Why am I constipated?

Constipation happens when stools remain in the large intestine for too long. The large intestine absorbs water from the stool, making them hard and dry, which then makes them hard to pass.

If you have constipation, you may experience one or more of the following symptoms:

• Lack of a regular bowel movement (going for a poo fewer than three times a week)
• Your stool is often large and dry, hard or lumpy
• You are straining or in pain when you pass a bowel movement

Bowel movements are essential as they allow the body to eliminate waste, and while everyone is different, research indicates that it’s normal to poo between three times a week and three times a day.

Stool consistency is also another factor in whether you may be constipated or not. Your stools should be soft and easy to pass, and ideally be sausage or snake-shaped, as this reflects the shape of your intestines. If your stools appear pellet-like or very lumpy and hard to pass, it may be a sign you are constipated.

Constipation may also be accompanied by other symptoms such as bloating, stomach ache, nausea and even loss of appetite.

Find out more about gut health including what to eat for better digestion and our gut-friendly recipes.

What causes constipation?

There can be several reasons why you may be constipated, and these include:

• Dehydration
• Not eating enough fibre
• Inactive or sedentary lifestyle
• Ignoring the urge to go to the toilet or holding a bowel movement in
• Certain medications such as painkillers, antidepressants or antihistamines
• Certain supplements such as iron tablets
• Stress and anxiety
• Neurological conditions such as Parkinson’s disease and multiple sclerosis
• Hormonal fluctuations, especially during pregnancy and menopause

How does diet affect constipation?

Your diet plays a key role in healthy bowel movements, in particular getting enough fluids and fibre.

Ensuring adequate hydration levels throughout the day helps to soften the stools, thereby making them easier to pass. Water and herbal teas are the most beneficial, while keeping caffeine, sugary drinks and alcohol to a minimum. Some people find that a cup of coffee can stimulate a bowel movement, but caffeine can also be dehydrating, and if you struggle with long-term constipation, is probably best avoided.

Fibre, in particular insoluble fibre, has been shown to help those who are constipated as it helps to increase the weight of the stool as well as increase bowel motility. Fibre also helps the large intestine retain water, making the stools less dry and easier to pass.

However, in some cases – and particularly those with chronic constipation – adding more fibre to the diet may in fact make things worse and reducing your fibre intake instead could help. Speak to your GP if you’re concerned.

Foods that may help constipation

Here are some of the top foods that can help ease constipation:

1. Prunes – prunes contain pectin and polyphenols that have been shown to help ease constipation.
2. Kiwi – kiwi fruit is high in fibre and has been shown to help ease constipation with just two kiwis a day.
3. Apples – apples are a rich source of fibre and also contain pectin which may help increase weight to the stool and speed its passage through the intestine.
4. Psyllium husks – 1 tbsp of psyllium husks twice a day has been shown to help ease constipation and improve bowel regularity.
5. Spinach – not only is spinach a good source of fibre and water, but it also contains magnesium. Collectively these can all help ease constipation.

Foods that may cause constipation

While one single food is unlikely to cause constipation, there are general foods that may play a contributing factor:

1. Alcohol – alcohol can be dehydrating which may contribute to constipation.
2. White bread – white bread and other low-fibre grains may contribute to constipation for some.
3. Milk – dairy can be a common cause of constipation for some, especially children, which may be due to a sensitivity to a protein that is found in cow’s milk.
4. Sugar – diets high in sugar and low in fibre may contribute to constipation.
5. Fried foods – diets high in saturated fats have been shown to contribute towards constipation.

How do I relieve constipation?

Diet and lifestyle recommendations

There are a few diet and lifestyle changes you should try first to ease constipation. These changes are considered more beneficial in the long-term, over a few weeks or longer, rather than using a quick fix to constipation.

• Stay hydrated – making sure you are drinking plenty of fluids during the day and minimising fizzy drinks, caffeine and alcohol.
• Increase fibre – start adding more fruits and vegetables, pulses and wholegrains to your meals.
• Get moving – increasing your daily movement through activities such as walking or other forms of exercise may be an effective solution to easing constipation.
• Improve your toilet routine – keeping to a regular time and place, and going when you need to go, can make it easier to pass a bowel movement.

Over-the-counter remedies

If you find diet and lifestyle changes haven’t helped, then you may want to speak to a pharmacist and consider an over-the-counter remedy such as laxatives.

• Stimulant laxatives – these may contain ingredients such as bisacodyl, senna or sodium picosulfate, and they help stimulate the nerves that control the muscles lining your digestive tract, encouraging your colon muscles to move the stool along.
• Stool softener laxatives – such as arachis oil and docusate sodium, which increase the fluid content of hard, dry stools, making them easier to pass.
• Suppositories – suppositories are also available for adults who struggle with occasional constipation. They typically contain glycerin and are inserted into the rectum, acting as a mild laxative.
• Lactulose oral solution – an ‘osmotic laxative’, it can help relieve constipation by drawing water into the large intestine and into the stool, helping to soften it.
• Fibre tablets or sachets – there are several different fibre chewable tablets or sachets that contain soluble fibre and make help ease constipation.

Can constipation be serious?

Long-term constipation can start to cause additional problems, including faecal impaction where stools build up in the rectum, the last part of the large intestine. Others may experience symptoms such as haemorrhoids or anal fissures which aren’t necessarily serious but can cause pain and discomfort.

You must talk to your GP if you struggle with constipation and experience any of the following:

• You have blood in your stool
• Your constipation is not getting better with time or treatment
• Unintentional weight loss
• You feel bloated or tired all the time

The bottom line…

Whilst constipation is a common digestive complaint for some, for many it should be short-lived and ease with changes to diet and lifestyle. It is worth making changes to your diet and lifestyle first, and finding out what may be causing your constipation, before seeking medical advice. However, if none of that works and you struggle with chronic constipation, then speak to your GP.

Further reading:
How much fibre should I eat every day?
How to stay hydrated
Gut health: what does it really mean?