best treatment is biofeedback with a specialist pelvic-floor physiotherapist, which retrains the coordination needed to open the bowels.

  • When do I need a colonoscopy?

    A colonoscopy is warranted if you have any alarm features - new symptoms after 50, rectal bleeding, weight loss, anaemia, a positive FIT test or a strong family history of bowel cancer - or if constipation is a new persistent change from your normal bowel habit.

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