Constipation is defined by the presence of two or more of the following for at least three months:

• Infrequent Bowel Movements: Fewer than three per week.
• Straining: Difficulty or discomfort during defecation.
• Hard or Lumpy Stools: Often described as Type 1 or 2 on the Bristol Stool Chart.
• Sensation of Incomplete Evacuation: Feeling that the bowel is not fully emptied.
• Abdominal Discomfort: Bloating, cramping, or pain.
• Manual Maneuvers: The need to use fingers to facilitate stool passage (Mayo Clinic).

Red Flags:

• Unexplained weight loss, rectal bleeding, or severe pain may indicate underlying conditions like colorectal cancer or bowel obstruction (Lippincott Review of Pathology).

Constipation can result from a variety of factors:

1. Lifestyle Factors:
   • Low fiber intake.
   • Inadequate fluid consumption.
   • Sedentary lifestyle.
2. Medications:
   • Opioids, anticholinergics, calcium channel blockers, and iron supplements (BNF).
3. Medical Conditions:
   • Hypothyroidism, diabetes, Parkinson’s disease, and irritable bowel syndrome (IBS-C).
4. Psychological Factors:
   • Stress, anxiety, or depression.
5. Structural Abnormalities:
   • Colonic strictures, rectal prolapse, or pelvic floor dysfunction (WHO).

Preventing constipation involves addressing modifiable risk factors:

1. Dietary Changes:
   • Increase fiber intake (25–30 g/day) through fruits, vegetables, and whole grains.
   • Stay hydrated (1.5–2 liters of water daily).
2. Regular Exercise: Promotes bowel motility.
3. Establish a Routine: Encourage regular bowel habits, ideally after meals.
4. Avoid Delaying Bowel Movements: Respond promptly to the urge to defecate.
5. Limit Constipating Medications: Consult healthcare providers for alternatives (Mayo Clinic).

1. Lifestyle and Dietary Interventions:

• Fiber Supplements: Psyllium, methylcellulose, or wheat dextrin (Comprehensive Pharmacy Review).
• Hydration: Adequate water intake to soften stools.

2. Pharmacological Therapy:

• Bulk-Forming Laxatives: Psyllium or methylcellulose (first-line for mild constipation).
• Osmotic Laxatives: Polyethylene glycol (PEG) or lactulose (draw water into the bowel).
• Stimulant Laxatives: Senna or bisacodyl (for short-term use).
• Stool Softeners: Docusate sodium (e.g., Colace).
• Lubricants: Mineral oil (for occasional use).
• Prescription Medications:
  • 5-HT4 Agonists: Prucalopride (for chronic idiopathic constipation).
  • Chloride Channel Activators: Lubiprostone (for IBS-C).
  • Guanylate Cyclase Agonists: Linaclotide or plecanatide (for IBS-C or chronic constipation) (Lippincott Textbook of Pharmacology).

3. Non-Pharmacological Approaches:

• Biofeedback Therapy: For pelvic floor dysfunction.
• Surgical Interventions: Rarely, for structural abnormalities like rectocele or strictures (Lange Textbook of Clinical Pharmacology).

4. Monitoring & Follow-Up:

• Adjust treatment based on response and side effects.
• Rule out secondary causes (e.g., hypothyroidism, colorectal cancer) (BNF).

Constipation is a manageable condition with a combination of lifestyle changes, dietary adjustments, and medical treatments. Early intervention and adherence to preventive measures can significantly improve symptoms and quality of life. Always consult healthcare providers for personalized care.