Chronic Constipation

What Is Chronic Constipation

Chronic constipation is a condition where you have fewer than 3 bowel movements per week, need to strain frequently, or feel as though you havenʼt fully emptied your bowels after passing motion – and this persist for three months or longer. It is different from the occasional bout of constipation that many people experience, as it is persistent and can affect daily life.

It happens because stool moves too slowly through the colon. The longer it remains in the colon, the more water is absorbed. This leaves stool hard, dry, and difficult to pass, which can cause ongoing bloating and discomfort.

This is a common issue in Singapore, where the average diet contains less fibre than recommended. On average, Singaporeans consume around 13 grams of dietary fibre per day, which is considerably lower than the recommended 30 grams.

Causes of Chronic Constipation

The causes of chronic constipation range from everyday lifestyle factors to underlying medical conditions.

Low-Fibre Diet and Dehydration

This is one of the most common causes of chronic constipation. Without enough fibre or water, stool loses the bulk and moisture it needs to move smoothly through the colon, becoming hard and dry.

Diets high in refined carbohydrates and processed foods are often low in fibre. Replacing some of these foods with whole grains, fruits and vegetables, while drinking enough water each day, may help keep stools soft and easier to pass.

Lack of Physical Activity

A sedentary lifestyle may slow down the bowel. This is especially common among the elderly, people with mobility issues, desk-bound workers, and those recovering from illness or surgery.

Medications

Several common medications list constipation as a side effect, including:

Opioid painkillers
Certain antidepressants
Blood pressure medications, including calcium channel blockers and beta-blockers
Antacids containing calcium or aluminium
Iron suppressants

If your constipation started shortly after beginning a new medication, this may be the cause. It is important to speak with your doctor before stopping or adjusting any prescribed medication.

Irritable Bowel Syndrome with Constipation (IBS-C)

IBS-C is a form of irritable bowel syndrome in which constipation is the predominant symptom. It is commonly associated with abdominal pain and bloating, which may improve after a bowel movement.

Pelvic Floor Dysfunction (Outlet Dysfunction Constipation)

Sometimes referred to as outlet dysfunction, this occurs when the pelvic floor muscle do not relax or coordinate properly during a bowel movement.

Instead of relaxing to allow stool to pass, the muscle may tighten or fail to coordinate, leading to excessive straining, a sensation of blockage, or incomplete bowel emptying.

Neurological and Endocrine Disorders

Certain neurological and endocrine conditions can slow bowel function and contribute to chronic constipation. These include hypothyroidism, diabetes, Parkinson’s disease, multiple sclerosis, spinal cord injuries, and stroke.

Structural Blockages or Narrowing of the Colon

Less commonly, constipation may be caused by a narrowing (stricture) or blockage in the colon or rectum. These may result from a variety of underlying conditions and should be assessed by a doctor.

Colorectal cancer or large polyps can sometimes present with persistent constipation, particularly when accompanied by warning signs such as blood in the stool or unexplained weight loss.

Learn more about colorectal cancer.

How to Tell If You Have Chronic Constipation

If you have had two or more of the following for at least three months, this may suggests chronic constipation:

Bowel movement frequency: Fewer than 3 bowel movements per week over a sustained period
Straining: Needing to strain excessively hard or for a prolonged period
Stool consistency: Hard or lumpy stools (Bristol Stool Chart Types 1-2)
Incomplete emptying: Feeling that your bowels have not emptied completely after a bowel movement
Sensation of blockage: Feeling as though something is preventing the stool from passing
Manual manoeuvres: Needing to press on the abdomen or use fingers to help pass stool
Abdominal symptoms: Bloating, discomfort, or lower abdominal cramps that may improve after passing motion
Laxative reliance: Regularly needing enemas, suppositories, or over-the-counter laxatives to have a bowel movement

See a Specialist about Chronic Constipation

If you think you have chronic constipation, book an appointment for proper medical examination with us, so that our colorectal specialist can recommend a suitable treatment plan following the assessment.

Schedule an appointment

What to Be Concerned about with Chronic Constipation

You should seek medical attention or consult a colorectal specialist if you experience any of the following:

A recent and persistent change in bowel habits, particularly if you are aged 40 or above
Blood in the stool, rectal bleeding, or black sticky stools
Unexplained weight loss, ongoing fatigue, or loss of appetite
Severe abdominal pain or constant bloating that does not improve
Iron-deficiency anaemia alongside constipation
Family history of colorectal cancer or inflammatory bowel disease
Constipation that fails to improve despite diet changes, fluids, and over-the-counter treatments
Inability to pass stool or gas, especially if accompanied with bloating, vomiting, or severe pain

These could signal something more serious, such as colorectal cancer, bowel obstruction, IBD, or a structural abnormality, that is best assessed by a colorectal specialist. An inability to pass stool or gas together with severe abdominal pain, bloating, or vomiting may require urgent medical attention.

How Chronic Constipation Is Diagnosed

Your colorectal specialist will take a detailed medical history and discuss your symptoms. This may include question about:

Bowel movement frequency and stool consistency
How long your have been experiencing constipation and whether your symptoms have changed over time
Your diet, fluid intake, and physical activity levels
Any medications, supplements, or laxatives you are taking
Other symptoms such as, abdominal pain, bloating, rectal bleeding, or unexplained weight loss
Family history of colorectal conditions or cancer

During the physical examination, your colorectal specialist will also check your abdomen and the area around the rectum. This may involve the following:

Checking the abdomen for distension, tenderness, or masses
A digital rectal exam to assess sphincter tone, check for stool impaction, and identify any structural abnormalities
Depending on findings, your colorectal specialist may recommend further tests such as imaging, stool tests, blood test or a colonoscopy.

Possible Treatments for Chronic Constipation

Treatment for chronic constipation depends on its severity and the underlying cause. Management typically follows a gradual, stepwise approach, beginning with conservative measures.

Lifestyle and Dietary Changes

Lifestyle and dietary changes are often recommended as an initial approach to managing chronic constipation. These may include:

Increase fibre gradually to 25-30g per day through fruits such as papaya, kiwi, prunes and apples, vegetables such as broccoli, spinach and leafy greens, whole grains such as oats, brown rice and wholemeal bread, and legumes.
Drink 8-10 glasses of fluids daily. Water generally the best choice and some people may find that drinking warm water in the morning helps stimulate bowel movement.
Engage in regular physical activity, such as a brisk 20-30 minute walk daily.
Establish a regular bowel routine, ideally after a meal to make use of the bodyʼs natural gastrocolic reflex.
Use a footstool to elevate your knees above your hips on the toilet. This may help straightens the anorectal angle for easier passage of stool.

Fibre Supplements and Over-the-Counter Laxatives

Fibre supplements (psyllium husk, methylcellulose) add bulk and soften stool. Introduce these gradually to avoid bloating.
Osmotic laxatives (polyethylene glycol, lactulose, magnesium hydroxide) draw water into the bowel and are often used first-line.
Stimulant laxatives (senna, bisacodyl) stimulate bowel contractions but should only be used short-term and under medical guidance, to avoid dependence.

Prescription Medications

If lifestyle measures and over-the-counter treatment do not provide sufficient relief, your colorectal specialist may prescribe medication based on the underlying cause of your constipation and your individual medical condition.

Surgical Options

Surgery is rarely needed for chronic constipation and is only considered when all other treatments have failed and a clear anatomical or functional problem is identified.

Options may include sacral nerve stimulation, colectomy (for severe slow-transit constipation), or surgical repair of structural issues such as rectocele or rectal prolapse.