Introduction
Constipation is a common digestive problem, but conversations about bowel habits can still feel uncomfortable. Some people simply put up with constipation for months, while others repeatedly reach for over-the-counter laxatives without investigating why the problem keeps returning.
Constipation is not necessarily a sign that something is seriously wrong. It can be related to diet, medications, changes in routine, bowel habits and other factors. However, persistent constipation deserves attention rather than being treated as something you simply have to live with.
This is particularly relevant in South Africa, where access to suitable food, clean and private toilet facilities, healthcare and medication can vary considerably between communities. These practical circumstances can influence how people manage their bowel health.
What Counts as Constipation?
Constipation is about more than simply how often you have a bowel movement.
Clinicians consider several features, including:
- Fewer than three spontaneous bowel movements per week
- Hard or lumpy stools
- Straining during bowel movements
- A feeling that the bowel has not emptied completely
- A sensation that something is blocking the passage of stool
- Needing to use manual manoeuvres to help empty the bowel
These symptoms are particularly relevant when they persist over time. The Rome IV criteria, commonly used in gastroenterology research and clinical practice, recognise that someone can have constipation even if they pass stool relatively frequently.
In other words, having a bowel movement every day does not automatically mean that you are free from constipation.
Likewise, not everyone who goes several days without a bowel movement necessarily has a chronic disorder. Bowel patterns vary between individuals.
How Common Is Constipation?
Constipation occurs across populations worldwide. A large systematic review and meta-analysis estimated that chronic idiopathic constipation affects approximately 14% of people overall, although estimates vary substantially depending on how constipation is defined and the population studied. The review also found that constipation was more common among women and increased with age and lower socioeconomic status.
It is important not to assume that this global estimate represents the prevalence of constipation specifically in South Africa. Robust, nationally representative South African data are limited.
What is clear is that constipation is common enough to be an important everyday health concern — and one that can affect quality of life.
What Can Contribute to Constipation?
Constipation rarely has just one possible explanation. Several factors can overlap.
1. Not getting enough fibre
Fibre adds bulk to stool and can help support regular bowel function.
Sources include:
- Beans and lentils
- Vegetables
- Fruit
- Oats
- Wholegrain breads and cereals
- Nuts and seeds
Research suggests that fibre supplementation can improve stool frequency and consistency in adults with chronic idiopathic constipation, although it can also increase bloating and gas in some people.
For South African households, this does not necessarily mean buying expensive speciality products. Familiar foods such as beans, lentils, oats, vegetables and fruit can contribute to overall fibre intake.
However, dietary patterns differ considerably across South Africa, so it would be inaccurate to suggest that all South Africans have low fibre intake. A 2024 study of adults in three low-income South African communities found that only 18.8% met the study’s fibre guideline and only 7% met its fruit-and-vegetable guideline, illustrating that access to protective foods can be an issue in some communities.
That finding should not be generalised to the entire South African population.
2. Not drinking enough fluid
Fluid intake can influence stool consistency, particularly when someone is dehydrated.
However, the relationship between water and constipation is more complicated than the common advice to simply “drink more water”. Studies have found associations between fluid intake and constipation in some populations, while other research has found that total water consumption is not independently associated with constipation after accounting for other factors.
The practical takeaway is simple: avoid becoming dehydrated, but do not assume that drinking excessive amounts of water will cure chronic constipation.
Access to reliable water can also be a practical consideration for some South African households. Advice about hydration should therefore recognise that healthcare recommendations do not always exist in a vacuum.
3. Being physically inactive
Movement can influence gastrointestinal function, and regular physical activity is generally beneficial for overall health.
For someone who spends most of the day sitting at a desk, driving or commuting, adding movement throughout the day can be a sensible part of a constipation-management plan.
This does not mean that exercise alone will resolve chronic constipation. Evidence for physical activity as a treatment specifically for constipation is less robust than evidence for some dietary and medication-based interventions.
Still, regular movement is a low-risk healthy habit for most people.
4. Ignoring the urge to have a bowel movement
Sometimes the issue is not a lack of opportunity to pass stool but a lack of suitable circumstances.
People may delay going because they are at work, travelling, at school or using a shared public toilet. Concerns about privacy, cleanliness or safety can make someone reluctant to use available facilities.
Repeatedly delaying bowel movements may contribute to difficulty establishing a comfortable bowel routine.
Where possible, give yourself enough time and privacy rather than consistently rushing or ignoring the urge.
5. Medications and supplements
Several medicines can contribute to constipation.
Examples include some:
- Opioid pain medicines
- Iron supplements
- Antidepressants
- Antihistamines
- Blood pressure medicines
- Antacids containing certain minerals
This does not mean you should stop a medication because you think it is causing constipation.
If constipation began after starting a medicine or supplement, speak to your doctor or pharmacist. They can determine whether the medication may be contributing and whether an alternative or additional treatment is appropriate.
Why You Shouldn’t Automatically Blame Your Diet
Fibre is important, but “eat more fibre” is not a complete treatment plan for everyone.
Some people with constipation experience significant bloating when they rapidly increase fibre. Others may have constipation related to slow movement through the colon, difficulty coordinating the muscles used for bowel movements, medication, an underlying medical condition or another cause.
There is also no universal “constipation diet” that works for everybody.
A balanced approach is more useful: assess the person’s symptoms, diet, fluid intake, medications, activity and bowel habits, and seek medical assessment when necessary.
What About Laxatives?
Laxatives can be useful medicines. They are not inherently harmful, and their appropriate use can form part of evidence-based constipation treatment.
The important distinction is between appropriate treatment and repeated self-treatment without addressing persistent symptoms.
Current clinical guidelines support several types of laxatives and other medicines for chronic idiopathic constipation. The American Gastroenterological Association and American College of Gastroenterology, for example, recommend or conditionally recommend several options depending on the individual circumstances, including fibre, polyethylene glycol, lactulose and stimulant laxatives such as bisacodyl or senna.
Stimulant laxatives have sometimes been described as causing inevitable “dependence” or permanently weakening the bowel. The evidence does not support such a simple claim.
However, long-term unsupervised use is still something to discuss with a healthcare professional. Evidence for prolonged use of some stimulant laxatives is limited, and clinical guidelines generally position them according to the individual’s circumstances rather than as a substitute for investigating persistent constipation.
If you find that you regularly need laxatives to have a bowel movement, that is a reason to discuss the pattern with a doctor or pharmacist.
A More Sustainable Approach to Constipation
If you experience occasional or mild constipation, several practical habits may help.
1. Increase fibre gradually
Include more vegetables, fruit, legumes and whole grains rather than making a sudden dramatic change.
If fibre makes your symptoms substantially worse, speak to a healthcare professional instead of simply increasing it further.
2. Drink regularly
Drink enough fluid to avoid dehydration, particularly in hot weather or when you are physically active.
There is no need to force excessive amounts of water.
3. Keep moving
Walking and other appropriate physical activity can form part of a generally healthy lifestyle.
Even breaking up long periods of sitting with short periods of movement can be worthwhile.
4. Respond to the urge
When circumstances allow, avoid repeatedly postponing bowel movements.
Give yourself adequate time and privacy rather than treating going to the toilet as something that must always be rushed.
5. Establish a routine
Some people find it helpful to sit on the toilet at roughly the same time each day, particularly after a meal.
This takes advantage of the gastrocolic reflex — the natural increase in bowel activity that can occur after eating.
A routine should be comfortable rather than forced. Straining excessively can make bowel movements more difficult.
6. Review your medicines
If constipation began after starting a medicine or supplement, ask a doctor or pharmacist whether there could be a connection.
Do not stop prescribed medication without professional advice.
When Should You See a Doctor?
Constipation that keeps returning, lasts for a long time or significantly affects your daily life deserves medical attention.
You should seek prompt medical advice if constipation is accompanied by symptoms such as:
- Blood in the stool
- Unexplained weight loss
- Persistent or severe abdominal pain
- Vomiting
- Significant abdominal swelling
- Anaemia
- A new and persistent change in bowel habits
- Inability to pass stool or gas
- Symptoms that are becoming progressively worse
These symptoms do not automatically mean that you have a serious disease. They indicate that self-treatment may not be enough and that the underlying cause should be assessed.
A South African study of patients referred for colonoscopy because of constipation illustrates why clinical context matters: some patients had significant findings, although the study population consisted of people already referred for investigation and therefore cannot be used to estimate cancer risk among everyone with constipation.
Breaking the Silence
Talking about bowel movements can feel embarrassing, but constipation is a health issue — not a personal failing.
If you are regularly uncomfortable, straining, relying on laxatives or changing your diet repeatedly without improvement, it is reasonable to ask for help.
Good gut health is not about having a bowel movement at a particular time every day. It is about understanding what is normal for you, recognising persistent changes and getting appropriate support when something is not right.
For more evidence-based information about digestive health, explore the Gut Health SA Gut Health Resources.
Conclusion
Constipation can have many contributors, including dietary patterns, medications, bowel habits, activity levels and underlying health conditions.
For many people, practical changes such as gradually increasing fibre, maintaining adequate hydration, staying active and responding to the urge to use the toilet can form part of a healthier bowel routine.
But persistent constipation should not simply be managed indefinitely with over-the-counter products. Laxatives can be appropriate treatments, but recurring symptoms deserve proper assessment.
Most importantly, there is nothing embarrassing about seeking help. Your bowel habits are part of your health, and they are worth talking about.
Health Disclaimer
This article is intended for general educational purposes only and does not replace personalised medical advice, diagnosis or treatment. Constipation can have many causes, and the appropriate treatment depends on the individual. If constipation is persistent, severe, recurrent or accompanied by concerning symptoms such as blood in the stool, unexplained weight loss, vomiting or significant abdominal pain, consult a doctor or other appropriately qualified healthcare professional.