GPAtlas🧭 When to suspect
Constipation is unsatisfactory defecation – infrequent stools, difficult or painful passage, or a sense of incomplete emptying.
It is best thought of as a symptom, not a disease, and what counts as "normal" varies widely (anything from three times a day to three times a week).
It is common, affecting roughly 1 in 7 adults, and is more frequent in women, older people, and during pregnancy.
First separate functional (primary/idiopathic) constipation – the large majority – from secondary constipation caused by a drug or an underlying condition.
The two clinical skills that matter in primary care are:
• Exclude red flags and reversible causes.
• Then treat with lifestyle measures and a titrated laxative.
Most cases need no investigation at all.
| Suspect constipation when two or more are present |
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• Fewer than three bowel movements per week |
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• Hard or lumpy stools – Bristol Stool Form Scale type 1–2 |
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• Excessive straining to pass stool |
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• Sensation of incomplete evacuation or anorectal blockage |
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• Need for manual manoeuvres (digitation, perineal support) to pass stool |
Symptoms persisting longer than three months define chronic constipation. New, persistent constipation in anyone over 50 – or at any age with weight loss, bleeding, or anaemia – needs active exclusion of malignancy before being labelled functional.
Source: NICE
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