Constipation is common and usually improves with simple changes and the right laxative used properly. Laxatives are safe when used as advised. A few warning signs need medical review.

What is it?

Constipation means opening your bowels less often than usual (often fewer than three times a week), passing hard or lumpy stools, straining, or feeling that you have not fully emptied. Normal frequency ranges widely, from three times a day to three times a week.

Common causes

• Low fibre or fluid intake, and irregular meals
• Ignoring the urge to go, or limited toilet access during the day
• Low physical activity
• Medicines: opioid painkillers (including codeine and tramadol), iron tablets, some antidepressants, calcium and aluminium antacids, some blood pressure medicines
• Pregnancy, travel and changes in routine
• Medical conditions such as an underactive thyroid, diabetes, high calcium, or irritable bowel syndrome
• Pelvic floor dyssynergia: the muscles that should relax during a bowel movement tighten instead

What you can do

• Eat regular meals; the bowel is most active after breakfast
• Respond to the urge and give yourself time, without straining hard
• Use a footstool so your knees are higher than your hips; this changes the angle of the rectum and makes passing stool easier
• Increase fibre gradually: fruit and vegetables, oats, legumes, wholegrains. Two green kiwifruit a day, or prunes, work well for many people
• Drink enough fluid, especially in hot weather and when adding fibre
• Move more: daily walking helps

Laxatives

If lifestyle changes are not enough, laxatives are safe and effective when used as directed:

• Bulk-forming (psyllium/ispaghula): take with plenty of water; can cause bloating at first
• Osmotic (macrogol/polyethylene glycol, lactulose): draw water into the stool. Macrogol is often the first choice and can be used long term
• Stimulant (senna, bisacodyl): make the bowel contract; useful as an add-on or for short periods
• Suppositories or enemas: for quick relief when stool is stuck low down

Laxatives do not make the bowel 'lazy' when used as advised. If they are not working after several weeks, see your doctor; there are prescription medicines and specialised tests for difficult cases.

Tests

Most people do not need tests. Your doctor may check blood count, thyroid, calcium and glucose. A colonoscopy is advised if there are warning features or you are due for bowel cancer screening. For long-standing difficult constipation, tests of bowel transit and pelvic floor function can guide treatment, including pelvic floor retraining (biofeedback).

Common questions

This leaflet is general information and does not replace advice from your own doctor. Version 1.0, October 2026. Next review October 2028.