Definition
Constipation is a common digestive disorder characterized by infrequent or difficult bowel movements, typically fewer than three per week. It may be accompanied by a feeling of incomplete evacuation or discomfort.
Pathogenesis
Constipation can be functional or organic. Functional factors include reduced bowel motility, diets low in fiber, and insufficient fluid intake. Organic causes may include obstructive disorders, neurological conditions, or medications that slow intestinal motility.
Diagnosis
Diagnosis is primarily based on medical history and physical examination. Criteria such as the Rome IV criteria aid in diagnosing functional constipation. Laboratory tests, endoscopy, or imaging methods are used to identify organic causes.
Treatment
Treatment involves lifestyle changes, such as increasing fiber and fluid intake and regular exercise. In persistent cases, laxatives or medications to stimulate bowel motility are recommended. For organic causes, the underlying condition is treated. Medical monitoring is important to avoid complications like hemorrhoids or fissures.
Key figures: The normal range is 3 times a day to 3 times a week. Constipation is defined as fewer than 3 bowel movements per week. Around 25 to 30 grams of fibre daily is recommended, increased gradually and with adequate fluid. New onset constipation after 45 to 50 warrants colonoscopy.
New onset constipation after the age of 45 warrants colonoscopy. Chronic straining also contributes to the formation of diverticula.
- Normal range: 3 times a day to 3 times a week
- Constipation: fewer than 3 bowel movements per week
- Fibre target: 25 to 30 g daily, increased gradually
- New onset after 45 to 50 warrants colonoscopy
Frequently asked questions
How often is it normal to open the bowels?
The normal range is wide, from 3 times a day to 3 times a week. Daily bowel movements are not required for health. What matters alongside frequency is stool consistency, the effort needed and whether a sense of incomplete evacuation remains.
When is colonoscopy needed?
When constipation is new after the age of 45 to 50, or at any age if accompanied by blood in the stool, weight loss, iron deficiency anaemia, narrower stools or nocturnal symptoms. A family history of colorectal cancer is also an indication. Without such features, initial management does not require endoscopy.
Are laxatives harmful?
Osmotic laxatives are considered safe even for long term use and are the first choice. Stimulant laxatives are used as an adjunct rather than a permanent solution without medical supervision. The essential step is to establish why the constipation is there, so that a problem needing different treatment is not simply masked.
Sources
- National Health Service, Constipation. https://www.nhs.uk/conditions/constipation/
Content last updated: September 2026 (14/09/2026).
