With 1 in 3 of us failing to spot we're constipated, what are the lesser-known signs of constipation?

Experts are calling for a new definition of constipation to help people recognise the symptoms [Photo: Getty]

Most of us would assume we’d be able to tell if we were constipated, but new research has revealed the way people define constipation isn’t actually correct.

Constipation is where you have difficultly opening or emptying your bowels, and passing stools.

Affecting one in seven people, it’s actually really common but doctors and the public often don’t agree on the symptoms of constipation.

And this means sufferers aren’t always getting the correct advice or treatment that they need.

The study, by Kings College London and published in the American Journal of Gastroenterology, found that the public's perception of constipation differs from that of doctors and official diagnosis guidelines.

Researchers collected data from 2,557 members of the public (of which 934 had self-reported constipation), 411 GPs and 365 gastroenterology specialists.

They found that of those who self-reported constipation, 94% met the formal diagnostic criteria.

Surprisingly, however, of the 1,623 who did not self-report constipation, 29% met these criteria too.

This means that nearly one in three "healthy" patients were, therefore, clinically constipated but did not recognise it.

What is constipation?

“Constipation is a really common problem seen in general practice. It describes difficulty opening the bowels and passing faeces (or stools),” explains Dr Sonal Shah, NHS GP and lifestyle medicine expert.

“It can make people feel very uncomfortable, bloated, cause abdominal pain and pain around the anus when a bowel motion is finally passed. Chronic constipation can give rise to haemorrhoids and rectal bleeding.”

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What are the symptoms?

According to Dr Kevin Barrett from the Primary Care Society for Gastroenterology (pcsg.org.uk) the signs of constipation vary from individual to individual.

“Having a poo less often than normal is the main sign, but there is no clear definition of how often we should be going - for some people normal is once or twice a week, for others it is two or three times a day.”

Dr Barrett says doctors get concerned about constipation when there is a change in how often people go, particularly in those aged over 60, although a persistent change at any age may need evaluation.

“Bloating, discomfort, pain, rectal bleeding, feeling full, reduced appetite, headaches, mood changes and lethargy can all result from constipation,” he adds.

What causes it?

Constipation can be caused by a number of different reasons.

“Most commonly it occurs when your diet is lacking in fibre, the substance needed to add bulk to your stool,” explains Dr Shah.

Other causes include being dehydrated, medications (particularly painkillers like codiene), pregnancy, those suffering with irritable bowel syndrome.

Dr Barrett says that genetics can also play a part, so a family history of "slow bowels" could also be considered a potential cause.

“Underlying medical conditions such as multiple sclerosis or cerebral palsy can make constipation more likely,” he adds.

Coelaic disease also often results in constipation, and while Irritable Bowel Syndrome and Crohn's Disease or Ulcerative Colitis often give diarrhoea, they can also lead to constipation.

“Cancer is something that is important to consider, and NICE NG12 gives clear guidance about who should be referred when constipation occurs to exclude bowel cancer,” Dr Barrett continues.

“And sometimes ovarian cancer can trigger constipation, so doctors are advised to consider this as a possibility in women aged over 50 who develops symptoms of irritable bowel syndrome for the first time,” he adds.

How often should we be going to the loo?

According to Dr Shah there is no specified number of times someone should open their bowel.

“It can vary between person and person, some open their bowels daily and others every few days, it is when this regular pattern is disrupted with associated difficulty that we say they are constipated.”

People are confused about the symptoms of constipation [Photo: Getty]

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Ways to reduce the risk of constipation

Dr Shah says the best way to avoid constipation is to eat a diet that is rich in fruits and vegetables, as this will ensure that you are consuming enough fibre.

“Ideally people need to eat at least 30g of fibre a day,” she says. “The best sources of fibre are fruits like apples, plums and apricots and vegetables such as peas, broccoli and carrots.

“I often tell patients to try eating dried apricots or dates to get their bowels going.

“Drinking water regularly will also help,” she adds.

Dr Barrett also recommends upping our fibre and H2O intake.

“Once a new underlying condition has been excluded, the answer to being constipated is usually the same advice that helps many other symptoms - eat more fibre, drink when we feel thirsty, and be more physically active,” he says.

He also recommends having a discussion with your doctor about the medication as there may be alternatives that may be more appropriate.

“Laxatives have a place, and there are many types to chose from, as well as newer medication that can help treat the symptoms of opioid-induced constipation where a reduced dose or alternatives may not be suitable,” he adds.

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Do we need a new definition of constipation?

As a result of their findings the team of researchers at Kings College London are calling for a new definition of constipation, which may help people recognise the symptoms more easily.

They say this list of six groups of symptoms could help form a new definition of constipation:

  • abdominal discomfort, pain and bloating - clothes not fitting as well as usual

  • rectal discomfort - bleeding from pushing too hard, pain or burning sensation in the anal area

  • infrequent bowel movements and hard stools - normal can range from three times a day to three times a week

  • sensory dysfunction - not having the urge to go or a sense of incomplete evacuation

  • flatulence and bloating - noisy or smelly wind

  • faecal incontinence - uncontrolled leakage or rectal bleeding

“People assume that unless they are straining or opening their bowels infrequently they can't be constipated, however constipation causes lots of other associated symptoms such as abdominal bloating, rectal pain and rectal bleeding,” explains Dr Shah.

“This confusion in diagnosis means that patients may wait before they see their doctor, leading to a delay in diagnosis and treatment.

“For most constipation is straightforward and easily managed but for some it may be a symptoms of inflammatory bowel disease or bowel cancer, so having a broader definition list will hopefully help patients come forward sooner.”