Constipation in adults

🔍 When to Suspect

Bowel movements <3 times per week, with hard, lumpy stools (Bristol Stool Form Scale Type 1-2), excessive straining, or a feeling of incomplete evacuation

From the full topic in The Ocean Library: Constipation in adults

🧭 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.

The single most useful split is functional (primary/idiopathic) constipation – the large majority – versus secondary constipation caused by a drug or an underlying condition. The two clinical skills that matter in primary care are therefore: 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
• Fewer than three bowel movements per week
• Hard or lumpy stools – Bristol Stool Form Scale type 1–2
• Excessive straining to pass stool
• Sensation of incomplete evacuation or anorectal blockage
• 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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