Why Can’t I Poo? A Dietitian’s Guide to Managing 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), or 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:
Dietary Factors: Low fibre intake, inadequate fluid, or not eating enough food.
Lifestyle: Lack of movement, "withholding" (ignoring the urge), or high stress levels.
Medications: Opioids, certain blood pressure meds, and iron or calcium supplements.
Medical Conditions: Diabetes, hypothyroidism, or neurological issues like Parkinson’s.
The Rome IV Diagnostic Criteria
Clinically, we use the Rome IV criteria 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
Rule Out the Serious Stuff: See your GP first to ensure there is no underlying obstruction.
Hydrate, Hydrate, Hydrate: Fibre needs water to work; without it, fibre can actually make constipation worse!
Get Enough Fibre: Make sure you’re getting enough fibre, slow is steady.
Start Moving: Physical activity stimulates the natural contractions (peristalsis) of your gut.
Use a "Squatty Potty": Elevating your knees above your hips straightens the anorectal angle for an easier exit.
Don't Ignore the Urge: "Poo fright" or avoiding opening your bowels can lead to stool becoming harder in the colon.
Relaxation: The gut and brain are connected; high stress can "shut down" digestive motility.
Consult a Gut Health Dietitian: If you've tried it all, you may need a personalised support and dietary advice to help relieve constipation.
Ready to Stop the Guesswork and Start Feeling Light Again?
If you’ve tried adding fibre and water but still aren’t seeing results. It’s time for a personalised approach. Let’s get your digestion back on track together.
REFERENCES
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.
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.
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.
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
