In short
Fewer than three bowel movements a week, or stools that are hard and difficult to pass. Fibre, fluid and routine do most of the work, but the order in which you add them decides whether it helps or makes bloating worse.
Emergency if: No stool or wind passed at all with vomiting, a swollen abdomen and severe pain — this suggests obstruction and needs emergency care now.
On your report
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On this page
01
What counts as constipation
Constipation means having fewer than three bowel movements a week, along with stools that are hard, dry or lumpy, difficult or painful to pass, or a feeling that the bowel has not emptied completely. Any of those features counts, which is why someone going daily can still be constipated if every visit is a struggle.
There is no requirement to go once a day. Normal ranges from three times a day to three times a week, and what matters is a change from your own pattern together with difficulty. Chasing a daily habit that was never yours leads to unnecessary laxative use.
02
Why it happens
The common causes are unremarkable: not enough fibre or fluid, inactivity, ignoring the urge to go, a change in routine such as travel, and pregnancy. Stool spends longer in the colon, more water is absorbed from it, and it becomes harder to pass — which makes going uncomfortable, which encourages further delay.
Medicines are an underestimated cause. Opioid painkillers are the strongest offenders, but iron tablets, some antidepressants, calcium and aluminium antacids, and certain blood pressure medicines all contribute. An underactive thyroid, diabetes, low potassium, high calcium, Parkinson's disease and multiple sclerosis can all slow the bowel, which is why persistent constipation prompts a small set of blood tests.
03
Fibre, fluid and the order that matters
Add fibre to your diet a little at a time so your body gets used to the change. Increasing fibre suddenly is the most frequent reason people conclude that fibre does not suit them — it causes bloating and wind for a week or two before the gut adapts. Building up gradually over several weeks avoids most of that.
Fibre needs fluid to work. Bulking fibre without enough water can make stools firmer rather than softer, and in someone with a slow bowel it can worsen matters. Soluble fibre from oats, psyllium, pulses and fruit tends to be better tolerated than large amounts of bran, particularly for those whose constipation overlaps with irritable bowel syndrome.
04
Routine, position and the urge
The bowel has a natural rhythm: activity increases after waking and after meals. Setting aside unhurried time about 20 to 30 minutes after breakfast uses that reflex rather than fighting it. Going when the urge arrives, instead of postponing it, is one of the highest-value habits there is, because a suppressed urge fades and the stool dries out further.
Position helps more than people expect. Raising the feet on a low stool so the knees sit above the hips straightens the angle of the rectum and reduces the need to strain. Regular physical activity — even daily walking — measurably improves bowel transit and is worth counting as treatment rather than general advice.
05
Laxatives, used sensibly
When self-care is not enough, over-the-counter medicines are the next step. Bulk-forming laxatives add substance and need generous fluid. Osmotic laxatives draw water into the stool and are well suited to hard stools and to longer-term use where needed. Stimulant laxatives prompt the bowel to contract and are best for short courses.
The old worry that the bowel becomes dependent on laxatives is overstated for the types used today, and under-treatment causes more harm — particularly with opioid painkillers, where a laxative should usually be started alongside rather than waiting for a problem. If self-care fails, prescription medicines, biofeedback for coordination problems, and rarely surgery are available options.
06
When constipation needs investigating
See a doctor if constipation comes with rectal bleeding, blood in the stool, continual abdominal pain, or other signs of a medical problem. Unintentional weight loss, a persistent change in bowel habit lasting weeks, constipation starting for the first time in an older adult, a family history of bowel cancer, or anaemia found on a blood test all warrant assessment rather than another laxative.
Constipation alternating with diarrhoea, or a stool that has become persistently narrow, is worth reporting. Complete inability to pass stool or wind, with vomiting, abdominal distension and severe pain, suggests obstruction and is an emergency. In frail or immobile people, ongoing leakage of liquid stool is often overflow around an impacted mass rather than diarrhoea, and treating it as diarrhoea makes it worse.
When to act
Routine — see a doctor
Hard stools and infrequent visits without other symptoms: build fibre gradually, increase fluids, use the after-breakfast window and add a laxative if needed.
Same-day — call promptly
Rectal bleeding, continual abdominal pain, unintentional weight loss, a change in bowel habit lasting weeks, or new constipation in an older adult.
Emergency — act now
No stool or wind passed at all with vomiting, a swollen abdomen and severe pain — this suggests obstruction and needs emergency care now.
Values mentioned in this story
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Sources
- Constipation — NIDDKniddk.nih.gov
- Constipation — NHSnhs.uk
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