Constipation is an everyday problem people do not like to talk about. Yet, when it happens, it can’t be ignored. You may find yourself spending too long in the toilet, straining to pass a hard stool, feeling bloated afterwards, or still feeling as though your stomach has not quite emptied.

It is easy to blame constipation on not eating enough vegetables, but food is only part of the picture. A change in routine, sitting for long periods, not drinking enough water, stress, or regularly ignoring the urge to use the toilet can also affect how often and how comfortably you pass stool.

And constipation is not simply about how often you go. Hard or lumpy stools, painful bowel movements, straining, and the feeling that you have not completely emptied your bowels are also common signs.

It is not always about food
For some people, the experience can be particularly uncomfortable. Robyn Barefoot, a registered dietitian who lives with constipation-predominant irritable bowel syndrome, has written about having painful constipation despite eating a varied diet, exercising and drinking plenty of water. She described trying several familiar remedies, including coffee, prunes, exercise and meditation, without finding an immediate solution.

Her experience is a useful reminder that constipation is not always as simple as eating poorly or not drinking enough water.

Dr Nwaiwu Obinna Michael, a general practitioner at Primrose Specialist Hospital, describes constipation as a common health problem that affects people of all ages. He notes that although it is often dismissed as a minor inconvenience, it can cause significant discomfort and may sometimes indicate an underlying medical condition.

“Constipation occurs when a person has difficulty passing stools or passes them less frequently than usual,” Dr Nwaiwu explains.

He adds that symptoms may include “passing hard, dry stools, straining during bowel movements, feeling that the bowel has not emptied completely, or spending an unusually long time in the toilet.”

One reason stools become difficult to pass is that they spend too long moving through the colon. As this happens, the body absorbs more water from them, leaving them harder and drier.

Diet is still important, however. Fibre adds bulk to stool and can help it move through the digestive system. Adults generally need around 22 to 34 grams of fibre a day, depending on age and sex. Beans, vegetables, fruits, whole grains and nuts are useful sources. Dietary fibre is an important part of a healthy diet.

The trick is not to suddenly overload the diet with fibre. Increasing it gradually can help the digestive system adjust and may reduce the bloating and discomfort that some people experience when they make a sudden change.

Your daily routine can play a part
Fluids matter too. Drinking regularly throughout the day can help prevent stools from becoming too dry, particularly when someone is increasing their fibre intake. There is no single amount that everyone must drink, because fluid needs vary, but thirst, weather, activity and diet can all affect how much a person needs.

Movement is another easily overlooked part of bowel health. Spending most of the day sitting can make an already sluggish routine worse. Regular activity, even something as simple as walking, can help stimulate bowel movement.

For many people, this is where ordinary life gets in the way. A busy morning, a long commute, hours at a desk and an evening spent resting can mean that very little movement happens during the day.

Stress and changes in routine can also affect bowel habits. Travelling, changing what you eat or simply being away from your usual schedule can sometimes leave the digestive system unsettled.

Dr Nwaiwu identifies a diet low in fibre as one of the most common causes of constipation. He also points to insufficient water intake, physical inactivity and repeatedly ignoring the urge to use the toilet.

Certain medications can contribute to the problem, including opioid painkillers, some antacids containing aluminium or calcium, iron supplements and some medicines used to treat depression.

In some cases, constipation may be associated with medical conditions such as diabetes, an underactive thyroid gland or disorders affecting the muscles and nerves involved in bowel movements.

As Dr Nwaiwu explains, “Persistent constipation should therefore not always be attributed to diet alone.”

Sometimes, you simply have to go
For someone rushing to work in the morning, sitting in traffic or dealing with an inconvenient office bathroom, postponing a bowel movement can become a habit. But repeatedly ignoring the body’s signal to go can contribute to constipation.

Creating time for the toilet may therefore be more useful than it sounds. Eating stimulates movement in the colon, so some people may find it helpful to try using the toilet around 15 to 45 minutes after breakfast. Sitting comfortably, relaxing rather than forcing the bowel movement and giving yourself enough time can also help.

Toilet position can also make a difference. Placing the feet on a small stool so that the knees are slightly higher than the hips can put the body in a position that makes passing stool easier for some people.

These may seem small, but bowel habits are often shaped by everyday routines.

How can constipation be prevented?
The good news is that many cases of constipation can be prevented or improved through simple lifestyle changes.

First, eat more fibre. Include fruits, vegetables, beans, peas, whole grains, and other fibre-rich foods in your daily meals. In Nigeria, foods such as beans, okra, vegetables, and whole-grain cereals can help increase fibre intake. Increase fibre gradually to reduce bloating and gas.

Second, drink enough water. Adequate fluid intake helps prevent stools from becoming excessively hard, particularly when increasing dietary fibre. People with medical conditions that require fluid restriction should follow their healthcare provider’s advice.

Third, stay physically active. Regular activities such as walking can help support normal bowel function. You do not necessarily need an expensive gym membership; consistent daily movement can make a difference. Natural approaches to constipation include lifestyle changes that support regular bowel movements.

Fourth, do not ignore the urge to defecate. Delaying bowel movements repeatedly can make constipation worse. Establishing a regular toilet routine, especially after meals, may help. Using a small footstool to raise the feet while sitting on the toilet can also make passing stools easier for some people.

Is it safe to use laxatives?
Laxatives are medicines that help relieve constipation. They can be useful when dietary and lifestyle changes are insufficient, but the appropriate choice depends on the cause of constipation, the person’s age, other medical conditions and the medicines they already take.

Some laxatives work by increasing the water content of stool, while others stimulate bowel contractions or increase stool bulk. A healthcare professional or pharmacist can help determine which option is appropriate.

However, repeatedly using laxatives without understanding the cause of persistent constipation is not advisable. People who require laxatives regularly should seek medical assessment rather than continually treating the symptoms themselves.

It is also important to avoid taking laxatives when bowel obstruction is suspected, particularly when constipation is accompanied by severe abdominal pain, vomiting and an inability to pass gas.

How can constipation become dangerous?
Constipation is not usually life-threatening, but severe or prolonged cases can lead to complications.

Faecal impaction: Hard stool can accumulate in the rectum or colon until it becomes difficult or impossible to pass. This is known as faecal impaction and may require medical treatment.

Intestinal obstruction: A bowel obstruction prevents stool and gas from moving normally through the intestines. Although constipation does not always cause an obstruction, the two can be associated. Without urgent treatment, an obstruction can damage the bowel and lead to serious complications.

Bowel perforation: In rare, severe cases, complications involving impacted stool or an intestinal obstruction can contribute to a tear in the intestinal wall. This can lead to a serious infection requiring emergency treatment.

These complications are uncommon, but knowing the warning signs is important. Severe abdominal pain, marked abdominal swelling, vomiting and an inability to pass stool or gas require urgent hospital assessment.

When it should not be ignored
Still, constipation should not always be treated as a problem to solve at home. Persistent symptoms deserve attention, particularly when they are accompanied by blood in the stool, unexplained weight loss, persistent abdominal pain, vomiting, fever, inability to pass gas, or a sudden change in bowel habits.

Dr Nwaiwu advises seeking medical assessment if constipation persists, keeps recurring or represents a significant change in a person’s usual bowel habits.

He identifies other warning signs, including “blood in the stool, unexplained weight loss, persistent abdominal pain, unusual tiredness, or symptoms suggestive of anaemia.”

A person who develops constipation for the first time later in adulthood, particularly when accompanied by other warning signs, should also be evaluated for an underlying cause. The need for further investigations depends on the person’s age, symptoms, medical history and risk factors.

Certain medicines and medical conditions can also cause constipation, so someone who is repeatedly struggling should not assume that the answer is simply more fibre or another home remedy.

For most people, improving bowel habits begins with ordinary things: eating enough fibre, drinking fluids, moving regularly and responding when the body says it is time to go. But when constipation keeps returning or feels markedly different from usual, another glass of water or a bowl of fruit may not be the whole answer. Sometimes, the right next step is to find out why the bowel is struggling in the first place.

Simple habits that may help
Add fibre gradually: Include more beans, vegetables, fruits and whole grains in your meals, but increase the amount slowly.

Keep fluids nearby: Drink regularly throughout the day rather than waiting until you are very thirsty.

Move more: A daily walk or regular movement during a long day of sitting can help keep the bowel active.

Do not keep postponing the toilet: When you feel the urge, try to go rather than making a habit of holding it.

Give yourself time: A relaxed toilet routine, particularly after breakfast, may make bowel movements easier.

Try a different position: A small footstool can raise the knees above the hips and make passing stool more comfortable for some people.