Constipation
Hard, infrequent or hard-to-pass poo. Very common and usually fixable with fibre, fluids, movement and the right laxative. Daily isn’t compulsory; comfortable is the goal.
The constipation ladder
Fix the basics first, then add a laxative if needed. Regular, sensible laxative use is fine. Straining on the throne with your phone is not.
- Step 1 · Self-careFibre, fluids, movement, routineFruit, veg, wholegrains, water, a daily walk, and a toilet visit after breakfast.
- Works
- Small benefit for mild constipation; two kiwifruit a day added about 1.5 complete poos a week in a trial
- Cost
- Grocery money
- How long
- 1–2 weeks to judge; for life
- Watch for
- Add fibre slowly or the wind will be spectacular.
Your bowel loves routine. Ignoring the urge until it’s convenient teaches it to stop asking.
- Step 2 · PharmacyFibre supplement (psyllium)Bulks and softens stool. Take with plenty of water.
- Works
- Adds about 1–2 poos a week in trials; best for mild constipation
- Cost
- About $10–25 a tub
- How long
- 2–3 days to work; fine long term
- Watch for
- Bloating and wind. Not for impacted stool or opioid constipation.
Fibre without water is basically cement.
- Step 3 · PharmacyOsmotic laxative (macrogol, lactulose)Draws water into the bowel to soften stool. Macrogol is the usual first choice.
- Works
- About 2–3 extra poos a week vs a dummy treatment; macrogol beats lactulose by about 1–2 a week
- Cost
- About $15–30 for 30 sachets; $25 on the PBS for some people with a script ($7.70 concession)
- How long
- 1–3 days to work; safe long term
- Watch for
- Bloating, loose stools. Adjust the dose up or down to suit.
Dose to effect: you’re aiming for soft and easy, not a sprint.
- Step 4 · PharmacyStimulant laxative (senna, bisacodyl)Nudges the bowel to move. Good for rescue or with an osmotic laxative.
- Works
- Usually works overnight; about 7 in 10 improved on senna vs about 1 in 10 on a dummy treatment
- Cost
- About $5–15
- How long
- 6–12 hours; short-term or occasional, or regular if advised
- Watch for
- Cramps, diarrhoea. Not for suspected blockage.
The “lazy bowel” fear is mostly a myth with sensible use.
- Step 5 · PrescriptionPrucaloprideFor long-term constipation when at least 2 laxatives haven’t worked.
- Works
- About 1 in 4 get back to 3+ full poos a week, vs about 1 in 9 on a dummy treatment
- Cost
- About $50–90 a month on a private script
- How long
- Judge at 4 weeks; stop if no help
- Watch for
- Headache, nausea, diarrhoea in the first days. Not in pregnancy.
For the stubborn cases, not the first bad week.
- Step 6 · Allied healthPelvic floor physio (biofeedback)For when stool reaches the exit but won’t leave: muscles squeeze when they should relax.
- Works
- About 8 in 10 with pelvic floor coordination problems improve, vs about 2 in 10 on laxatives alone
- Cost
- About $90–150 a session; Medicare rebates with a GP care plan
- How long
- 4–6 sessions plus home practice
- Watch for
- Needs the right diagnosis first.
Sometimes the problem isn’t the pipes, it’s the door.
- Step 7 · SpecialistGastroenterologist or colorectal surgeonColonoscopy, transit or pelvic floor testing, and rare surgery.
- Works
- Not a treatment in itself: finds the cause when red flags are present or nothing else works
- Cost
- Medicare rebates with a GP referral; specialist and procedure gaps vary
- How long
- Depends on findings
- Watch for
- Bowel prep for colonoscopy is the worst part. Truly.
Rarely needed, but no shame in getting there.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Colonic irrigation and coffee enemasNo evidence of benefit, with real risks such as bowel injury and salt imbalances.
- “Detox” teasOften senna in a fancy box at a fancier price. Your liver does the detox for free.
- Docusate (stool softener)Little evidence it helps long-term constipation. Macrogol does the job better.
- ProbioticsMay help a little, but results vary by strain and the evidence is mixed. Try one for 4 weeks and stop if nothing changes.
What you can do
- Go when you feel the urge. Don’t sit there scrolling: 5 minutes, then get up.
- Feet on a footstool, lean forward, elbows on knees.
- Check your medicines: codeine and other opioids, iron and some antacids are classic culprits.
- Aged 45–74 in Australia? Do the free bowel cancer screening kit.
See your GP if
- New constipation over 50, or lasting more than a few weeks
- Blood in stool, weight loss, or a family history of bowel cancer
- Laxatives aren’t helping, or you need them for more than a few weeks
- A child is constipated for more than a week or soils their pants
Get urgent help for severe tummy pain, a swollen belly, vomiting, or no poo or wind at all: call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
Common questions
How often should you poo?
Anywhere from 3 times a day to 3 times a week is normal. Hard, straining or painful poos matter more than the count.
Is it bad to take laxatives every day?
Not when they’re the right type at the right dose. Fibre and osmotic laxatives such as macrogol are safe long term. Get checked if you need them for more than a few weeks.
What is the best laxative for constipation?
For most adults, a fibre supplement first, then macrogol. Senna or bisacodyl work well for quick relief or when added to macrogol.
When is constipation serious?
Blood, weight loss, severe pain, vomiting or a new change in bowel habit (especially over 50) need a doctor. No poo or wind with a swollen, painful belly is an emergency.
Helpful resources
- National Continence Helpline (1800 33 00 66)Free, confidential advice from continence nurses on bowel problems, weekdays 8am–8pm. Australia only.
- Bristol stool chartFree download from the Continence Foundation of Australia. Handy for tracking what “normal” looks like and for showing your doctor.
- Queensland Health: Are you pooing properly?The footstool-and-lean-forward toilet position, explained. Free.
Evidence and more information
- Healthdirect: Constipation
- NICE CKS: Constipation
- NICE: Prucalopride for chronic constipation
- National Bowel Cancer Screening Program
- Ford and Suares: Drugs for chronic constipation, meta-analysis (Gut 2011)
- ACG summary: Kiwifruit vs psyllium trial (2023)
- Morishita et al: Senna vs placebo trial (2021)
- Chiarioni et al: Biofeedback vs laxatives trial (2006)
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