How to relieve constipation

Constipation is a common problem that can affect anyone at any time. While it’s usually temporary, chronic constipation can be uncomfortable and disruptive. This article will explore what constipation is, its causes, natural remedies, prevention methods, and treatment options. We’ll also answer some common questions about constipation to help you better understand and manage this condition.

There is no correct number of times to open your bowels, some people normally go more than once a day and others only go a few times a week. What matters more is whether your bowel habit has changed and whether passing the stool has become difficult or uncomfortable.

The range that gets quoted in every textbook, three times a day to three times a week, comes from a single British study published in the BMJ in 1965. Connell and colleagues surveyed two population samples and found fewer than 1% of healthy people went less often than three times a week. This is now sixty years old and was done in one country, and our knowledge has changed a lot since the study was done.

The clinical definition doesn't rest on frequency alone. The Rome IV criteria, which is what is used these days, look for two or more of the following: straining, hard or lumpy stools, a feeling that you haven't fully emptied, a sensation of being blocked, needing to help things along physically, or fewer than three bowel movements a week.^[1]

You can still be constipated despite going every day if you are only passing small, hard pieces, straining heavily or repeatedly leaving the toilet feeling that there is more to come. Equally, someone who normally opens their bowels every two or three days and passes a soft, formed stool without pain or straining may not need a laxative at all.

When choosing a treatment you shouldn't be looking for "the strongest" laxative; you should be asking yourself, is the stool hard? is it soft but not moving? does it feel stuck? The answers to these will actually tell you which type of laxative is most likely to help.

Two people can be suffering from constipation but with very different symptoms and problems that need solving. One person could be trying to pass dry, solid stool and the other may have soft stool but it doesn't want to move. 

Your constipation may fit into multiple categories, but the consistency is what will provide the most useful starting point. 

Your stool is hard, dry or comes out in pellets.

If you are passing separates, hard pellets, one large lumpy stool or something is painful to push out, your stool probably needs softening first. This is best done using an osmotic laxative such as macrogrol (Laxido, Movicol etc.) and lactulose, these work by causing more water to enter the bowel, softening the stool and making them easier to pass. These can take a few days to work and it is important to make sure you are drinking enough water. 

A stimulant laxative like senna or bisacodyl will cause your bowel contract but as the stool is dry, could cause cramping and make it very uncomfortable to pass the dry stool. They can be taken alongside a stool softener to help the stool out once it has been softened.

Your stool is soft but it won't come out.

If your stool is already soft but is stuck, a stimulant laxative like senna and bisacodyl that encourage the muscles of the bowel to contract are the best here. They work quite quickly in around 6-12 hours. These will also be the best if you feel like your bowels aren't fully emptying after going to the toilet. Persistent difficulty emptying your bowels should be discussed with your GP.

If it feels as though the stool is stuck near the bottom.

Sometimes the urge to go is present and it feels as though the stool has reached the rectum, but it will not come out. In this case suppositories are your best option. Bisacodyl suppositories work in around 10 to 45 minutes, much faster the tablets.

You are passing watery stool but still feel constipated.

Watery stool does not always mean that the constipation has cleared.

With faecal impaction, a build-up of solid stool sits in the rectum while liquid stool leaks around it. This can look like diarrhoea even though the underlying problem is severe constipation. Other clues can include ongoing bloating, a persistent feeling of blockage, small amounts of leakage or having been constipated for several days beforehand.

Do not automatically take an anti-diarrhoea medicine such as loperamide when you still feel constipated or your abdomen is swollen. If you think you are suffering with faecal impaction, discuss your symptoms with your GP, 111 or a pharmacist.

The different types of laxatives all work in different ways. So which ones you use and if you need more than one will depend on the type of constipation you are suffering with. 

They fall into four groups bulk-forming laxatives, osmotic laxatives, stool softeners and stimulant laxatives. Suppositories and enemas act directly in the rectum and are usually considered separately because they work much more quickly than oral treatments.

Bulk-forming laxatives.

If your constipation is mild, it is the one you should likely start with. They take a while to work and you must drink it with the amount of water stated on the leaflet, too little fluid can cause the mixture to swell before it passes properly and may make constipation worse. They will increase your stools bulk by absorbing liquid increasing the size and softeness of the stool, the extra bulk then helps trigger the bowel to move it along. They shouldn't be used if you are suffering from constipation caused by opioids (codeine, morphine etc.), where there is suspected intestinal obstruction or faecal impaction, abdominal pain or if you have nausea and vomitting.

Macrogols. 

Macrogol is an osmotic laxative, they work by keeping water in the bowel making the stools softer and easier to pass. If you are passing dry, pellet-like or firm stools, this is a good option as it can help soften the stools rather than just making the bowel contract.

These will not work instantly, they can take two to three days to work, so don't expect to take one sachet and get instant results.

Lactulose.

Like macrogol it is an osmotic laxative, it works in the same way by drawing water into the bowel and softening the stool and again takes a few days to work.

Senna and bisacodyl tablets.

Senna and bisacodyl are stimulant laxatives and work by encouraging the muscles lining the bowels to contract and move the stool towards the rectum. If your stools are already soft but is moving slowly or your find it find it hard to pass, they can be a good option.

They work in around 8-12 hours, and this makes people think they are "stronger" laxatives, but they are performing a different job and using them if you are struggling with dry or pellet like stools, can cause pain when passing. 

They can cause urgency, stomach cramps and diarrhoea and cramps, and should only be used short term as  excessive use can cause diarrhoea, dehydration and disturbances in the body’s salt levels.

Docusate.

Docusate is classed as a stool softener. It allows more water into hard stool, making it softer and easier to pass. It can be particularly useful where straining needs to be avoided, such as when hard stools are aggravating piles or an anal fissure

Glycerol and bisacodyl suppositories.

Suppositories act directly in the rectum, so they are generally much faster than a sachet, syrup or tablet that must pass through the digestive system.

Glycerol suppositories melt inside the rectum, where they lubricate and soften the stool while mildly stimulating the lower bowel. Retain the suppository for at least 15 to 20 minutes if possible because it will not work immediately, and they are intended for occasional constipation rather than continuous daily self-treatment.

Bisacodyl suppositories provide a stronger local stimulant effect and normally work within 10 to 45 minutes. Because the result can be sudden, it is sensible to remain close to a toilet after using one.

Rectal treatments may be practical when there is a definite urge to go and the stool feels as though it is sitting near the bottom. They are less likely to solve constipation where stool remains higher in the bowel.

By far the most common reason we see for a laxative failing, is that it hasn't been given enough time to work. People take a dose of lactulose or a laxido sachet and expect it to work within a few hours or overnight, when it doesn't they assume the treatment hasn't worked and then go and get another laxative before the first one had a chacne to work. 

This can cause side effects like cramps, urgency or even going the other way and cause diarrhoea when they all begin at once.

The next most common problem is taking the wrong laxative for the job. Read above and make sure you are taking the correct laxative if it doesn't seem to be working for you.

Not taking it correctly or consistently is another common issue. For example, taking one dose of lactulose whenever the constipation becomes uncomfortable and then stopping because nothing happened that evening is unlikely to give it enough time to soften the stool. Similarly, frequently forgetting Fybogel or macrogol doses can make it difficult to judge whether the treatment is helping.

Macrogol sachets need to be dissolved in the stated amount of water. For standard adult Movicol, Laxido and similar full-strength sachets, this is commonly around 125 ml, although you should follow the instructions for the exact product you have. The water used to prepare macrogol does not replace your normal fluid intake, so you should continue drinking normally while taking it.

Fybogel also needs to be mixed correctly. A sachet is usually added to at least 150 ml of water, stirred and drunk straight away before it thickens. You must also drink enough fluid during the day. Taking ispaghula husk with too little liquid can make constipation worse and, rarely, contribute to an obstruction.

Fybogel also needs to be mixed correctly. A sachet is usually added to at least 150 ml of water, stirred and drunk straight away before it thickens. You must also drink enough fluid during the day. Taking ispaghula husk with too little liquid can make constipation worse and, rarely, contribute to an obstruction.

A laxative may provide temporary relief without correcting whatever is continuing to slow the bowel.

Common examples include:

1. Regularly taking codeine, co-codamol or another opioid.
2. Taking iron tablets or another constipating medicine.
3. Eating or drinking very little because of illness.
4. Reduced mobility.
5. Repeatedly ignoring the urge to open your bowels.
6. An ongoing medical condition affecting bowel movement.

If the cause remains, the constipation may return as soon as the laxative is stopped. This does not necessarily mean that you need an increasingly strong laxative; it may mean that the cause and longer-term treatment need reviewing.

A dramatic bowel movement is not the only sign that a laxative is working. A treatment may first make the stool softer, reduce straining or allow you to pass a larger amount than before without producing sudden urgency.

Passing liquid stool is also not proof that the constipation has been completely cleared. Diarrhoea may be a side effect of taking too much laxative, but watery stool can also leak around impacted stool while a blockage remains.

The short answer is yes. But two doesn't automatically mean they will work better than one. One laxative that fits the job will usually be enough. Two may be recommended where the stool needs to be both softened and help moving through the bowel. 

The choice of the laxatives should be done carefully and two of the same class is very rarely done. Instead it is usually a two laxatives that perform different jobs e.g. an osmotic (lactulose) and stimulant laxative (senna). But do not add them too quickly or without consulting a pharmacist or doctor first as they can cause  side effects if done incorrectly or for the incorrect reasons. 

Yes, fibre can help constipation, but “eat more fibre” is incomplete advice. Fibre is more useful for preventing or managing mild, recurring constipation than it is as an instant way to clear a hard stool that already feels stuck. The type of fibre, how much you take and whether you drink enough alongside it all make a difference.

UK adults are advised to aim for around 30 g of fibre a day as part of a healthy, balanced diet. That is a useful target for general health, but it does not mean that suddenly eating a large bowl of bran will fix every case of constipation. Increasing fibre too quickly can leave you with considerably more wind, bloating and discomfort before it provides any benefit.

The 2025 British Dietetic Association guidelines reviewed 75 randomised trials of dietary treatments for chronic constipation. ^[3] Surprisingly, the researchers could not make a recommendation for an overall high-fibre diet because only one randomised trial had properly assessed a whole-diet approach. Most of the direct evidence was for individual foods or fibre supplements rather than simply advising people to eat more fibre from any source. I am no telling you that eating fruit, vegetables, pulses and wholegrains is pointless or that a balanced high-fibre diet cannot help. It means that the evidence is more specific than the advice commonly given.

Drinking enough fluid matters, particularly if you are dehydrated or increasing the amount of fibre in your diet. However, water is not a laxative in its own right, and forcing down several extra litres is unlikely to clear established constipation if you were already drinking enough.

When the body is short of fluid, less water is available to remain in the stool, which can leave it harder and more difficult to pass. Correcting that dehydration may help. But once you are adequately hydrated, there is little evidence that continually increasing your fluid intake will make the bowel work better. The British Dietetic Association advises that increasing fluid further has not been shown to prevent constipation in somebody who is already well hydrated.^[4]

A laxative may clear one episode of constipation without addressing what caused it. If the same problem returns as soon as you stop treatment, the answer may not be another laxative. Something may still be slowing the bowel, drying the stool or making it difficult to empty properly.

Common reasons constipation keeps returning include:

1. Taking a medicine that slows the bowel.
2. Regularly eating or drinking very little.
3. Reduced mobility.
4. Ignoring the urge to open your bowels.
5. Changes in routine, including travel, illness or starting a new diet.
6. Irritable bowel syndrome.
7. Difficulty coordinating the muscles used to empty the rectum.
8. Medical conditions that affect the bowel or the nerves controlling it.

Constipation is also more likely during pregnancy and after childbirth, and in conditions such as diabetes, Parkinson’s disease and following a stroke.

Medicines are an easily missed cause. If your constipation started shortly after starting a new medicine, increasing a dose or beginning to take something more regularly it could be the cause.

Medicines commonly associated with constipation include:

1. Codeine, co-codamol, tramadol, morphine and other opioid painkillers.
2. Iron and calcium supplements.
3. Some antidepressants.
4. Some antipsychotics.
5. Medicines with anticholinergic effects.
6. Some antacids containing aluminium or calcium.
7. Some medicines used for blood pressure or heart conditions.
8. Weight-loss injections such as Mounjaro and Wegovy.

This is not a complete list, and constipation may result from the combined effect of several medicines rather than one obvious culprit. Do not stop a prescribed medicine without speaking to the prescriber. They may be able to adjust the dose, change the treatment or recommend a suitable laxative plan.

Opioid constipation deserves particular attention because the medicine continually slows movement through the bowel. Someone taking codeine or morphine regularly may therefore become constipated again whenever their laxative is stopped.

This includes commonly used products such as:

1. Co-codamol.
2. Codeine tablets or liquid.
3. Tramadol.
4. Morphine.
5. Oxycodone.
6. Buprenorphine.

Established opioid-induced constipation is not usually managed by simply adding more bulk to the stool. NICE advises against bulk-forming laxatives such as Fybogel in opioid-induced constipation and instead recommends offering an osmotic laxative together with a stimulant laxative. In practice, that may mean softening the stool with macrogol while also using something such as senna to help move it.

Constipation is a recognised side effect of both tirzepatide and semaglutide. It may become more noticeable after starting treatment or increasing the dose, particularly if reduced appetite also means that you are eating and drinking less.

In the weight-management trials for Wegovy 2.4 mg, constipation was reported by 24.2% of people taking semaglutide compared with 11.1% taking placebo. Unlike nausea and vomiting, which were generally short-lived, constipation was described as lasting longer. Constipation is also listed as a very common side effect of Mounjaro when it is used for weight management.

Speak to your GP if:

1. Your constipation is not improving despite using an appropriate treatment correctly.
2. You are regularly constipated or bloated.
3. You regularly need laxatives to open your bowels.
4. You have blood in your stool.
5. You have lost weight without trying.
6. You feel persistently tired.
7. You have ongoing abdominal pain.
8. You have noticed a sudden or persistent change from your normal bowel habit.
9. You think one of your prescribed medicines is causing the problem.

These symptoms do not necessarily mean that something serious is wrong. Blood may come from piles or an anal fissure, for example, and changes in bowel habit have many possible causes. However, persistent bleeding, unexplained weight loss, tiredness or a lasting change in how often you open your bowels should be assessed rather than repeatedly covered up with laxatives.

Seek urgent medical help rather than taking another laxative if you have:

1. Severe or worsening abdominal pain.
2. Persistent vomiting.
3. A significantly swollen or increasingly distended abdomen.
4. An inability to pass either stool or wind.
5. Heavy or continuous bleeding from the rectum.
6. A large amount of blood or blood clots.
7. Black or dark-red stools.
8. Severe pain accompanied by feeling faint, confused or seriously unwell.

Severe abdominal pain together with vomiting, swelling or an inability to pass wind can be a sign of bowel obstruction. Continuing to add fibre or laxatives without assessment may delay the treatment you actually need.