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Constipation in adults | Mate tūtae kore

Key points about constipation

Constipation (mate tūtae kore) is when your bowel movements (poos) become hard and lumpy, making them painful or difficult to get out. It is a common problem.
Constipation tends to affect women more than men.
It is also more common in older adults, people who are immobile, or people who have a diet that does not contain enough fibre.
If you have a child with constipation see our page on constipation in children.
In most cases, constipation lasts a short time and is not serious.
For some people, it causes ongoing discomfort and may need proper assessment by a doctor.

Change in your usual bowel movement pattern.
Hard or lumpy bowel movements.
Difficulty passing bowel movements or straining.
Gas, wind, bloating or stomach cramps and discomfort.
The feeling of being unable to completely empty the bowel.
The feeling that there is something blocking your bowel.

People can become constipated for no apparent reason, starting as early as childhood and continuing through life. Unexplained constipation affects women more often than men. Common causes of constipation include:

Diet
- Can involve eating too little, where the portion size of the meals are too small, or not eating enough fibre (roughage).
- Most New Zealander's eat less than half of the recommended amount of 25 grams to 30 grams each day.
Dehydration (not drinking enough fluids)
- Often as a result of drinking too little fluid, or losing too much fluid such as by vomiting or excessive sweating.
- Your daily fluid intake should be equivalent to 6 to 8 glasses of water.
Lack of exercise
- Getting little or no physical activity can increase your risk of constipation.
Change in routine
- Changes in diet and the usual time of meals.
- Limited access to toileting facilities.
Ignoring the urge
- Not responding to the urge to have a bowel motion can not only cause constipation but may also cause you to stop feeling the urge to go.
Pain or discomfort around the anus
- Pain around the anus, such as an anal fissure or haemorrhoids, can make bowel movements painful or uncomfortable. This may cause you to resist the urge to have a bowel movement.
Some medicines
- A number of medicines can cause constipation as a side effect. For example, antacids, iron supplements, opioid pain relievers, diuretics (water tablets), drugs for Parkinson's disease, antidepressants.
Various medical conditions
- Constipation may result from underlying conditions, eg, irritable bowel syndrome, diabetes, neurological conditions such as Parkinson's disease and MS, depression, coeliac disease, hypothyroidism.
Ageing
- Older people are at particular risk of constipation because they usually have a smaller appetite and a less bulky diet, lacking in fibre.
- There is also a tendency to be less mobile or active.
- A higher use of medicines and other health conditions can also cause constipation.
Pregnancy
- Constipation is a common complaint in pregnancy.
- It is caused by the change in hormones, which slows a woman's bowel movement. As the baby grows, this also presses on the lower bowel.
- Women taking iron supplements in pregnancy can also find these cause constipation.

The two most important things you can do to ease or prevent constipation are to be as active as possible and to ensure your diet contains plenty of fibre and fluid.

Exercise

Regular exercise helps strengthen the lower colon muscles and promotes normal muscle contractions in the bowel wall.
You should aim to be active for a minimum of 30 minutes every day.

Fibre and fluids

These help to bulk out and soften bowel motions by trapping water. This also helps to keep your bowel motions moving along.
Fibre can be from a range of sources such as vegetables, fruits, wholegrain breads and cereals.
As a guide, men should eat at least 30 grams of fibre a day, and women about 25 grams a day, although there is no upper limit in the recommendations.
You need to drink at least 1.5 litres of fluid – ideally water – every day, unless you are elderly and your doctor advises differently.

Natural laxatives

Certain foods have a natural laxative effect and eating them can help relieve constipation:

Kiwifruit contains an enzyme which is said to help with constipation and many people find it helpful.
Bran is not broken down in the digestive system and is able to hold water as it moves through the bowel.
Many fruits and dried fruits contain high levels of sorbitol and can act as natural laxatives, such as apples, apricots, grapes (and raisins), peaches, pears, plums (and prunes), raspberries and strawberries.

Medications used to treat constipation are called laxatives. Treatment with a laxative is needed only if the self care measures above do not work well. There are several types of laxatives that differ in how quickly they start working, how helpful they are in different situations, possible side effects, their taste and their cost. Your doctor or pharmacist will advise you on a suitable laxative for your needs. The four main groups of laxatives are:

Fibre supplements or bulk-forming laxatives: These add bulk to the faeces.
Osmotic laxatives: These draw water into the bowel which stimulates the bowel muscles to contract and help the bowel movement along.
.Stimulant laxatives: These act on the bowel's nervous system to get the bowel moving
Stool or faecal softeners: These laxatives soften the faeces.

Laxatives are available in different forms.

Tablets, capsules and powders are taken by mouth, and depending on the type of laxative, can take hours or days to work.
Laxatives are also available as rectal formulations (enemas or suppositories) which are inserted into the rectum (bottom). These are usually effective within minutes to an hour and are mainly used as a last resort to treat severe constipation.

Laxatives should be used only as recommended by your doctor or pharmacist and not for longer than advised. Read more about laxatives and the types available in Aotearoa New Zealand.

In most cases constipation lasts a short time and is not serious. But for some people, it causes ongoing discomfort and can interfere with their ability to go about their daily tasks. In this case, constipation needs proper assessment by a doctor. You should also see your doctor if:

You have been constipated or have a persistent feeling of not being able to empty your bowel completely that doesn't go away within 6 weeks.
Your tummy becomes increasingly swollen, or you start vomiting, which could suggest your bowels are blocked.
You are over 50 years of age and have never suffered from constipation before.
You suspect that a medication you are taking makes you constipated.
You notice blood in your stools but you don't have any pain or discomfort around the opening of your anal area.
You are losing weight for no apparent reason, feeling tired all the time, 'not quite right', sweaty or feverish.