Constipation: symptoms, causes, treatment and how long it lasts

The NHS says it is likely to be constipation if you have not had a poo at least 3 times in the last week or are pooing less often than usual, the poo is unusually large or small and is dry, hard or lumpy, you are straining or in pain when you poo, or you feel like you have not fully emptied your bowels. You may also have a stomach ache and feel bloated or sick.

NHS inform notes that normal bowel habits vary from person to person: some adults go to the toilet more than once a day, while others only go every 3 or 4 days. Other symptoms can include stomach ache and cramps, feeling bloated, feeling sick and loss of appetite.

If you are caring for an older person, or someone with dementia or a learning disability, the NHS says constipation may be easily missed. Look out for behaviour changes such as confusion, as it might mean they are in pain or discomfort.

The NHS says you can usually treat constipation with simple changes to your diet and lifestyle. You may notice a difference within a few days, but sometimes it takes a few weeks before your symptoms improve. NHS inform says diet and lifestyle changes are usually recommended as the first treatment, and that treatment is effective, although in some cases it can take several months before a regular bowel pattern is re-established.

If diet and lifestyle changes are not helping, the NHS says to speak to a pharmacist, who can suggest a suitable laxative. Most laxatives work within 3 days and they should only be used for a short time. The NHS medicines pages describe two common ones: lactulose is an osmotic laxative that works by bringing water into the bowel and can take 2 to 3 days to start working, and senna is a stimulant laxative that takes around 8 to 12 hours to work and should not be taken for more than 7 days unless a doctor or pharmacist has advised it.

The NHS lists changes to make poo softer and easier to pass. Making changes gradually matters, particularly with fibre.

• Eat a healthy balanced diet and include fruits that contain sorbitol, such as apples, apricots, grapes (and raisins), raspberries and strawberries.

• Drink plenty of water and other fluids and avoid alcohol.

• Gradually increase the fibre in your diet; add some wheat bran, oats or linseed.

• Keep to a regular time and place for the toilet and give yourself plenty of time.

• Do not delay if you feel the urge to poo.

• Rest your feet on a low stool while going to the toilet and, if possible, raise your knees above your hips.

• Consider increasing your activity: a daily walk or run can help.

The NHS says constipation in adults has many possible causes and sometimes there is no obvious reason. NHS inform adds that constipation usually occurs when stools remain in the colon for too long and the colon absorbs too much water, making them hard and dry.

• Not eating enough fibre.

• Not drinking enough fluids.

• Not moving enough and spending long periods sitting or lying down.

• Ignoring the urge to go to the toilet.

• Changing your diet or daily routine.

• A side effect of medicine.

• Stress, anxiety or depression.

• Pregnancy and after giving birth, and being over 65 years old.

• A medical condition such as diverticular disease or bowel cancer, which the NHS says is rare.

The NHS says constipation is common during pregnancy and after giving birth, and that it is safe to try simple diet and lifestyle measures when you are pregnant. NHS inform says constipation is more common during pregnancy.

The NHS pregnancy guide on piles says constipation can cause piles, and suggests keeping stools soft and regular by eating plenty of high-fibre foods such as wholemeal bread, fruit and vegetables and drinking plenty of water, taking regular exercise, and avoiding straining. It advises that you should ask your doctor, midwife or pharmacist before using a cream or medicine.

If diet changes do not help, speak to your pharmacist, midwife or GP about which laxative is suitable for you in pregnancy rather than choosing one yourself.

The NHS says constipation is common in childhood, particularly when children are being potty trained at around 2 to 3 years old. It lists signs: fewer than 3 poos in the last week, a poo that is large and hard or looks like rabbit droppings or pellets, straining or pain, some bleeding because the poo is large and hard, and poor appetite or stomach pain that improves after they poo. If a child over 1 year old has soiled pants, this can be overflow soiling, where runny poo leaks around hard poo.

The NHS says causes can include not eating enough fibre, not drinking enough, feeling pressured or being interrupted during potty training and feeling worried or anxious. It says to take your child to a GP if you think they may be constipated, because the longer the constipation, the harder it can be to get back to normal. Laxatives are often recommended for children eating solid foods, alongside diet and lifestyle changes, and it may take several months for treatments to work.

The NHS says soiling is not something a child is doing on purpose, so there is no reason to get cross. Offer plenty to drink; breastfed babies not eating solids yet should have plenty of breastfeeds, and formula-fed babies can have extra drinks of water between feeds (cooled boiled water for babies under 6 months). Establish a routine of regularly sitting on the potty or toilet, after meals or before bed, make sure feet rest flat on the floor or a step, and stay calm and reassuring.

The NHS says you may notice a difference within a few days of simple changes, though sometimes it takes a few weeks. NHS inform says to see your GP if constipation lasts longer than 14 days without improvement, and that in some cases it can take several months before a regular bowel pattern is re-established.

Most laxatives work within 3 days according to the NHS; lactulose can take 2 to 3 days, and the NHS says to see a doctor if you have taken lactulose for more than 3 days and symptoms have not improved or have got worse.

The NHS says to see a GP if you are constipated and it is not getting better with treatment, you are regularly constipated, you are regularly bloated, you have blood in your poo, you have lost weight without trying, you are constipated and feel tired all the time, you are taking medicine that is causing constipation (such as opioid painkillers), you notice sudden changes in how you poo, or you have tummy pain. Speak to the GP before you stop taking any prescribed medicine.

NHS inform adds that you should see your GP if you notice any rectal bleeding, unexplained weight loss or persistent tiredness, or if constipation lasts longer than 14 days without improvement.

The NHS says long-term constipation can lead to faecal impaction, where poo has built up in the last part of the large intestine (rectum). The main symptom is diarrhoea, which leaks through the build-up of solid poo. It may be treated with stronger laxatives prescribed by a GP, a suppository, a mini enema or a healthcare professional removing some of the poo, which is not something you should do yourself.

NHS inform lists haemorrhoids (piles), faecal impaction and bowel incontinence as complications that can occur with long-term constipation.

NHS inform says constipation is not usually serious and can be treated by a pharmacist, who may recommend contacting your GP practice if required. Most people never need a hospital appointment.

If constipation is persistent or comes with red-flag symptoms, a GP can review your medicines and arrange tests or specialist referral. Private gastroenterology or colorectal consultations are available, but the first-line advice on fibre, fluids, activity and short-term laxatives is the same.