Constipation

• ABOUT CONSTIPATION

Constipation is when your bowel motions ('poo', stools or faeces) are infrequent / incomplete and you have trouble passing them because they are often dry and hard. Other signs you may be constipated are pain, cramps or swelling in the abdominal area or you leave the toilet feeling your bowel is not completely empty.

What causes constipation?

Common causes of constipation include:

• not eating enough fibre (fruit and vegetables, wholemeal bread, high fibre cereals)
• not drinking enough - always drink more when you increase fibre in your diet
• not doing enough exercise
• anxiety, depression, grief
• delaying the urge to go to the toilet 
• using laxatives for a long time
• the side effects of some medicines (even some common ones like pain killers or iron tablets)

You may also get constipation when you:

• are pregnant
• take certain medications such as pain killers or iron tablets
• have bowel problems such as haemorrhoids, irritable bowel syndrome (IBS) and diverticulitis
• have a medical condition such as Parkinson's, multiple sclerosis, diabetes
• have a slow transit bowel which means it takes longer for the faeces to travel along the bowel causing more water to be removed and therefore the faeces becomes harder and more difficult to pass

IMPACT ON THE BLADDER, BOWEL AND PELVIC FLOOR

Constipation and the bowel

Severe constipation is the most common cause of faecal incontinence (or bowel leakage), especially in older people. This is because hard bowel motions are difficult to pass and may cause a partial blockage high up the bowel, resulting in watery bowel motions flowing around the constipated stool without warning. This is sometimes mistaken for diarrhoea.

You can use the Bristol Stool Chart to check what your bowel motions should look like.

Constipation and the bladder

Constipation can affect bladder control and urinary continence. If you sometimes leak urine (wee) or feel that you need to frequently visit the toilet to pass urine, it could be that constipation is involved. An over-full bowel (due to constipation) can press on the bladder, reducing the amount of urine it can hold or making you feel like to need to pass urine urgently.

Constipation and the pelvic floor

Constipation can affect your pelvic floor muscles. Pelvic floor muscle strength is important for both bladder and bowel control. These muscles stretch like a trampoline from the pubic bone at the front to the coccyx (tail-bone) at the back. They can be weakened by straining due to constipation, pregnancy and childbirth, or perhaps heavy lifting. Strong pelvic floor muscles are necessary for bladder and bowel control - to be able to 'hold on'.

MANAGEMENT

Dietary tips for managing constipation

Try to drink at least 4-6 glasses of fluid a day and increase your fibre intake from a wide variety of foods. Fibre is classified as either soluble or insoluble. Most plant foods contain a combination of both types of fibre. Insoluble fibre such as wheat bran, wholegrain breads and cereal helps increase the dry weight and ability of bowel motions to hold moisture. Soluble fibre such as in fruits, vegetables and legumes help to soften the poo and make it easier to pass.

Processed foods such as biscuits, cakes, pastries and fast foods are generally low in fibre and will contribute to constipation. Fruit and vegetable juice contain little fibre and are not a good substitute for whole fruit and vegetables.

TREATMENT

The first step is to talk to your doctor

If you think you have constipation, talk to your doctor who can recommend some ways to help. Two common treatments that can be used are: