Common GI Symptoms

Common GI Symptoms > Constipation and You

Constipation And You

What is Constipation?
Constipation is a common problem with more than 10% of adults complaining of constipation.

Constipation is defined by infrequent bowel movements, typically <3 per week.

Patients may complain of the following associated symptoms:

  • Hard stools
  • Small stools
  • Abdominal discomfort
  • Bloating and distension
  • Excessive straining
  • A feeling of incomplete evacuation
  • A sense of anorectal blockage during defecation
  • Need for manual manoeuvres during defecation

What are the causes of constipation?
There are many causes of constipation that may range from dietary to drugs, to more worrisome conditions such as cancer of the colon:

Causes of Constipation

  • Poor diet: Deficient of fibre, or insufficient water intake
  • Drugs: anti-histamines, anti-spasmodics, iron supplements, anti hypertensives anti-depressants, anti-psychotics
  • Irritable bowel syndrome (IBS)
  • Diseases of the colon (stricture, cancer, anal fissure, proctitis)
  • Metabolic disturbances (hypercalcemia, hypothyroidism, diabetes mellitus)
  • Neurologic disorders (parkinsonism, spinal cord lesions)

When to seek medical advice?
Worrisome features that require early medical attention include:

  • Bleeding from your backpassage (anus) after passing motion
  • Unexplained Weight loss
  • Progressive pain in abdomen and/or perianal region
  • Fever
  • Weakness
  • Your symptoms are new or not normal for you
  • The problem lasts longer than 3 weeks
  • A family history of colorectal cancer or inflammatory bowel disease

How would your doctor evaluate your constipation?
Your doctor would start by taking a detailed history and perform a physical examination to evaluate your constipation. The physical examination usually involves the doctor performing a rectal examination with a glove finger to evaluate for any masses.

Your doctor may then order a series of investigation (if relevant):

  • Blood tests: e.g a thyroid panel, electrolytes such as calcium levels
  • Colonoscopy or CT colonography (see relevant page)
  • Anorectal Manometry, defecography: these tests evaluate the coordination and strength of the muscles involved in passing motion.

What can I do to help my constipation?
Firstly, daily bowel movements are NOT the norm or necessary for health. If you feel the urge to pass motion, go to the bathroom to open your bowel, don’t hold your motion unnecessarily.

Dietary changes that may help with constipation include:

  • Increasing the amount of dietary fibre to approx. 25-40g/day (see the section on dietary fibre)
  • Increasing water intake: 6-8 cups/day

What other interventions may my doctor prescribe?
Depending on the underlying cause of your constipation, your doctor may prescribe:


  • Fibre 20-35g/day eg psyllium, methylcellulose
  • Laxatives:
    • Osmotic agents: Lactulose, macrogol, polyethylene glycol (PEG)
    • Stimulant laxatives: Bisacodyl, Senna
    • Enemas: E.g sodium phosphate enemas

Biofeedback: these are techniques that teach patients to re-train and coordinate the muscles involve in passing motion to allow patients to pass stool more easily