Chronic Constipation

If you feel like you're constantly battling bloating and discomfort, you aren't alone. In Australia, roughly 1 in 4 adults suffer from chronic constipation. As a dietitian, I know that "normal" is a wide range, but "comfort" is non-negotiable.

In this guide, we’ll break down what constitutes a healthy bowel movement, the red flags you shouldn't ignore, and how to get things moving again.

What is Constipation?

Constipation is more than just "not going." It is a clinical condition where you experience difficulty passing stool, often involving straining, hard textures, or a sense that you haven't fully emptied your bowels.

Common Symptoms of Constipation

• Stool Consistency: Hard, dry, lumpy "pebbles" (rabbit or sheep droppings).

• Frequency: Opening your bowels fewer than three times per week.

• Straining: Spending more than a few minutes on the toilet pushing to get anything to pass.

• Blockage: The physical sensation that there’s a physical blockage or obstruction.

• Incomplete Evacuation: Feeling like poo is remaining despite passing stool.

• Physical Discomfort: Abdominal pain, bloating, nausea, and even heartburn.

• Manual Support: Needing to use fingers or toilet paper to assist in evacuation.

WHAT Does a “Normal” Poo Look Like?

Many people worry unnecessarily about their habits. Use the checklist below to see if your digestive health is on track.

The Healthy Stool Checklist:

• Shape: Like a sausage with cracks (Type 3) or a smooth, soft snake (Type 4) on the Bristol Stool Scale.

• Frequency: Anywhere from 3 times per day to 3 times per week is considered "normal."

• Effort: Should be passed easily without significant straining or pain.

• Colour: Shades of brown are ideal.

When is it Abnormal?

You should take note if your stool is:

• Consistently liquid (diarrhoea)

• Extremely hard (Types 1-2)

• A strange colour (black, red, pale/clay, or green).

🚩Red Flag Symptoms: When to See a GP

While constipation is often dietary, sometimes it is a symptom of something more serious. Please consult your doctor immediately if you experience:

• Unexplained weight loss or fever.

• Blood in the stool or rectal bleeding.

• Waking up at night specifically to pass stool.

• A sudden, persistent change in bowel habits after age 50.

• A family history of bowel cancer or Inflammatory Bowel Disease (IBD).

Why am I Constipated? (Common Causes)

Constipation is rarely caused by just one thing. It is usually a combination of:

1. Dietary Factors: Low fibre intake, inadequate fluid, or not eating enough food.

2. Lifestyle: Lack of movement, "withholding" (ignoring the urge), or high stress levels.

3. Medications: Opioids, certain blood pressure meds, and iron or calcium supplements.

4. Medical Conditions: Diabetes, hypothyroidism, or neurological issues like Parkinson’s.

The Rome IV Diagnostic Criteria

Clinically, the Rome IV criteria is used to diagnose specific types of constipation, such as IBS-C (where pain is a primary factor) or Functional Constipation (where the focus is on the mechanics of passing stool).

8 Dietitian Tips FOR CONSTIPATION relief

1. Rule Out the Serious Stuff: See your GP first to ensure there is no underlying obstruction.

2. Hydrate, Hydrate, Hydrate: Fibre needs water to work; without it, fibre can actually make constipation worse!

3. Get Enough Fibre: Make sure you’re getting enough fibre, slow is steady.

4. Start Moving: Physical activity stimulates the natural contractions (peristalsis) of your gut.

5. Use a "Squatty Potty": Elevating your knees above your hips straightens the anorectal angle for an easier exit.

6. Don't Ignore the Urge: "Poo fright" or avoiding opening your bowels can lead to stool becoming harder in the colon.

7. Relaxation: The gut and brain are connected; high stress can "shut down" digestive motility.

8. Consult a Gut Health Dietitian: If you've tried it all, you may need a personalised support and dietary advice to help relieve constipation.

Read Other Gut Health Articles

• IBS Symptoms & Management Guide I Dietitian & Nutritionist

• How Are Farts Made? I Dietitian & Nutritionist

• What's a Normal Poo? I Dietitian & Nutritionist

• Lactose Intolerance | Gut Health I Dietitian & Nutritionist

• Going Gluten-Free? Read This I Dietitian & Nutritionist

References

1. Barberio, B., Judge, C., Savarino, E. V., & Ford, A. C. (2021). Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis.The Lancet Gastroenterology & Hepatology, 6, 8, p638-648.

2. Judkins, C. P., Wang, Y., Jelinic, M., Bobik, A., Vinh, A., Sobey, C. G., & Drummond, G. R. (2023). Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients.Scientific Reports, 13.

3. Werth, B. L., Williams, K. A., Fisher, M. J., & Pont, L. G. (2019). Defining constipation to estimate its prevalence in the community: results from a national survey.BMC Gastroenterology, 19, 75.

4. Werth, B. L., Williams, K. A., Fisher, M. J., & Pont, L. G. (2020). Chronic Constipation in the Community: A National Survey of Australian Adults. Journal of Wound, Ostomy and Continence Nursing 47(3):p 259-264, doi: 10.1097/WON.0000000000000632