Constipation: Causes and 9 Ways to Get Relief

Everyone's bowel habits are different: anywhere from three times a day to three times a week can be normal. You're constipated if you're going less often than usual, or if your stools are hard, lumpy and difficult or painful to pass.

Common causes

• not eating enough fibre (refined flour, white rice and processed snacks have very little)
• not drinking enough fluids, especially in hot weather
• sitting for long hours and too little physical activity
• ignoring the urge to go, or a change in routine such as travel
• medicines including iron and calcium supplements, some antacids, strong painkillers and certain antidepressants
• pregnancy and the weeks after giving birth
• conditions such as hypothyroidism, diabetes and irritable bowel syndrome

9 ways to get relief

1. Increase fibre gradually. Good sources include whole wheat atta, millets (jowar, bajra, ragi), oats, dals and rajma, vegetables, fruit with the skin, and seeds such as flax and chia. Adding too much too fast causes gas.
2. Try isabgol (psyllium husk). A teaspoon in a glass of water or buttermilk is a gentle, well studied fibre supplement.
3. Drink enough water: fibre needs fluid to work. Use our water intake calculator.
4. Eat fruits that help. Prunes, kiwi, papaya, pears and guava all have good evidence or a long track record.
5. Move more. A 20 to 30 minute walk stimulates the bowel.
6. Set a routine. Try to go at the same time each day, ideally 15 to 30 minutes after breakfast, when the bowel is naturally most active.
7. Use a footstool. Raising your feet so your knees are above your hips (similar to an Indian style toilet posture) straightens the rectum and makes passing stool easier.
8. Don't strain or rush. Straining can cause piles and fissures.
9. Review your medicines with your doctor if constipation started after a new prescription.

When to use laxatives

If diet changes don't help within a week or two, a pharmacist or doctor may suggest:

• bulk forming laxatives (isabgol): start here
• osmotic laxatives (lactulose, polyethylene glycol): draw water into the bowel
• stimulant laxatives (bisacodyl, senna), for short term use

Avoid using laxatives every day for long periods without medical advice.

Constipation in children and older adults

Children often hold in stools after a painful experience; more fruit, water and a relaxed toilet routine help. In older adults, constipation is common with reduced mobility and multiple medicines: see our guide to caring for a bedridden patient.

When to see a doctor

Consult a doctor if constipation lasts more than three weeks, or you notice:

• blood in or on your stool, or black stools
• unexplained weight loss or tiredness
• severe belly pain, vomiting or a swollen abdomen
• a lasting change in bowel habit, especially if you're over 50