Struggling with constipation? You’re not alone. Constipation is a very common condition that affects people of all ages, from young children to older adults. Understanding how your bowels work and what causes constipation can help you manage it effectively and get back to feeling your best.
How Do Your Bowels Work? Understanding the Digestive Process
Before we dive into constipation relief, it’s helpful to understand the normal digestive process.
The digestive journey begins in your mouth. Food and fluid are broken down through chewing and travel to your stomach, which breaks everything down into a liquid before it moves into the small intestine. The small intestine extracts the nutrients from food to keep us healthy and strong.
The waste, still in liquid form, travels into the large intestine (also called the colon). The colon’s important role is to draw water out of stool to make it a formed soft sausage – not liquid but not too lumpy.
The stool then enters the rectum and puts pressure on the anal sphincter, a circular band of muscles at the base of the rectum. This pressure sends a signal to your brain telling it that it’s time to have a bowel movement. You then decide whether to listen to these signals. If you do, the muscles relax, and the stool is evacuated.
What does healthy stool look like? A good stool consistency is like a soft sausage, smooth and easy to pass – this is Type 4 on the Bristol Stool Chart, which doctors use to assess digestive health.
What Is Constipation? Signs and Symptoms
Constipation is when a person passes hard, lumpy, and often large stool, typically less than once a day. If you’re experiencing painful bowel movements or straining to pass stool, you may be dealing with constipation.
What Causes Constipation?
Constipation occurs when:
- Dehydration: Too little fluid has been consumed, forcing the body to draw more water from the stool, making it harder and more difficult to pass.
- Low fibre intake: Not enough fibre in the diet. Fibre helps form the stool, soften it, and propel it along the gut—it’s essential for healthy digestion.
- Ignoring the urge: The urge to pass stool is ignored. After about 10 minutes, the urge to go passes, but the stool stays in the rectum and becomes harder.
Understanding the Constipation Cycle
These factors, either alone or together, cause hard and lumpy poo which can be painful to pass. When stool is painful to pass, the body remembers this and withholds stool. A “poo traffic jam” can build up, which stretches the rectum. Over time, people lose the urge to poop, causing further buildup of hard, firm stool and worsening constipation. A vicious cycle then develops.
Can constipation cause accidents? Yes. In some people, faecal accidents can occur as liquid poo slides past the hard poo and seeps into the underwear. People, especially children, are often unaware this has happened.
The Constipation Cycle: How It Starts and Why It’s Hard to Break
Understanding the constipation cycle is key to breaking free from chronic bowel issues. This cycle can affect anyone, but it’s particularly common in children and older adults. The medical term for this cycle is encopresis when it results in stool leakage.
The 5 Stages of the Constipation Cycle
Stage 1: Uncomfortable Defecation The cycle begins when passing stool becomes uncomfortable or painful. This might be due to pain from hard stool or avoidance because of a social event or unfamiliar bathroom. The discomfort creates anxiety about future bowel movements.
Stage 2: Holding Onto Stool Here’s what happens next: Your body remembers the pain. To avoid repeating the uncomfortable experience, the person (often unconsciously) begins holding onto stool and ignoring the urge to go. This is especially common in children who may withhold stool to avoid discomfort.
Stage 3: Increased Water Absorption in the Rectum When stool stays in the rectum longer than it should, the colon continues doing its job – absorbing water. The longer the stool remains, the more water is drawn out, making it progressively harder and drier.
Stage 4: Hardening of Stool As more water is absorbed, the stool becomes increasingly hard and lumpy. This makes it even more difficult and painful to pass, reinforcing the desire to hold on. A “poo traffic jam” builds up, and the problem worsens.
Stage 5: Increased Difficulty Passing Stool Now the cycle loops back to the beginning. The hard, large stool is even more uncomfortable to pass than before, strengthening the urge to withhold. And so the vicious cycle continues, with each rotation making the problem worse.
What Happens When the Cycle Continues
As the cycle repeats, serious complications develop:
Rectum Distension: The rectum becomes more and more distended (stretched) from the accumulating stool. This constant stretching damages the rectum’s ability to function normally.
Overflow Incontinence: In some cases, particularly in children, the buildup becomes so severe that liquid stool begins to seep around the hard, impacted mass. This is called “stool leakage” or overflow incontinence and causes faecal accidents where liquid poo slides past the blockage and leaks into underwear.
Loss of Rectal Sensation: The stretched rectum gradually loses sensitivity and can no longer send proper signals to the brain.
Loss of Urge to Defecate: People gradually lose the natural urge to poop. Without this signal, even more stools accumulates, becoming harder and larger.
Enlarged Intestines: Over time, chronic constipation can cause the intestines to become enlarged, further complicating the problem.
Difficulty Starting Bathroom Trips: The child or adult may develop significant difficulty initiating bathroom trips, creating behavioural challenges around toileting.
Breaking the Cycle
The good news? This cycle can be broken. The strategies outlined in this guide – proper hydration, adequate fibre, responding to urges, correct positioning, and when necessary, medical intervention – work together to reverse this process. With consistent application of these techniques, the rectum can gradually return to normal size and sensitivity, restoring healthy bowel function.
9 Proven Ways to Manage Constipation Naturally
- Drink Plenty of Water for Constipation Relief
How much water should you drink? Drink enough fluids so that your urine is a pale yellow, straw, or champagne colour. This means you’re sufficiently hydrated, and the body doesn’t have to take too much liquid from the stool. Proper hydration is one of the simplest and most effective natural remedies for constipation.
- Increase Your Fibre Intake
How much fibre do you need? Children aged 4-8 need 15-20g of fibre per day, progressing to adults who need 25-30g fibre per day.
Best high fibre foods for constipation:
- Beans and legumes
- Nuts and seeds
- Bran and wholemeal foods
- Fruits and vegetables, especially leafy greens, pears, and kiwifruit
Easy fibre tip: Little swaps like brown bread instead of white bread can quickly increase your fibre intake.
Bonus benefits of fibre: Fibre also has other health benefits, such as increasing the sense of fullness (helping with weight management), and reducing risks of diabetes and heart disease.
- Stay Active and Exercise Regularly
Physical activity helps constipation. Even a gentle walk each day can help keep your bowels regular and improve digestive function.
- Consider Laxatives When Needed
When should you use laxatives? Laxative medications can help keep stool soft and easy to pass. Talk to your doctor or pharmacist about these options to find the right treatment for your situation.
- Don’t Ignore the Urge to Go
When you feel the urge to go to the toilet, it’s important to listen and go. Delaying bowel movements can worsen constipation.
Tip for parents: For children, having toys to play with in the toilet can lessen the disappointment of leaving their other toys, making them less likely to defer.
- Use the Proper Toilet Posture
The right position can make a significant difference in how easily you pass stool:
- Elevate your knees higher than hips – This changes the angle of the rectum from being bent (good for continence) to being straight (better for elimination). Consider using a footstool.
- Relax your elbows on your knees – This relaxes the body and reduces straining
- Take a deep breath in and then say “MOOO” – This helps propel the stool easily by using the abdominal muscles in the correct pattern
- For kids: Blowing toys like bubbles and whistles have the same effect and make toilet time fun
- Try Abdominal Massage for Constipation
Gentle abdominal massage can help stimulate bowel movements and provide natural constipation relief.
- Be Aware of Other Factors That Affect Constipation
Several things can contribute to constipation:
- Medications: Some medications can affect movements through the bowel
- Travel: Changes in routine and diet can trigger constipation
- Stress: Periods of high stress can impact digestive function
- When to See a Pelvic Floor Physiotherapist
Pelvic floor physiotherapists specialise in bowel and bladder health. They can help with constipation and other issues related to defecation, providing personalised treatment strategies.
Take Control of Your Digestive Health
Constipation doesn’t have to be a constant struggle. By understanding how your bowels work and implementing these evidence-based management strategies, you can break the cycle and restore healthy bowel habits. Remember, if constipation persists despite these measures, consult with your healthcare provider to rule out underlying conditions.
Start today: Choose one or two strategies from this list and begin incorporating them into your daily routine. Your digestive system will thank you!
Need Professional Support?
If you need help managing constipation or have concerns about your bowel health, our pelvic health team is here to support you. We offer personalised assessment and treatment strategies to help you or your child achieve better digestive health.
Contact us today to learn more about how we can help.
This information is for educational purposes. Always consult with your doctor or healthcare provider for medical advice tailored to your individual situation.
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