Constipation

Gastrointestinal Conditions

Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.

Clinical features

Reduced frequency and increased difficulty of defaecation, relative to normal bowel habit

In addition, a child with constipation may have the following symptoms: loss of appetite, lethargy, malaise, irritability, foul-smelling flatulence and stools, abdominal pain and discomfort

Suspected hypothyroidism (fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, hoarseness and muscle weakness) or depression

Medicine-induced constipation (examples include iron, aluminium-containing antacids, opioids)

Laxatives take different times to have their effect:
- Stimulants: 6 to 12 hours (orally) and 20 to 60 min (rectally)
- Bulk-forming/osmotic: 24 to 72 hours
- Stool softeners: 12 to 72 hours

Non-pharmacological advice

Lifestyle measures: advise a diet containing grains, fruits high in sorbitol (examples include: apples, strawberries, raspberries, peaches, pears, plums and grapes) and vegetables, increasing dietary fibre gradually towards the UK recommendation of 30 grams per day (SACN / NHS Eatwell Guide), having adequate fluid intake, and exercising in line with recommended targets. Foods rich in fibre include oats, wholegrain bread, rice and pasta, and pulses like lentils and beans

Defecation should follow a regular routine and not be hurried; the person should ensure there is enough time to complete defecation. Also, if the patient is unsteady on the toilet, supported seating may be useful. It is also important to advise patients to respond immediately to the sensation of needing to defecate (also referred to as the ‘call to stool’). Inadequate privacy may also contribute to constipation

Pharmacological advice

Offer oral laxatives if dietary measures are ineffective or symptoms do not respond adequately. The person should be advised that laxatives can be gradually reduced and stopped once the person is producing soft formed stools that are passed without straining (at least 3 times a week)

Start treatment with a bulk-forming laxative, emphasising the need for concurrent adequate fluid intake [if stools remain hard or difficult to pass, add or switch to an osmotic laxative such as a macrogol as a next step. NB: This guidance about next steps and other options is written primarily for prescribers, rather than suggesting it should be managed in an OTC context only]

Ispaghula should not be recommended for constipation related to opioid use. An osmotic laxative (or a faecal softener such as docusate) combined with a stimulant laxative is the usual approach, although this is probably beyond self-care and typically involves the patient's doctor. NICE (CG140) recommends that a laxative is prescribed regularly at an effective dose for everyone starting a strong opioid, without specifying a laxative class

Pregnancy: advise on dietary measures, including an adequate fluid intake, regular light or moderate exercise can also be helpful. If there is a poor response to the above lifestyle measures, consider using laxatives. Some ispaghula husk-containing products are licensed for sale OTC for constipation in pregnancy

Infants: the MHRA advises that rectal catheters sold for personal use (sold as ‘gas relievers’ or ‘colic relievers’) should not be used in infants, including for constipation, and that any already purchased should be disposed of (Device Safety Information DSI/2026/008, 18 August 2026, updated 20 August 2026). These devices are sold without prescription online and in shops. This does not apply to catheters used for specialist medical treatment (for example Hirschsprung’s disease, meconium ileus or gastroschisis) where parents or carers have been trained by healthcare professionals. See also the Colic page