Constipation

What it is

Slow-transit constipation is what most people assume: the colon moves contents along too slowly, so more water is absorbed and the stool becomes hard. Fibre, fluid and movement all help this version.

The second version catches people out. In dyssynergic defecation the pelvic floor and anal sphincter contract when they should relax, so pushing harder closes the exit rather than opening it. It affects a large minority of people with chronic constipation, and no amount of fibre fixes it - the treatment is learning to coordinate the pelvic floor, usually with a pelvic health physiotherapist.

What it feels like

• Fewer than three bowel movements a week, or a clear change from your own normal
• Hard, lumpy stools that are difficult to pass
• Straining for a long time, sometimes with no result
• A sense of incomplete emptying afterwards
• Bloating, abdominal discomfort and needing to press or manoeuvre to help

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Slow colonic transit

The colon's job is to move contents along and reabsorb water. When it moves slowly, more water is absorbed and the stool becomes hard and difficult - a self-reinforcing problem once it starts.

Paradoxical pelvic floor contraction

The puborectalis muscle and the anal sphincter must relax to let stool out. In dyssynergic defecation they tighten on straining instead, which physically closes the exit. This is common, under-recognised and does not respond to laxatives.

Inactivity

Physical activity stimulates colonic motility directly. Prolonged sitting and bed rest slow it measurably, which is why constipation is near-universal in hospital.

Low fibre and low fluid intake

Fibre adds bulk and holds water in the stool. Without adequate fluid alongside it, however, increasing fibre can make things worse rather than better - the two go together or not at all.

Ignoring the urge

The urge to go passes if it is not acted on, and the rectum adapts to being full. Repeatedly delaying - at work, on a journey, in an unfamiliar toilet - progressively blunts the signal.

Medications

Opioids are the most powerful cause and produce constipation in almost everyone taking them. Iron, some antidepressants, calcium channel blockers and antacids containing aluminium all contribute.

Toilet posture

Sitting at ninety degrees keeps the puborectalis muscle looped around the rectum, maintaining a kink. Raising the knees above the hips straightens it, which is a genuine mechanical improvement rather than a fad.

Dehydration

The colon reabsorbs water in proportion to how much the body needs. Poor fluid intake means harder stool by design, and it undermines every other measure.

Pregnancy and hormonal change

Progesterone relaxes smooth muscle including the gut, and later pregnancy adds mechanical pressure. Constipation is one of the most common complaints across pregnancy.

Underlying conditions

Underactive thyroid, diabetes, Parkinson's disease and, importantly, bowel cancer all cause constipation. A persistent change in bowel habit in an adult, especially with bleeding or weight loss, needs assessment rather than a laxative.

Who tends to get it

• Older adults, in whom it is very common and often medication-related
• Anyone taking opioid painkillers, in whom it is close to universal
• Pregnant women
• People with a sedentary job or limited mobility
• Anyone who habitually delays going, which includes most shift workers and many carers

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineDigestion & Gut Comfort

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Blood in stool; unexplained weight loss; new constipation after 50; alternating with diarrhea - refer

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Slow-transit constipation usually responds within two to four weeks to movement, fibre, fluid and posture. If it does not, the pelvic floor version is likely and it needs a different treatment: biofeedback and pelvic floor retraining with a specialist physiotherapist, which is highly effective and rarely offered because the mechanism is rarely recognised. A persistent change in bowel habit, bleeding, unexplained weight loss or a new onset over the age of about fifty needs medical assessment first.

Prevalence basis: Systematic review of population studies

Others the same routine covers

These share the Digestion & Gut Comfort routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.