Constipation occurs when the muscle action in the large bowel or colon is not fully effective, making the waste more difficult to eliminate from the body. It is a condition where bowel emptying is less frequent than is normal for the particular individual, the stools may be hard and small, or where passing a stool can cause pain.

The symptoms of constipation include painful, difficult bowel movements and feeling gassy or bloated. Other signs include hard, dry stools or excessive straining to pass a bowel movement. Tummy pain, or a feeling of incomplete emptying of the bowel, are also common symptoms.

Constipation can in fact be one of the most common causes of diarrhoea in older people. What happens is that a hard plug of stool in the lower bowel prevents a full bowel movement and only a runny stool can be passed.

Women are also more prone to constipation because bowel movements can be influenced by hormonal changes, particularly during pregnancy and menopause. However, infrequent bowel movements alone do not necessarily indicate constipation.

Constipation is generally diagnosed when someone has fewer than three bowel movements a week, and/or stools are hard and dry. There are remedies available in the pharmacy but if your condition gets worse or recurs, a visit to the doctor is recommended.

Signs that there might be a more serious problem include:

• Finding blood or mucus in the stools
• Experiencing severe pain during bowel movement.

Where there is blood or mucous associated with constipation, or it alternates with diarrhoea, your doctor may want to undertake certain investigations to rule out more serious problems. Some may need to be done in a hospital clinic. These include:

• A rectal examination
• A stool sample to test for blood
• Blood tests to check for dehydration or anaemia and other medical problems
• A barium enema to assess whether there may be bowel problems
• A sigmoidoscopy or colonoscopy investigation

What causes constipation?

Constipation can occur when the normal muscle action in the large colon (large intestine) fail to work properly. What happens then is that the contents of the bowel cannot be eliminated normally.

The causes of constipation are complex and for many people with long-standing constipation there may be no identifiable cause. However, the causes of constipation may be one of the following:

• Poor general health
• Lack of exercise
• Not enough fluids
• A diet too low in fibre
• Poor toilet facilities, which discourage people from going to the bathroom
• Recovery from surgery
• Changes in routine
• Hormonal changes

In addition, there are a number of illnesses and medicines that are linked to constipation. Where there is blood or mucus in association with constipation or it alternates with diarrhoea, medical advice is essential.

Illnesses include:

• Irritable bowel syndrome
• Under-active thyroid gland
• Bowel cancer
• Kidney failure
• Spinal injury
• Multiple sclerosis
• Too much calcium in the blood

Haemorrhoids

Constipation and prolonged straining when using the toilet may lead to haemorrhoids. Haemorrhoids are small, blood-filled swellings which are caused by dilated varicose veins. They occur just inside the anus but can sometimes stick out.

Haemorrhoids are not dangerous but can be very uncomfortable and can be treated by products available at your pharmacy which will ease the pain and soreness.

When haemorrhoids occur it is important to avoid straining when passing a bowel movement. Some laxatives may help relieve the pain and discomfort of going to the loo by making the stools softer and more easily passed.