Your GP will first advise you about how you can change your diet and lifestyle, which may mean that your constipation passes without the use of medication.
Some ways you can help treat your constipation include:
- Increase your daily intake of fibre. You should eat at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables and cereals.
- Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.
- Increase your fluid intake. Drink at least 1.2 litres (six to eight glasses) of fluid a day
- Get more exercise by going for a daily walk or run.
- If your constipation is causing pain or discomfort, you may want to take a painkiller such as paracetamol. Make sure you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin. Avoid codeine based medicines as they cause constipation.
- Identify a routine of a place and time of day when you are comfortably able to spend time in the toilet. Respond to your bowel's natural pattern: when you feel the urge, do not delay.
If these diet and lifestyle changes do not help, your GP or pharmacist may advise on an oral laxative.
Laxatives are a type of medicine that help you pass stools. There are several different types and each one has a different effect on your digestive system.
These laxatives work by helping your stools to retain fluid. This means they are less likely to dry out, which can lead to faecal impaction . Bulk-forming laxatives also make your stools denser and softer, which means they should be easier to pass.
Commonly used bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids. Also, do not take them before going to bed. It will usually be two to three days before you feel the effects of a bulk-forming laxative.
If your stools remain hard after you have taken a bulk-forming laxative, you may be advised to use an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. This helps to stimulate your body to pass stools and also softens stools.
Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be two to three days before you feel the effect of the laxative.
If your stools are soft but you still have difficulty passing them, you may be advised to use a stimulant laxative. This laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus.
The most commonly used stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they will usually start to work within 6 to 12 hours.
According to your individual preference and the speed with which you require relief, you may be advised to combine different laxatives.
Treating faecal impaction
Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.
If you have faecal impaction, you will initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative.
If you do not respond to these laxatives, you may need one of the medications described below.
- Suppository: this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl and glycerol are two medicines that can be given in suppository form.
- Mini enema: this is when a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.
Pregnancy or breastfeeding
If you are pregnant, there are ways for you to safely treat constipation without harming you or your baby. Your GP will first advise you to change your diet by increasing fibre and fluid intake. You will also be advised to do gentle exercise.
If dietary and lifestyle changes do not work, you may be prescribed a laxative to help you pass stools more regularly.
Lots of laxatives are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.
Laxatives that are safe to use during pregnancy include the bulk-forming laxatives lactulose and macrogols. If these do not work, your GP may advise a small dose of bisacodyl or senna (stimulant laxatives).
However, senna may not be suitable if you are in your third trimester of pregnancy (27 weeks to birth) because this medicine is partially absorbed by your digestive system.
Babies who have not yet been weaned
If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make the formula as directed by the manufacturer and do not dilute the mixture.
Adding sugar to feeds or water is no longer recommended as the infant’s metabolism is not able to deal with this sugar load.
You may want to try gently moving your baby's legs in a bicycling motion or carefully massaging their abdomen (tummy) to help stimulate their bowels.
Babies who are eating solids
If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pureed or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:
Note that banana and rice tend to aggravate constipation.
Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience.
If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this does not work, they can be prescribed a stimulant laxative.
As with babies and adults, children with constipation will first be advised to change their diet. If this does not work, laxatives can be prescribed, usually an osmotic laxative followed if necessary by a stimulant laxative.
As well as eating fruit, older children should have a well-balanced diet, which also contains vegetables and wholegrain foods such as wholemeal bread and pasta.
Try to minimise stress or conflict associated with using the toilet or meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet to make sure they have passed as many stools as possible.
To encourage a positive toilet routine, try making a diary of your child's bowel movements linked to a reward system. This can help them focus on using the toilet successfully.