Chronic Constipation
Chronic constipation is ongoing difficulty passing stool, hard stools, straining or a sense of incomplete emptying over several months.
Key takeaways
- Normal bowel frequency varies, so symptoms and difficulty matter more than a fixed number of weekly movements.
- Opioids, iron, anticholinergic medicines, low fluid intake and thyroid or neurological disease can contribute.
- Fibre, osmotic laxatives, stimulant laxatives and pelvic-floor therapy solve different problems and should be selected accordingly.
The listings below do not identify the constipation type; obstruction and alarm features need assessment before self-treatment.
Finding the mechanism
History covers stool form, straining, diet, medicines and whether manual manoeuvres are needed. Examination and tests are targeted to age and warning signs rather than routine for everyone. Difficulty coordinating pelvic-floor muscles may require anorectal testing and biofeedback rather than more laxative.
A stepwise approach
Increase fibre gradually when appropriate and maintain adequate fluid and activity. Polyethylene glycol or other osmotic agents soften stool; stimulant laxatives can increase bowel movement and have legitimate short- or longer-term roles under guidance. Opioid-induced constipation may need a specific preventive plan.
When to seek urgent care
Seek urgent care for severe or worsening abdominal pain, repeated vomiting, a markedly swollen abdomen, inability to pass stool or gas, black or bloody stool, fainting or unexplained rapid weight loss.