Constipation can mean different things to different people. There is a common belief that people need to open their bowel every day, but this is not the case. Opening the bowels can vary between three times a day to three times a week in healthy individuals. You have constipation if you open your bowel less than three times a week, or if you are passing a hard or pellet-like stool on more than a quarter of occasions, or if you need to strain to open your bowels on more than a quarter of occasions, or if you experience a sense of incomplete emptying after a bowel opening.
There are three main physical causes for constipation;
One of the causes is where the muscles of the intestine and large bowel stop working properly; this results in slow movement of contents through the bowel down to the rectum (leading to a reduced urge to empty the bowel and hard stools). This is termed slow transit constipation and patients have an infrequent urge to go to the toilet.
Another type of constipation is called obstructed defaecation where the movement (transit) of the bowel is normal, but the person experiences symptoms of difficulty with emptying their bowel.
Patients may need to strain, and feel they cannot empty. There are some patients who have both slow transit and obstructed defaecation.
Finally, there is constipation-predominant Irritable Bowel Syndrome (IBS-C) when the person has difficulty with bowel opening and abdominal pain associated with not going. This type of
constipation can be made worse with stress or depression.
Most treatment is self-managed and based around dietary and lifestyle changes such as
consumption of high fibre diet, increased oral fluid intake to 2 litres of uncaffeinated fluid per day, regular exercise, establishing a daily toilet routine, and learning the correct toilet posture by leaning forward and use of a foot rest to keep knees higher than hips. Occasional use of laxatives is not harmful, but you should discuss regular use of laxatives with your doctor. Laxatives are best to be used with proper guidance. Suppositories or mini-enemas are more predictable than laxatives and tend to be very well tolerated and effective especially for people who have difficulty with needing to strain to evacuate their bowel.