Constipation

What is constipation?

Constipation is characterised by infrequent bowel movements (fewer than three per week), hard or dry or lumpy stools, straining, and a feeling of incomplete evacuation. It is very common and can be short-lived or long-standing.

The World Gastroenterology Organisation (WGO) 2025 global guidance puts prevalence at approximately 9–20%, with higher rates in women and older adults. The NHS advises that most people experience constipation at some point, and it often resolves with simple lifestyle changes.

When constipation is chronic

Chronic constipation is usually defined as symptoms lasting more than three months. The WGO 2025 cascade approach separates:

• Normal-transit constipation — stool moves at normal speed but patients still feel blocked or strained.
• Slow-transit constipation — delayed movement through the colon. See our slow-transit constipation page.
• Defecatory disorders — difficulty evacuating despite normal transit, often related to pelvic floor dysfunction. See dyssynergic defecation and pelvic floor dysfunction.

Common symptoms

• Fewer than three bowel movements per week
• Hard, dry, or lumpy stools (Bristol Stool Scale type 1–2)
• Straining during bowel movements
• Feeling of incomplete evacuation
• Bloating and abdominal discomfort
• Reduced urge to defecate

Common causes and contributors

• Low dietary fibre and inadequate fluid intake
• Physical inactivity and sedentary lifestyle
• Ignoring the urge to defecate or irregular toilet routine
• Medications — opioids, anticholinergics, iron supplements, some antidepressants, calcium channel blockers
• Pregnancy and postpartum changes
• Older age and neurological conditions
• Dehydration from illness or travel

Medication-induced constipation is covered on our medication-related symptoms page.

Red flags — seek urgent assessment

The NHS warns that new or persistent rectal bleeding, unexplained weight loss, a sudden and persistent change in bowel habit, or iron-deficiency anaemia can signal serious pathology including bowel cancer. Do not self-manage these symptoms.

Approaches people discuss

Constipation management is usually stepwise, starting with lifestyle and dietary changes before moving to medicines or specialist referral.

• Established Lifestyle measures first-line: increase dietary fibre gradually, drink adequate fluids, stay physically active, establish a regular toilet routine, and allow unhurried time on the toilet. The NHS and WGO 2025 both place these at the foundation of management. Sources: NHS constipation advice; WGO 2025 global cascade.
• Established Stepwise laxative approach guided by a clinician if lifestyle changes are insufficient. NICE CKS outlines bulk-forming, osmotic, stimulant, and faecal softener options in sequence. Sources: NICE Clinical Knowledge Summaries on constipation.
• Established Naldemedine for opioid-induced constipation after laxatives have failed, within its marketing authorisation (NICE TA651, reflected in CKS November 2025). Sources: NICE CKS November 2025.
• Emerging BDA 2025 guidelines provide evidence-based dietary recommendations including fibre type (soluble and insoluble), fluid intake targets, and note that probiotic evidence for constipation remains limited. Sources: Dimidi et al. BDA 2025 PMID 41081381.
• Emerging Regular gentle exercise such as walking may help constipation symptoms, though trial quality is mixed. Sources: WGO 2025; community walking theme.
• Limited Abdominal massage as a proven treatment for constipation. NICE CKS frames it at most as a limited adjunct. Sources: NICE Clinical Knowledge Summaries on constipation.

What not to self-manage

These are cautions, not approaches people discuss: long-term stimulant-laxative dependence without addressing underlying causes; “detox” or colon-cleansing products; attributing all constipation to “leaky gut” or food intolerance without assessment.