Will you need to have any tests?

The decision to perform investigations depends on your symptoms, your age and possibly whether you have a history of bowel problems within your family. It is often unnecessary to carry out tests for constipation, but if your doctor is worried they may organise one or more of the following:

•  blood tests.

•  flexible sigmoidoscopy, colonoscopy, barium enema or CT scan – these tests show doctors how the lining of your bowel looks and are routine procedures which are extremely safe.

•  transit studies – these are very simple tests, involving an X-ray after you have swallowed some capsules or tablets which show up how quickly things move through your intestines.

•  anorectal physiology testing and proctography – these are specialist tests that are only rarely needed. They indicate how the nerves and muscles around the back passage work. 

Should I take laxatives and are they safe?

Regular use of laxatives is generally not encouraged, but occasional use is not harmful. The commonest problem with laxatives is that their effects are unpredictable – a dose that works today may not produce an effect tomorrow. Also, they can cause pain and result in the passage of loose stools if the dose is high. One further problem with long-term use of laxatives is that the bowel becomes progressively less responsive,meaning that gradually higher doses are needed. The longer you take laxatives, the less likely it is that your bowel will work well on its own. The balance of scientific evidence suggests that laxatives do not cause permanent changes in the way the colon works. There is no evidence that using laxatives puts you at risk of getting colon cancer. Suppositories or mini-enemas are more predictable than laxatives and tend to be very well tolerated and effective.

A key point is that certain types of laxative will work in some patients but not others. Unless your constipation improves with fairly simple measures, it might be best to use laxatives only with proper guidance.

What other treatments are available?

If you remain troubled with constipation despite strict adherence to the measures described before, you may need further treatment. A technique used only in some specialist centres is called ‘biofeedback’, where patients are trained to co-ordinate their tummy muscles better in order to help the bowel empty rather more effectively. Some other methods that your doctor might suggest are still far from established. It can be very frustrating for patients as well as their doctors when constipation does not respond to different treatments. However, it is usually best to avoid surgery for constipation because many patients do not have a successful outcome. Indeed there are some patients who develop new symptoms after an operation such as diarrhoea, bowel obstruction or incontinence.

What research is needed?

We still have much to learn about how what we eat and drink moves through our insides. If we knew more clearly how this happens, then we would hope to understand rather better how to influence the process to the benefit of our patients. This would lead to far more effective ways of regulating our bowel habit than we have at present.