Constipation
Also called: hard stools, difficulty passing stools, chronic constipation, functional constipation
Constipation means passing stools less often than usual, or stools that are hard, dry and difficult to push out. It is very common and usually gets better with more fibre, fluids and activity, sometimes with a short course of laxatives. See a doctor if you notice blood or weight loss.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Constipation is when you open your bowels less often than normal, or when your stools (poo) are hard, dry or lumpy and painful to pass. Many people describe it as straining, or feeling that the bowel has not fully emptied. Doctors often use a simple guide: fewer than three bowel movements a week is a common sign. Not everyone needs to go every day, so a change from your own usual pattern matters more than a fixed number.
Almost everyone is constipated now and then, usually for a short time and without harm. It becomes chronic (long-term) when symptoms keep coming back for several months. It is more common in women, in pregnancy and after childbirth, and in older people. Children get it too, and it is one of the most common bowel problems in childhood.
Most constipation is caused by everyday things: too little fibre in food, not drinking enough, sitting or lying down for long periods, ignoring the urge to go, or a change in routine. Some medicines, such as strong painkillers and iron tablets, are common causes. Less often, an illness such as an underactive thyroid or, rarely, bowel cancer is behind it. Simple diet and lifestyle changes help many people. If they do not, a pharmacist or doctor can suggest a suitable laxative (a medicine that helps you pass stools).
In Pakistan
A study in Karachi found functional constipation in about half of hospital patients and their attendants and in a third of medical students. Low fibre intake and lack of physical activity were the main risk factors, and many of those affected were already using laxatives.
Symptoms
- Passing stools less often than usual, often fewer than three times a week
- Hard, dry or lumpy stools that may be very large or very small
- Straining or pain when passing stools
- A feeling that the bowel has not fully emptied after going to the toilet
- A feeling of blockage in the back passage, sometimes needing to press or help with a finger to pass stool
- Tummy ache, bloating or feeling sick
- In older people or those with dementia, confusion or a change in behaviour may be a sign of discomfort
- Runny stool leaking around a hard blockage, which can be mistaken for diarrhoea
Causes and risk factors
Causes
- Not eating enough fibre (fruit, vegetables, whole grains) or not drinking enough fluids
- Not moving enough, or sitting or lying down for long periods, for example during illness or after surgery
- Ignoring the urge to go, or changes in diet, travel or daily routine
- Side effects of medicines such as opioid painkillers, iron and calcium tablets, some antacids, some antidepressants and some blood pressure medicines
- Stress, anxiety or depression
- Medical conditions such as an underactive thyroid, diabetes, Parkinson's disease, stroke, problems with the pelvic floor muscles or, rarely, bowel cancer
What makes it more likely
- Being female
- Pregnancy and the weeks after childbirth
- Being over 65 years old
- A diet low in fibre and low fluid intake
- Lack of physical activity
- Taking medicines that slow the bowel, such as opioid painkillers or iron
- Long-term illness that limits movement, or nerve and muscle conditions
- Stress, anxiety or depression
Complications
Most short episodes cause no lasting harm. Long-term straining and hard stools can lead to haemorrhoids (piles), anal fissures (small painful tears in the skin of the back passage) and rectal prolapse, where part of the lower bowel slips out through the anus. Stool can build up and harden in the rectum, called faecal impaction; a common sign is runny stool leaking around the blockage, and it may need stronger treatment or removal by a health professional. Long-term constipation can also cause loss of bowel control, trouble passing urine and damage to the pelvic floor. Very rarely, hard stool can cause an ulcer or a tear in the bowel wall. Ongoing symptoms can greatly affect quality of life.
When to see a doctor
- Blood in your stools or bleeding from the back passage
- Weight loss that you cannot explain, or ongoing tiredness
- A sudden change in your usual bowel habit that does not settle, especially with a family history of bowel cancer
- Constant or severe tummy pain, or a lump in the tummy
- Vomiting with a swollen, tight tummy and being unable to pass stool or wind: get emergency help, as the bowel may be blocked
- In a newborn baby, no first stool within 48 hours of birth, or in a child, a very swollen tummy with vomiting or new weakness in the legs: see a doctor urgently
- Constipation that does not improve with treatment or keeps coming back
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Diagnosis
Constipation is usually diagnosed from your story. The doctor asks how often you go, what your stools look like (often using a chart of stool shapes called the Bristol Stool Form Scale), whether you strain, and which medicines you take. They examine your tummy and may, with your permission, examine the back passage with a gloved finger to look for hard stool, piles, tears or a lump. Doctors also look for warning signs. In children, guidelines say routine tests are not needed to diagnose ordinary constipation.
Tests are used only in some cases. A blood count may be checked if there is bleeding, and a thyroid test if diet changes do not help. A tummy X-ray can show stool building up or a blockage. A colonoscopy (a camera test of the large bowel) is done when there are warning signs such as bleeding or weight loss. If constipation lasts for months despite treatment, specialist tests can measure how the back passage muscles work (anorectal manometry) or how fast stool moves through the bowel (transit study).
Treatment
- Start with diet and lifestyle: slowly add more fibre, drink plenty of fluids, keep active, and go to the toilet as soon as you feel the urge at a regular time each day.
- Review your medicines with your doctor or pharmacist, because some painkillers, iron tablets and other medicines can cause constipation. Do not stop a prescribed medicine on your own.
- If these changes are not enough, a pharmacist or doctor can suggest a laxative. A fibre supplement or an osmotic laxative (one that draws water into the bowel to soften stool) is often tried first. Most laxatives work within a few days. Your doctor decides the dose and how long to use it.
- A stimulant laxative, which makes the bowel muscles push stool along, may be added for a short time or used as a rescue when other laxatives have not worked.
- If stool is stuck hard in the rectum (faecal impaction), the doctor may use stronger laxatives, a suppository or a small enema, or remove the stool. Do not try to remove it yourself.
- For long-term constipation that does not respond to pharmacy laxatives, a specialist may prescribe newer medicines that help the bowel move or hold more water, or refer you for pelvic floor therapy and biofeedback (training to use the bowel muscles correctly).
- Children need a laxative together with diet changes and a regular toilet routine, often for weeks or months. The doctor will reduce it slowly rather than stopping it suddenly.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Osmotic laxatives | Usually first choice when diet changes are not enough; they soften stool by holding water in the bowel. Polyethylene glycol (macrogol) is strongly recommended for long-term use in adults and is the first choice for children; lactulose is another option | Polyethylene glycol 3350 + Sodium chloride + Sodium bicarbonate + Potassium chloride (2 brands), Lactulose (74 brands) |
| Stimulant laxatives | Make the bowel muscles push stool along; used for short courses or as a rescue when other laxatives fail, and added in children when an osmotic laxative alone does not work | Bisacodyl (10 brands) |
| Bulk-forming laxatives (fibre supplements) | Add bulk and water to stool; can help people who cannot get enough fibre from food. They work best with plenty of fluids | Chosen by your specialist |
| Specialist medicines for chronic constipation | Prescribed by a doctor when pharmacy laxatives have not worked; they help the bowel move faster or draw more water into it | Chosen by your specialist |
| Peripherally acting opioid antagonists | Used for constipation caused by opioid painkillers when ordinary laxatives are not enough; they block the effect of opioids on the bowel without stopping pain relief | Chosen by your specialist |
Also used (not yet in our price list): Ispaghula husk (psyllium), Senna, Sodium picosulfate, Magnesium oxide, Prucalopride, Linaclotide, Plecanatide, Lubiprostone, Methylnaltrexone, Naloxegol, Naldemedine
Self-care and prevention
Self-care
- Increase fibre slowly, with foods such as whole grains, oats, pulses, fruit and vegetables, to avoid wind and bloating
- Drink plenty of fluids through the day, and limit alcohol
- Fruits such as apples, grapes and strawberries contain natural sugars that can help soften stool
- Be active every day, for example a daily walk
- Keep a regular toilet time and place, give yourself enough time, and do not delay when you feel the urge
- Rest your feet on a low stool while on the toilet so your knees are higher than your hips
- Use pharmacy laxatives only for a short time unless your doctor advises otherwise, and ask a pharmacist or doctor before using them in pregnancy
Prevention
- Eat a balanced diet with enough fibre every day
- Drink enough fluids every day
- Stay physically active
- Do not ignore the urge to open your bowels
- Ask your doctor or pharmacist whether any of your medicines can cause constipation
Common questions
How often should I pass stools?
There is no single normal number, and you do not need to go every day. Fewer than three times a week, or a clear change from your usual pattern with hard stools or straining, suggests constipation.
Are laxatives safe to use?
Most pharmacy laxatives are safe for short-term use and work within a few days. Some, such as polyethylene glycol, can be used for longer under medical advice, while stimulant laxatives are usually kept for short courses. If you need laxatives often, see a doctor to look for the cause.
Is constipation common in pregnancy?
Yes, it is common during pregnancy and after childbirth. More fibre, fluids and gentle activity are safe to try. Ask a pharmacist or doctor before taking any laxative while pregnant.
How is constipation treated in children?
Guidelines say diet changes alone are not enough to start with. Children usually need a laxative, most often polyethylene glycol, together with more fluids, high-fibre foods, activity and a regular toilet routine. Treatment often continues for weeks or months after things improve and is reduced slowly.
When is constipation a sign of something serious?
Most constipation is not serious. See a doctor if you have blood in your stools, unexplained weight loss, ongoing tummy pain or a sudden change in bowel habit. Get emergency help if you are vomiting, your tummy is swollen and you cannot pass stool or wind.
Sources
- NICE. Constipation in children and young people: diagnosis and management (CG99) - Recommendations (n.d.).
- American College of Gastroenterology. AGA-ACG Clinical Practice Guideline on Chronic Idiopathic Constipation Treatments: Parsing Benefits and Risks (2023).
- NHS. Constipation - NHS (2023).
- MedlinePlus. Constipation | MedlinePlus (2025).
- StatPearls (NCBI Bookshelf). Constipation - StatPearls - NCBI Bookshelf (2023).
- Journal of the Pakistan Medical Association. Frequency of functional constipation in 3 different populations and its causative factors (2011).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Irritable bowel syndrome (IBS)Piles (haemorrhoids)Underactive thyroid (hypothyroidism)