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Constipation and When To See a Doctor

An article published in the Daily Star (UK) reported that a woman lost ten years of her memory after straining on the toilet seat because of constipation. While it may seem rather comical that someone can forget themselves after straining, this is a real medical condition. The doctors that saw her suspected that one of the blood vessels connected to her brain was not functioning normally, and at the point of exertion, blood flow to the brain was compromised, leading to memory loss. This is, in essence, a mini-stroke. Fortunately for her, her memory came back. This is not the first case of someone’s brain being affected by straining because of constipation.

So why does this lady have to strain so hard just to defecate?

Bowel Movements and Constipation

Today, we will talk about bowel movements and constipation. Before we talk about what is abnormal, we need to know what is normal.

Everyone’s bowel movements are different and can change as you grow older. But in general, when defining diarrhoea or constipation, the general range is from three times a day to three times a week. Less than three movements per week are generally considered constipation, while three or more loose stools per day are considered diarrhea. As you grow older, your bowel movement slows down as well, and that is the reason why the elderly are more prone to constipation.

Having said that, what may be normal to someone may be abnormal for another person. If a person normally has two bowel movements a day, a sudden decrease to one bowel movement every two days can be considered as constipation for him. On the other hand, someone who has always had one bowel movement every two days might see two bowel movements a day to be considered as diarrhea.


Consistency & Frequency

As doctors, we do not just look at the frequency of bowel movements (or the change in frequency), we look at the consistency as well. Are your stools soft and fluffy? Are they in one solid piece? Is it completely liquid?

In Singapore hospitals, we commonly use the Bristol Stool Scale to describe stool, and there are 7 types of stool that can be described. A change in consistency of stool may indicate to your doctor that there might be something wrong.

So What is Constipation Then?

It can mean that you are not passing stools as frequently as you are used to or you are unable to completely empty your bowel. Constipation can also cause your stools to be hard and lumpy, or unusually large or small. It can be painful or uncomfortable to defecate as well.


Common Causes of Constipation

There are many things that can cause constipation, and they can range from the benign to the life-threatening. The most common causes of constipation are diet and activity related. Changes to your diet can cause your gut to move slower. A diet that is low in fibre or fluids such as water can make your stools hard and therefore harder to pass.

Stress is a huge contributor to constipation as well. We do see some people get constipated during times of stress. If you are inactive and do not exercise regularly, you can be prone to constipation as well.

Medications that slow your gut such as cough syrups, iron tablets and some painkillers can lead to constipation. Overuse or dependence of laxatives can also slow your gut. Any mass lesion that obstructs the gut can lead to constipation as well and can range from the benign like pregnancy to dangerous like colon or pelvic cancer. Constipation may also be a sign of bowel obstruction. There are some neurological diseases that are associated with constipation, like Multiple Sclerosis and Parkinson’s disease. Certain metabolic conditions such as hypothyroidism can alter the movement of your gut too.

So Why Do We Have to Care?

First and foremost, constipation can be very uncomfortable. Defecation can be painful and if the stools are hard enough, they can cut the insides of your gut, leading to bleeding. People usually complain of a bloated abdomen and may report the feeling of incomplete evacuation of stool. Complications include conditions such as diverticular disease, haemorrhoids, anal fissures, fecal impaction and rectal prolapse due to the straining.

Thing You Can Do to Prevent Constipation

So knowing the above, there are some things we can do to try and prevent constipation. Eat a variety of fruits, vegetables and high fibre foods that can help bulk up your stool. Stay hydrated with lots of fluids and exercise regularly. Reduce your stress levels.

These will also add benefits to your general health! Avoid constipating medications such as codeine and iron supplements.


If the above fails, there are medications that can be given to assist in defecation. They can range from oral medications to suppositories. These can bulk up the stool, draw more water into the gut or stimulate the gut to move. But remember, dependence on these medications can lead to constipation too, so as far as possible, the lifestyle changes recommended above are the first line of treatment.

All in All

As mentioned, constipation may be a sign of something more ominous. If there is significant pain associated with constipation, this might be an acute bowel obstruction.

If there are any red flags like weight loss, per rectal bleeding, a sudden  change in bowel habits, loss of appetite or an abdominal mass, it could possibly be something like cancer and further investigations might need to be done.

See your doctor if you have these warning signs.

Take Care!

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