Medical advice

There is a strong connection between emotional feelings and how the gut works. Feeling upset can make your bowel slow down or speed up. Emotional upsets, even in childhood, may result in constipation many years later. Ignoring the natural urge to open your bowels (because you want to avoid public toilets or because you are too busy at work) can result in changes in how your bowel muscles work and so cause lasting changes in the pattern of opening your bowels. In addition, some patients strain excessively because they have difficulty co-ordinating the muscles that empty the bowel and they just end up by straining even more. Irregular meal times, reduced liquid intake, inactivity and fear of pain on passing stool may worsen symptoms in patients with a tendency towards constipation. Some women notice that their bowels are more sluggish at certain times of their menstrual cycle.

What are the unusual causes of constipation?

In rare cases the bowels may not be working properly because the bowel itself is diseased by being narrowed or even blocked as a result of scarring, diverticular disease or inflammation. Even more rarely, a colonic tumour may cause constipation. It is important to emphasise that cancer is an extremely rare cause of constipation. There are also some uncommon abnormalities that happen when the gut just seems to widen (megacolon) or ends up pushing itself in the wrong direction (rectocoele). Sometimes problems with hormones (such as an under-active thyroid gland) or with the metabolism (such as a high level of calcium in the blood) may cause the gut to be sluggish, leading to constipation. These conditions are easily diagnosed by simple tests.

What should you do if you are constipated?

A high fibre diet may help some patients with constipation. Try to eat a mixture of high fibre foods. Fruit, vegetables, nuts, wholemeal bread and pasta, wholegrain cereals and brown rice are all good sources of fibre. Aim to have a high fibre food at each meal and eat five portions of fruit or vegetables each day.

Some people may find that it helps to take fibre in the form of fruit and vegetables (soluble fibre) rather than that in cereals and grains (insoluble). This is because insoluble fibre may lead to bloating and can worsen any discomfort.

Fibre is most helpful for patients with mild symptoms of constipation – if you are severely troubled, you will not benefit from progressively higher doses of fibre, and may even be made worse.

Regular meals and an adequate fluid intake (approximately 10 cups a day) are the mainstays of treating and
preventing constipation. It is also important to identify a routine of a place and time of day when you are comfortably able to spend time in the toilet. Respond to your bowel’s natural pattern – when you feel the urge, don't delay. Keeping active and mobile helps some people whose bowel is sluggish.