Overview
Functional constipation is chronic constipation without an identifiable structural, biochemical, or medication-related cause. Defined by the Rome IV criteria, it is diagnosed when a patient has two or more of the following for at least 3 months: straining in more than 25% of defecations, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, need for manual manoeuvres, or fewer than 3 spontaneous bowel movements per week. It is among the most prevalent GI disorders worldwide and is distinct from irritable bowel syndrome with constipation (IBS-C) in that abdominal pain or discomfort is NOT the predominant feature.
Symptoms
Fewer than 3 spontaneous bowel movements per week
Hard, dry, lumpy stools (Bristol Stool Types 1–2)
Excessive straining during defecation
Sensation of incomplete evacuation after a bowel movement
Sensation of anorectal blockage or obstruction
Common Causes
Low-fibre diet and inadequate fluid intake
Physical inactivity and sedentary lifestyle
Medications: opioids, iron supplements, calcium channel blockers, tricyclic antidepressants, aluminium-based antacids
Pelvic floor dysfunction (dyssynergic defecation) — always excluded before labelling as simple functional constipation
Systemic conditions: hypothyroidism, diabetes with autonomic neuropathy, hypercalcaemia
Self-Care Tips
Increase dietary fibre gradually to 25–30g per day — add 5g per week to avoid bloating; focus on soluble fibre (oats, psyllium, lentils, pears)
Drink at least 8–10 glasses (2 litres) of water daily — fibre absorbs water and without adequate hydration it can worsen constipation
Exercise regularly; even 30 minutes of walking daily accelerates colon transit significantly
Use a footstool to raise your feet during defecation to create a squatting-like position that straightens the anorectal angle
Respond promptly to the urge to defecate — suppressing the urge trains the rectum to become less sensitive over time
If lifestyle measures fail, osmotic laxatives (polyethylene glycol/macrogol) are safe for long-term use and are evidence-based first-line therapy
When to See a Doctor
See a gastroenterologist if constipation is new onset after the age of 50, is accompanied by rectal bleeding, unexplained weight loss, or a family history of colorectal cancer; if constipation does not improve with 4–6 weeks of dietary and lifestyle changes; or if you require daily laxative use to maintain bowel regularity.
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