Constipation

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Symptoms Causes Diagnosis Treatment Prevention FAQ

Constipation is a condition where bowel movements become less frequent, and stools become hard, dry, or difficult to pass.

It may cause discomfort, bloating, and a sense of incomplete evacuation. While occasional constipation is common, persistent or chronic constipation may require medical evaluation to determine the cause and appropriate management.

Symptoms of Constipation

Symptoms can vary in severity, but constipation is generally associated with difficulty passing stools and abdominal discomfort.

Infrequent bowel movements

Having fewer than three bowel movements per week is a common sign of constipation. This may cause a sensation of fullness, discomfort, or the need to strain more than usual.

Hard or lumpy stools

Stools may become dry, compacted, and difficult to pass. They may appear as small, hard pellets or irregularly shaped lumps.

Straining during bowel movements

Increased effort is required to push stools out, sometimes leading to pain, pressure, or a prolonged time on the toilet.

Sensation of incomplete evacuation

Even after passing stools, there may still be a lingering feeling that the bowel is not fully emptied, leading to repeated trips to the toilet.

Abdominal bloating or discomfort

A sense of tightness, swelling, or mild cramping in the abdomen may occur, often worsening after meals or prolonged constipation.

Reduced stool volume

Stools may become smaller or less frequent than usual, sometimes requiring more effort to pass despite the urge to defecate.

Causes and Risk Factors

Constipation can result from a combination of diet, lifestyle habits, medical conditions, and certain medications.

Low-fibre diet

Fibre helps stools retain water, keeping them soft and easier to pass. A diet lacking in fruits, vegetables, and whole grains can lead to harder stools and less frequent bowel movements.
Inadequate fluid intake

Not drinking enough water or fluids can make stools dry and compacted. This may slow bowel movements and make passing stools more difficult.
Lack of physical activity

Reduced movement can slow down bowel function and digestion. This is more common in individuals with a sedentary lifestyle, limited mobility, or prolonged bed rest.
Ignoring the urge to pass stools

Delaying bowel movements can lead to stool retention. Over time, stools may become harder, making them more difficult to pass.
Certain medications

Some painkillers, antidepressants, iron supplements, and calcium channel blockers can reduce bowel movement frequency. These medications may slow intestinal contractions or affect stool consistency.
Hormonal changes

Pregnancy, thyroid disorders, and other hormonal conditions can slow digestion and delay bowel movements, increasing the likelihood of constipation.
Underlying medical conditions

Conditions such as irritable bowel syndrome (IBS), diabetes, and neurological disorders can disrupt normal bowel function. These conditions may affect nerve signals, muscle coordination, or digestion speed.
Colorectal disorders

Structural issues such as strictures, rectal prolapse, or tumours can partially or fully block the passage of stools. This may cause persistent constipation and require medical evaluation.

Diagnostic Methods

Medical history and physical examination

Diet, bowel habits, fluid intake, and medication use are reviewed to identify factors affecting bowel function. A physical examination, including an abdominal and rectal exam, may assess stool retention, muscle tone, and any structural abnormalities.

Blood tests

These can help identify conditions such as thyroid disorders, diabetes, or electrolyte imbalances. Abnormal results may suggest an underlying medical cause affecting bowel function.

Stool analysis

A stool sample may be tested for signs of infection, inflammation, or hidden blood. These findings can indicate digestive conditions such as infections, malabsorption issues, or bleeding from the gastrointestinal tract.

Colonoscopy or sigmoidoscopy

A thin, flexible tube with a camera is inserted into the colon to examine for structural abnormalities, inflammation, strictures, or growths such as polyps or tumours. A sigmoidoscopy focuses on the lower part of the colon, while a colonoscopy evaluates the entire colon.

Anorectal manometry

This test measures the strength and coordination of the anal sphincter and rectal muscles. It helps assess whether muscle dysfunction is contributing to constipation, particularly in cases of pelvic floor disorders.

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Treatment Options

Treatment for constipation depends on its cause and severity, with most cases managed through lifestyle changes and medical treatments.

Dietary and lifestyle changes

A fibre-rich diet that includes fruits, vegetables, and whole grains can improve stool consistency and promote regular bowel movements. Drinking adequate fluids prevents stools from becoming too dry, while regular physical activity helps stimulate intestinal function.

Laxatives

Bulk-forming, osmotic, and stimulant laxatives may be used based on symptoms and response to other treatments. Bulk-forming laxatives absorb water to soften stools, osmotic laxatives draw water into the intestines to ease passage, and stimulant laxatives promote bowel contractions. These should be taken as directed to prevent overuse.

Stool softeners

These help retain moisture in stools, making them easier to pass without excessive straining. They are commonly used for short-term relief in cases where stools are particularly hard or dry.

Most cases of constipation do not require surgery. However, if a structural condition such as a stricture, rectal prolapse, or tumour is causing persistent or severe symptoms, further evaluation may be needed to determine whether a surgical approach is appropriate.

Prevention and Management

A balanced diet with sufficient fibre, adequate hydration, and regular exercise can help regulate bowel movements. Establishing a routine for passing stools and responding to natural urges may also prevent constipation. If symptoms persist despite lifestyle adjustments, a doctor can evaluate underlying causes and suggest additional treatment options.

Dr Calvin Ong Jianming

Senior Consultant, Colorectal & General Surgeon

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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