What causes constipation, and how can I look after myself?

Constipation usually comes down to everyday things: too little fibre, too little fluid, too little movement, holding it in when you need to go, or a change in routine such as travel. Simple things you can do yourself are to add fibre gradually, drink enough, walk every day and go to the toilet at a regular time. If that does not help, or you see blood in your stool, see a doctor.

Constipation is common. The NIDDK, part of the US National Institutes of Health, says about 16 in 100 adults have symptoms of constipation, rising to about 33 in 100 among adults aged 60 and older.

How many days without a bowel movement counts as constipation?

The UK's NHS and the NIDDK use similar signs. You may be constipated if any of these apply:

• fewer than 3 bowel movements in a week
• stools that are hard, dry or lumpy, or unusually large or small
• straining, or pain when you go
• feeling that you have not fully emptied your bowels

How often people go varies. Some go every day, others every other day, so it helps to compare with what is normal for you rather than only with other people. The NIDDK notes that constipation may last a short or a long time.

What causes constipation?

The NHS lists the common causes below, and the NIDDK notes that constipation may have more than one cause at a time.

Food and fluids

• not eating enough fibre, which is found in vegetables, fruit and cereals
• not drinking enough water and other fluids
• often eating foods with little or no fibre; the NIDDK gives examples such as chips, fast food, meat, frozen ready meals and processed foods like hot dogs

Moving too little and sitting too long

Not moving much, or sitting for long stretches, for example at a screen all day or on long journeys.

Toilet habits

Holding it in when you feel the urge, perhaps because you are in a hurry, do not like using toilets away from home, or the toilet is busy. The NIDDK lists ignoring the urge to go as one cause of constipation.

Changes in routine

Changes to your diet or daily routine, such as moving house, switching to shift work, or travelling. The NIDDK says plainly that constipation can happen when you travel (see the travel section below).

Other factors

• side effects of some medicines
• stress or anxiety
• pregnancy and the time after giving birth
• older age; the NHS notes it is more common in people over 65

Some health conditions can also cause constipation. If it keeps happening or comes with other symptoms, ask a doctor to look for the cause (see the last section).

What simple things can I do myself for constipation?

The NHS and NIDDK suggest starting with food, fluids, movement and toilet habits. They suggest keeping these habits up as part of your everyday routine.

Add fibre gradually

The Thai Reference Daily Intake (Thai RDI) for dietary fibre is 25 grams a day for the general population aged 3 and over. The NIDDK advises adding fibre a little at a time so your body gets used to the change.

• Choose whole grains, beans and lentils, vegetables, fruit and nuts. The NIDDK gives examples such as oatmeal, lentils, berries, broccoli and almonds, and the NHS suggests wheat bran, oats and linseed.
• The NHS suggests including fruits such as apples, apricots, grapes (and raisins), raspberries and strawberries.
• In Thai meals, swapping white rice for brown rice at some meals, or ordering extra vegetables with a one-plate dish, adds fibre without changing the menu. For more ideas, see How do you add fibre to a Thai diet?

Drink enough

The NHS advises drinking plenty of water and other fluids and avoiding alcohol. The NIDDK suggests water, naturally sweetened fruit and vegetable juices and clear soups alongside extra fibre. Drink more on hot days or when you sweat a lot.

Move every day

The NHS says a daily walk or run can help you go more regularly, and the NIDDK also recommends regular physical activity. If you sit at work all day, get up and walk now and then.

Set a toilet routine

• Go at a regular time and place, and give yourself plenty of time.
• Do not delay when you feel the urge.
• The NIDDK suggests trying 15 to 45 minutes after breakfast, because eating helps your colon move stool.
• The NHS and NIDDK suggest resting your feet on a low stool while on the toilet, and trying to relax your muscles.

What if it is not getting better?

How long it takes varies from person to person. If changes to diet and routine are not working, the NHS suggests asking a pharmacist, and it is best not to keep taking any medicine on your own without advice from a doctor or pharmacist.

I always get constipated when I travel. How can I avoid it?

Travel is one of the causes the NIDDK lists. On a trip, several of the things above change at once: when you wake and eat, what you eat, long hours sitting in a car or plane, drinking less so you do not need the toilet on the way, and holding it in because the toilets are unfamiliar. Avoiding it means taking the same basics with you.

Before you go

• In the days before you leave, keep eating vegetables, fruit and whole grains as usual rather than changing your diet suddenly.
• Plan time for the toilet after breakfast so you are not rushing out of your room.

On the way

• Carry a water bottle and sip regularly, especially on planes or in air-conditioned vehicles all day.
• On long car or plane journeys, get up and walk or stretch your legs when you can.
• Keep alcohol down, as the NHS advises.

At your destination

• Try to go at about the same time as at home, for example after breakfast.
• Do not hold it in when you feel the urge, even if the toilet is unfamiliar.
• Choose vegetables and fruit at each meal, such as a salad, stir-fried vegetables or fruit after a meal, rather than only fast food or snacks.
• Walk to explore instead of riding everywhere when you can.

If your bowel habits do not settle back to normal once you are home, or you have any of the symptoms in the next section, see a doctor.

When should I see a doctor about constipation?

The NIDDK advises seeing a doctor right away if you are constipated and have any of the following:

• bleeding from your rectum, or blood in your stool
• constant pain in your abdomen
• being unable to pass gas
• vomiting
• fever
• lower back pain
• unexplained weight loss

The NHS advises booking a GP appointment if:

• you are constipated and it is not getting better with self-care
• you are regularly constipated or regularly bloated
• you feel tired all the time along with constipation
• you think a medicine you take is causing it
• your bowel habits change suddenly
• you have tummy pain

If you are pregnant, older, or take medicines regularly, talk to a doctor or pharmacist before using anything for constipation.