🚽 Men's Health

Chronic Constipation

When the bowel won't cooperate — causes, relief, and when to investigate

Constipation is defined as fewer than 3 bowel movements per week, straining, hard stools, or the sensation of incomplete evacuation. Chronic constipation (lasting more than 3 months) is common across all age groups in Nigeria. Most cases are functional — caused by diet, inactivity, or fluid intake. Some are caused by medications or underlying disease. Rarely, new constipation in an older adult is the first sign of colorectal cancer.

Signs and Symptoms

✓ Fewer than 3 bowel movements per week

✓ Hard, dry, or lumpy stools

✓ Straining to pass stool

✓ Sensation that the bowel is not fully emptied

✓ Feeling of a blockage in the rectum

✓ Need to use fingers or manual manoeuvres to help defaecation

✓ Abdominal bloating or discomfort

Risk Factors

Low fibre diet — insufficient fruit, vegetables, and whole grains
Inadequate fluid intake — especially in hot weather
Physical inactivity
Holding the urge to defaecate (common in busy work schedules)
Medications: opioid pain killers, iron tablets, calcium channel blockers, some antidepressants, aluminium antacids
Pregnancy — progesterone slows gut motility
Hypothyroidism
Diabetes
Irritable bowel syndrome (constipation-predominant)
Age over 60 — reduced gut motility

When to Seek Help

New constipation in anyone over 50Must be investigated — colorectal cancer is a common cause of new constipation in this age group.

Blood in stool or rectal bleedingNever a feature of simple constipation — requires colonoscopy.

Significant weight lossUnexplained weight loss with constipation warrants urgent investigation.

Abdominal mass or distensionMay indicate bowel obstruction — requires urgent assessment.

Tests & Diagnosis

🧪 Digital rectal examination

Assesses the anal sphincter, rectal fullness, and pelvic floor function. Done by a doctor.

🧪 Blood tests: thyroid (TSH), calcium, glucose

Hypothyroidism, hypercalcaemia, and diabetes all cause constipation.

🧪 Colonoscopy

For anyone over 50 with new constipation, or if alarm features are present.

🧪 Colonic transit study

For severe constipation not responding to treatment — measures how fast stool moves through the colon. Available at specialist GI centres.

🧪 Anorectal manometry

Assesses rectal and sphincter function — for suspected defaecation disorders (e.g., pelvic floor dysfunction, Hirschsprung disease).

Treatment Options

Increase dietary fibre

Target 25–35g fibre daily. Best sources: oats, beans, lentils, vegetables, fruits with skin (pears, apples), whole grain bread. Increase gradually to avoid excessive bloating.

Drink more water

Aim for 2–2.5 litres per day in Nigerian heat (more if exercising). Fibre without water makes constipation worse.

Exercise regularly

Physical activity stimulates gut motility. Even 30 minutes of walking daily improves bowel regularity.

Respond to the urge promptly

Never ignore the urge to defaecate. Set aside 10–15 minutes after breakfast (gastrocolic reflex peaks then). Use a footstool to raise your feet — squatting posture relaxes the puborectalis muscle.

Bulk-forming laxatives

Ispaghula husk (Fybogel/Metamucil) — safest first-line laxative. Take with plenty of water. Takes 2–3 days to work. Safe for long-term use.

Osmotic laxatives

Lactulose or polyethylene glycol (Movicol) draw water into the stool. Effective for moderate constipation. Lactulose is widely available in Nigerian pharmacies.

Stimulant laxatives — short-term only

Bisacodyl or senna stimulate bowel contractions. Effective for short-term relief but should not be used daily long-term (can cause laxative dependence).

Stop causative medications if possible

With your doctor's guidance, switch or reduce doses of medications known to cause constipation (e.g., codeine-containing analgesics).

Frequently Asked Questions

How often should I open my bowels?

Normal bowel habit ranges from 3 times a day to 3 times a week. There is no 'correct' frequency — what matters is whether stool is easy to pass and you feel empty after. Any change from your normal pattern lasting >4 weeks should be investigated.

Are traditional enemas safe?

Commercial phosphate enemas (Microlax, Fleet) used occasionally are safe. Traditional herbal enemas (agbo jedi-jedi, or cassava-based enemas) used in some Nigerian communities can be dangerous — chemical burns, electrolyte disturbance, and bowel perforation have been reported. Avoid them.

Can constipation cause cancer?

Constipation itself does not cause colorectal cancer. However, new constipation in an older adult can be a symptom of colorectal cancer — so investigation is important. Long-term constipation is associated with haemorrhoids and anal fissures.

Are laxatives safe to take daily?

Bulk-forming and osmotic laxatives (e.g., lactulose, Movicol) are safe for long-term daily use. Stimulant laxatives (senna, bisacodyl) should not be used daily long-term without medical supervision.

Why do I get constipated when I travel?

Disruption to routine, dehydration, different food, and holding the urge in unfamiliar toilets all contribute. Maintain fluid intake, carry a bulk-forming laxative, and try to keep meal times consistent when travelling.