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This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Constipation means passing stools less often than usual (often fewer than three times a week), or stools that are hard, lumpy and difficult to pass, with straining, a feeling of incomplete emptying or a need for help to empty. People mean different things by it, so doctors look at the whole picture (Rome IV criteria). There are three broad patterns: normal-transit constipation, where the stool moves normally but is hard or difficult, which is the most common and usually responds to diet; slow-transit constipation, where the colon moves stool slowly; and a pelvic-floor or evacuation disorder, where the muscles of the rectum and anus do not coordinate to let stool out. Diet helps mainly the first. This article is about diet; for causes, tests and medicines please read our constipation article. It also applies to children, with the notes below.
How common is it?
Constipation is very common: about 1 in 7 people worldwide report it. It is more frequent in women, in people over 65, in pregnancy and after childbirth, and in people with low activity or who take certain medicines. In children, it is among the most common reasons for visiting a paediatric clinic.
Why does it happen?
Common contributors are too little fibre and fluid, little physical activity, ignoring the urge to go, travel or a change in routine (including Ramadan), stress, and pregnancy. Many medicines cause constipation: opioid painkillers, iron, calcium and aluminium antacids, some blood-pressure and antidepressant tablets, and anticholinergic medicines. Medical causes include an underactive thyroid, diabetes, nerve and muscle disorders, irritable bowel syndrome with constipation, and, much less often, a narrowing or growth in the bowel. Do not stop any prescribed medicine on your own; talk to your doctor.
Symptoms
- Fewer than three bowel movements a week, or fewer than usual for you
- Hard, dry, lumpy stools (types 1 and 2 on the Bristol stool chart)
- Straining, pain, or a feeling that you have not emptied completely
- Bloating, lower abdominal discomfort and loss of appetite
- Needing to press on the abdomen or near the anus to help stool out (suggests an evacuation problem)
Red flags — seek urgent medical care
Blood in the stool, or black stools
Needs prompt medical assessment. Go to the emergency room if bleeding is heavy or you feel faint.
Unintended weight loss, anaemia, or tiredness with new constipation
May point to a problem in the bowel or elsewhere. See your doctor soon for tests, such as a colonoscopy.
A new and lasting change in bowel habit, especially after about the age of 45 to 50, or a family history of bowel cancer
Do not simply treat it with fibre and laxatives; ask for a medical review.
Severe abdominal pain, a swollen belly and vomiting, with no passing of wind or stool
Possible bowel obstruction. Do not take laxatives. Go to the emergency room.
In an older or bedbound person, watery leakage with hard stool still inside, confusion or loss of appetite
May be faecal impaction (overflow). Needs medical help to clear it.
In babies and children: no meconium in the first 48 hours, poor weight gain, vomiting, a very swollen belly, blood in the stool, or constipation from early infancy
Needs a paediatric review; a structural or nerve problem of the bowel must be excluded.
How is it diagnosed?
Doctors rely on your history, a stool diary or the Bristol stool chart, a list of your medicines, an examination (including a rectal examination when appropriate) and sometimes blood tests such as a blood count, thyroid and calcium. A colonoscopy is advised if there are warning signs or you are in the age group for bowel-cancer screening. If treatment does not help, tests of how the colon moves or how the rectum empties (anorectal manometry, balloon expulsion) can show whether you have slow transit or an evacuation disorder, which need different treatment. A dietitian can review your fibre and fluid intake.
What the latest science says
The joint AGA–ACG guideline on pharmacological management of chronic idiopathic constipation (2023) places fibre supplements such as psyllium alongside osmotic and stimulant laxatives and newer prescription medicines, with a conditional recommendation for psyllium based on low-certainty evidence. Meta-analyses of fibre trials show that fibre increases stool frequency and softens stool in chronic constipation, but a study in people with proven slow transit or an evacuation disorder found fibre much less helpful (Voderholzer and colleagues, 1997), which is why a poor response to fibre should lead to further assessment rather than to more fibre. Randomised trials, mostly small, suggest that dried plums (prunes) (about 50 g twice daily in a trial that compared them with psyllium, Attaluri and colleagues, 2011) and green kiwifruit (about two a day for four weeks in several trials, summarised in systematic reviews) improve stool frequency and consistency. Evidence that drinking extra water treats constipation is weak unless a person is dehydrated. In children, the ESPGHAN/NASPGHAN guideline (2014) found no good evidence that extra fibre or fluids treat functional constipation, and recommends a normal balanced diet, toilet training and an osmotic laxative.
Outlook — what to expect
Most constipation caused by low fibre, low fluids or routine changes improves within days to a few weeks of the changes below. Long-standing constipation often needs a combination of diet, toilet habits and, when necessary, a laxative taken regularly under medical advice. If there is slow transit or a pelvic-floor problem, specific treatments such as biofeedback therapy help many people.
Treatment
Habits & Lifestyle
Toilet and daily habits are as important as the food.
- Go when you feel the urge; do not put it off. Try a regular time, ideally 20 to 30 minutes after a meal, when the bowel is naturally more active (especially after breakfast).
- Sit with your feet on a low stool so that your knees are above your hips, lean forward, relax and do not strain for long.
- Be physically active every day; even a brisk walk helps the bowel.
- Review your medicines with your doctor or pharmacist if constipation began after starting a new one.
- Keep a simple stool diary for a week or two.
Diet
For most adults the basics are: enough fibre added slowly, enough fluid, and a few foods with trial evidence. Add one change at a time and give each a few weeks.
- Aim for about 25 to 30 grams of fibre a day in total (the US NIDDK suggests 22 to 34 grams depending on age and sex). Most people eat much less. Increase by a few grams every few days to weeks, because a sudden jump causes gas, bloating and cramps.
- Good sources: whole grains (oats, whole-wheat bread, brown rice, bulgur, jareesh), legumes (lentils, chickpeas, beans, foul), vegetables (carrots, broccoli, peas, leafy greens), fruit with the skin (apples, pears, berries, oranges), nuts and seeds (almonds, linseed, chia).
- Dried plums (prunes): in a trial, about 50 g twice a day worked better than psyllium for stool consistency. Start with a few and build up; some people get gas or loose stools. Dried figs, apricots and dates also add fibre, and fruits with sorbitol (apples, pears, apricots, grapes and raisins, plums) soften stool.
- Green kiwifruit: about two a day for around four weeks improved stool frequency and ease in several trials. Eat them with the skin if you like; wash well.
- Fibre supplements: psyllium (ispaghula) is a soluble fibre with the best evidence. Take it with a full glass of water, start with a small amount, increase slowly, and avoid it if you have difficulty swallowing or a known bowel narrowing. Wheat bran may cause more bloating than soluble fibre.
- Fluids: aim for about 1.5 to 2 litres a day (more in hot weather or when you sweat), mostly water. Fibre needs fluid to work. Extra water beyond that has little proven effect if you are already well hydrated. A warm drink or coffee in the morning stimulates the bowel in some people.
- Keep eating regularly; breakfast in particular starts the bowel’s natural reflex.
- Cut down on the low-fibre, highly processed foods that replace fibre in the diet: white bread and pastries, white rice in large portions, chips, fast food and many ready meals.
- Be careful with herbal “cleansing” and slimming teas, including senna tea (sana makki). They are stimulant laxatives; occasional short use is acceptable, but regular use can cause cramps and salt loss, and some slimming blends contain undeclared stimulants. Ask your pharmacist or doctor.
- If more fibre makes you more bloated and uncomfortable without any improvement in your bowel movements, do not keep increasing it; this can happen with slow-transit constipation, an evacuation disorder or irritable bowel syndrome. Ask for further assessment.
- Children: the diet should be normal and balanced, with fruit, vegetables, whole grains and water suited to their age. There is no good evidence that extra fibre or water cures constipation in children, so do not force foods. Treatment mainly rests on a regular toilet routine after meals, a reward-based approach and a medicine prescribed by the paediatrician.
Medications
If diet and habits are not enough, medicines are described in our constipation article. In brief:
- Osmotic laxatives (such as polyethylene glycol, lactulose or magnesium products) draw water into the stool and are usually first choice.
- Stimulant laxatives (such as senna or bisacodyl) are added for short periods when needed.
- Prescription medicines are available for constipation that does not respond; they are chosen and monitored by your doctor.
- Do not use laxatives if you have severe abdominal pain, vomiting or suspect a blockage.
Procedures & Surgery
Procedures are for constipation that does not respond or has warning features:
- Colonoscopy if there are warning signs or you are due for screening.
- Anorectal manometry and balloon expulsion test to look for an evacuation disorder; biofeedback therapy is the most effective treatment for it.
- Removal of impacted stool by a healthcare professional, with suppositories or an enema, if the rectum is blocked with hard stool.
- Surgery is very rarely needed and only for selected people after specialist assessment.
Living with the condition
- Build fibre, fluids and activity into your daily routine rather than treating constipation only when it appears.
- Keep fibre-rich snacks (fruit, nuts, dried fruit) within reach for work and travel.
- Do not ignore the urge to go, even in public or at work.
- See your doctor if you need laxatives regularly for more than a few weeks.
In the Saudi context
Constipation often worsens in Ramadan because of less fluid, fewer fibre-rich meals, more fried and sweet food, less activity and a changed routine. Practical tips: break the fast with water and dates (dates add fibre); have soup, a salad and a dish with legumes or whole grains at iftar; spread water through the evening (for example a glass or two with iftar, a glass every hour or so afterwards, and more at suhoor); at suhoor choose oats, whole-grain bread, laban and fruit such as prunes, figs or kiwi; limit white bread, fried samboosa and very sweet desserts; walk after Tarawih; and keep a regular toilet time after iftar or suhoor. If you use a laxative, ask your doctor when to take it during the month. Traditional foods that help include jareesh and harees made with whole wheat, foul, lentil soup and tamarind-based drinks (evidence is limited, but they add fluid and some fibre; watch the sugar). In hot weather, drink more water. Ask for wholegrain or brown bread when it is available, and do not rely on repeated Arabic coffee or tea for fluids, since they also contain caffeine.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How much fibre and fluid should I aim for, and how fast should I increase them?
- Could one of my medicines be causing my constipation?
- Do I need any tests, such as a colonoscopy or blood tests?
- Which laxative is safe for me, and for how long?
- How should I manage constipation in Ramadan, or in my child?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide