Constipation: Manage at Home or Be Seen?

Key takeaways

Per NIDDK, how often people pass stool differs from person to person and only you know what is normal for you. The measure is «less often and harder than usual», not a number.
Per NIDDK, constipation is not a disease in itself but can be a symptom of something else. Most of it can be managed at home; a smaller share is a sign that has to be seen, and that group can be recognised.
Be seen straight away if constipation comes with: bleeding from the back passage or blood in the stool, constant abdominal pain, being unable to pass wind, vomiting, fever, pain in the lower back, or unintended weight loss — NIDDK's list.
Per MedlinePlus, using senna regularly or continuously can make you dependent on laxatives and can stop the bowel working normally. Shop-bought «laxative teas» are usually exactly that.
If you suspect a medicine you are taking is causing the constipation, tell the prescribing doctor; do not stop it yourself: both NIDDK and NHS say not to change or stop a prescribed medicine without asking a qualified professional first.

Most bouts of constipation are a matter of diet and daily routine and can be dealt with at home. But per NIDDK, constipation is not a disease in itself — it can be a symptom of something else. The job is to tell those two groups apart.

Recognising it: compare with yourself, not with other people

Do not count against a number you heard somewhere. Per NIDDK, how often people pass stool differs from one person to another and only you know what is normal for you; per MedlinePlus, constipation is when you are not passing stool as often as you usually do.

Passing stool markedly less often than usual; stool dry, hard, lumpy, or unusually large or small. Straining hard or pain on passing, a feeling of not having finished, possibly with abdominal pain, bloating or queasiness — per NHS.
Per NHS, long-standing constipation can cause stool to become impacted in the last part of the large bowel, and the main sign of impaction is DIARRHOEA — liquid stool seeping past the hardened mass. If somebody is both bloated for days and passing liquid stool, do not give them something to stop the diarrhoea.
Per NHS, in older people and in people with cognitive conditions, constipation is very easily missed: watch for changes in behaviour such as being more confused than usual, because that may be how they are telling you they are in pain.

What to do now

Increase fibre, but INCREASE IT GRADUALLY — per NHS, build it up slowly; add wheat bran, oats or linseed, and eat fruit containing sorbitol such as apples, apricots, raisins and strawberries. Drink enough fluid and avoid alcohol (NHS); per NIDDK, if you add fibre you must drink more fluid.
When you feel the urge, go; do not hold on: NIDDK, NHS and MedlinePlus each mention this separately.
Practise going at a set time, with enough time set aside — per NIDDK, try after breakfast, because eating makes the colon move stool along. Rest your feet on a low stool so the knees are higher than the hips (NHS); relax the muscles rather than straining hard (NIDDK).
A daily walk helps keep things regular. Per NHS, the measures above are safe in pregnancy, and it can take several days to several weeks before things improve.

What you must NOT do

Do NOT use laxatives on your own over a long period: per NHS, these should only be used for a short time, and you should ask a pharmacist which one to choose.
Do NOT treat «laxative tea» or «slimming tea» as harmless. If the label says senna leaf, that is a medicine: per MedlinePlus, senna is a stimulant laxative, and using it regularly or continuously can make you dependent on laxatives.
Do NOT give yourself an enema — per NHS, once stool is impacted, removing it is a job for a qualified professional.
Do NOT stop or change a prescribed medicine yourself: NIDDK says directly not to change or stop any medicine without telling a qualified professional. And if you cannot pass stool without a laxative, do NOT cut it out abruptly either — ask a doctor how to reduce it gradually.
Do NOT take a laxative while there is constant abdominal pain, vomiting or an inability to pass wind — per NIDDK that is the moment to be seen straight away. All the more so if the pain is settling into the lower right abdomen and building: see the article on appendicitis.

Constipation caused by medicines: the group most often missed

Many cases of persistent constipation have their cause sitting right there in the medicine box. Take the box along and tell the prescribing doctor: per NIDDK, they may be able to change the dose or change the medicine. The list below follows NIDDK, with opioids named specifically by NHS.

Opioid painkillers and narcotic painkillers.
Antacids containing aluminium and calcium.
Anticholinergic medicines, antispasmodics and anticonvulsants.
Calcium channel blockers; diuretics; iron supplements.
Medicines for Parkinson's disease; some medicines for depression.

When you must go to hospital

GO FOR EMERGENCY CARE or call 115 (the emergency number in Vietnam) NOW if the abdomen is tight and distended, the pain is severe, and the person can neither pass stool nor pass wind, with vomiting as well — that points towards a bowel obstruction. — BE SEEN STRAIGHT AWAY, do not wait until tomorrow, if constipation comes with ANY of the signs on NIDDK's list: bleeding from the back passage; blood in the stool; constant abdominal pain; being unable to pass wind; vomiting; fever; pain in the lower part of the back; weight loss you did not intend. — BE SEEN WITHIN 24 TO 72 HOURS if: you have changed your diet and routine with no improvement; the constipation keeps coming back; you feel tired all the time; you are taking a medicine that causes constipation; there has been a sudden change in the way you pass stool — NHS's list of reasons to see a doctor. Per NIDDK, you should also be seen if the symptoms do not clear despite self-care, or if a family member has had colon cancer or rectal cancer.

Per the US CDC, constipation is on the list of symptoms of colorectal cancer — CDC states plainly that this disease does not always cause symptoms, which is why screening is recommended from the age of 45, and that if you do have symptoms you should tell a doctor, because they may have another cause.

We give advice by video call when it is not clear whether you need to be seen — though not for somebody who is drowsy or having seizures; a doctor visiting the home examines the patient, says clearly which cases must be admitted, and arranges tests if they are needed. Our medication review service goes through what you are taking and points out duplicated active ingredients; we do not sell medicines and we do not change a medicine on your behalf. If any sign in the box above is present, go in first and call afterwards.

This article passes on the recommendations of NIDDK, the United Kingdom's NHS, MedlinePlus and the US CDC, and does not replace being examined. CDC has no separate community page on constipation, so the CDC material here covers only colorectal cancer. This article is written for adults; we do not take on paediatric care, and MedlinePlus warns against giving a child laxatives or an enema without asking the child's doctor first. Citing CDC does not imply that CDC endorses us.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

NHS — Constipation
CDC — Colorectal Cancer Basics

Frequently asked questions

How many days without passing stool counts as constipation?

There is no figure that is right for everybody. Per NIDDK, how often people pass stool differs from one person to another, and only you know what is normal for you; per MedlinePlus, constipation is when you are not passing stool as often as you usually do. Rather than counting, look at this: is it markedly less often than usual, is the stool dry and hard and difficult to pass, and is any sign from the red-flag box above present. One sign from that box means being seen, even if it has only been a day.

Is there any harm in taking a laxative every day to keep things moving?

Ask a pharmacist or a doctor first. Per NHS, laxatives should only be used for a short time; per NIDDK, the stimulant group is only for severe constipation or when other approaches have not worked. Per MedlinePlus, senna in particular, used regularly or continuously, can make you dependent on laxatives and can stop the bowel working normally. If you have already reached the point of not being able to pass stool without the medicine, do not simply cut it out: NIDDK advises talking to a doctor about reducing it gradually.

I am on painkillers after surgery and I am constipated — should I stop the medicine?

Do not stop it yourself. NIDDK says directly not to change or stop any medicine or supplement without telling a qualified professional, and NHS likewise says to ask a doctor before stopping a prescribed medicine. The right thing to do is tell the prescribing doctor that you are constipated — per NIDDK they may change the dose or switch you to something else. Opioid painkillers are the group NHS names specifically, so if your prescription includes one, it is all the more worth mentioning early.

I was constipated for days and now suddenly have loose stools — does that mean it is over?

Not necessarily, and this is the situation most easily handled wrongly. Per NHS, long-standing constipation can lead to stool becoming impacted in the last part of the large bowel, and the main sign of impaction is in fact diarrhoea: liquid stool seeping past the hardened mass inside. If the abdomen is still bloated and still feels as though there is stool that has not come out, yet the stools are loose, then giving something to stop the diarrhoea makes matters worse. Be seen — per NHS, once stool is impacted, removing it is a job for a qualified professional.

What do I do about constipation in an older relative who is bedbound?

Three things, in order. Do not miss it: per NHS, in older people and in people with cognitive conditions constipation is very easily overlooked, so watch for changes in behaviour such as being more confused than usual. Go through the medicine box, because this group often takes several medicines and NIDDK lists a good many that cause constipation. And get them moving: NHS puts lying or sitting for long periods among the commonest causes, so changing position and exercises done in bed are part of the treatment, not a side issue.

Is constipation a sign of cancer?

It can be, but it is not the first possibility. Per NHS, constipation can be caused by a condition such as diverticular disease or bowel cancer, but this is uncommon; the usual causes are too little fibre, too little fluid, too little movement, holding on when you feel the urge, a change of diet or routine, a side effect of medicine, and stress and anxiety. Per the US CDC, the list of symptoms of colorectal cancer includes constipation, blood in or on the stool, a change in bowel habits, abdominal pain that does not go away, unexplained weight loss and low iron in the blood — and CDC states plainly that those symptoms may have another cause, so tell a doctor.