Chronic constipation
Constipation means passing stools fewer than three times a week, or stools that are hard, painful or difficult to pass, often with a feeling of not emptying fully. It becomes chronic when it lasts for months. Most cases improve with more fibre, fluids, activity and a regular toilet routine, with an osmotic laxative if needed. Bleeding, unexplained weight loss, a persistent change in bowel habit or a family history of bowel cancer need assessment, which may include a colonoscopy. Further tests help when symptoms persist despite treatment, and surgery is rarely needed.
What is chronic constipation?
Constipation means opening your bowels fewer than three times a week, or passing stools that are hard, painful or difficult to pass, often with a feeling of not emptying fully. It is chronic when it lasts for months. Most chronic constipation has no serious cause, but warning signs need investigation.
Constipation is a symptom rather than a disease. Chronic constipation can come from slow movement of stool through the colon, difficulty emptying the rectum because the pelvic floor muscles do not relax properly, or both. It can also be caused by medicines, other medical conditions or, rarely, a blockage in the bowel.
What causes chronic constipation?
Common causes are too little fibre, fluid or activity, ignoring the urge to go, and medicines such as opioid painkillers, some antidepressants and iron or calcium supplements. Some people have a slow-moving colon or pelvic floor muscles that do not relax. Diabetes, an underactive thyroid and irritable bowel syndrome can also cause it.
- Too little fibre or fluid in the diet
- Too little physical activity
- Often ignoring the urge to go
- Medicines, including opioid painkillers, some antidepressants, calcium channel blockers, and iron or calcium supplements
- Pregnancy, older age and changes in routine such as travel
- Slow movement of stool through the colon
- Pelvic floor muscles that do not relax when you try to empty the bowel
- Conditions such as diabetes, an underactive thyroid, Parkinson's disease or irritable bowel syndrome
- Rarely, a narrowing or growth in the bowel
What are the symptoms?
Chronic constipation causes infrequent bowel movements, hard or lumpy stools, straining or pain when passing stool, and a feeling that the bowel has not emptied completely. Bloating and tummy discomfort are common. In older people, constipation can be missed, and a change in behaviour may be a sign of discomfort. Sudden confusion needs urgent medical assessment and should not be assumed to be constipation.
- Opening your bowels fewer than three times a week
- Hard, dry or lumpy stools
- Straining or pain when passing stool
- A feeling that the bowel has not emptied completely
- Bloating or tummy discomfort
When should I see a doctor about constipation?
See a doctor if constipation keeps returning or does not improve with simple measures. Blood in the stool, unexplained weight loss, anaemia, a persistent change in bowel habit or a family history of bowel cancer need prompt assessment. Seek urgent care for constant tummy pain, vomiting or being unable to pass wind.
The warning signs below need prompt attention.
- Blood in or on the stool
- Losing weight without trying
- A recent change in bowel habit, especially from age 50
- A family history of bowel cancer
- Anaemia or feeling tired all the time
- Constant tummy pain, vomiting, or being unable to pass wind, which needs urgent care
How is it diagnosed?
Assessment starts with your bowel habit, diet, medicines and other conditions, and an examination including the back passage. Blood tests may be done. A colonoscopy is arranged when warning signs are present. If simple treatment fails, tests of the pelvic floor and of how fast stool moves through the colon help find the cause.
- A careful history of your bowel habit, diet, medicines and other conditions
- Examination, including a gentle examination of the back passage
- Blood tests where needed, for example for anaemia or thyroid problems
- Colonoscopy when warning signs are present, or when age or family history call for it
- Anorectal physiology tests or a defecation scan if emptying the rectum is the main problem
- A colonic transit study to measure how fast stool moves, before any surgery is considered
How is chronic constipation treated?
Most constipation improves with more fibre, fluids and activity, and a regular toilet routine. Osmotic laxatives are the usual first medicine, with stimulant laxatives as a second line. Pelvic floor problems are treated with biofeedback. Surgery is reserved for carefully selected people after specialist tests, such as those with a rectocele causing symptoms, a rectal prolapse or a severely slow colon.
- More fibre, introduced gradually, with plenty of fluids
- Regular activity and a regular, unhurried toilet routine, with the feet raised on a low stool
- Reviewing medicines that may be causing constipation, without stopping any prescribed medicine on your own
- Osmotic laxatives as the usual first medicine, with stimulant laxatives as a second-line or rescue option
- Prescription medicines for constipation that does not respond to standard laxatives
- Biofeedback therapy to retrain the pelvic floor muscles when they do not relax
- Surgery for carefully selected patients after specialist testing and non-surgical treatment, such as repair of a rectocele that is causing symptoms or of a rectal prolapse, or rarely removal of the colon for severe slow-transit constipation once pelvic floor problems have been assessed
Is it covered by MediSave or insurance?
Dr Wong is a panel doctor under Alliance Medinet. Before your procedure, he can request pre-authorisation from Prudential and AIA, and the clinic writes in to other insurers in the same way. Prudential patients can claim when Dr Wong operates at Aptus Surgery (Paragon), a day surgery centre listed on Prudential's PRUPanel Connect. Pre-authorisation is decided by the insurer and is not a guarantee of payment. Eligible charges may be paid from MediSave within the limits for your procedure, and any uncovered balance is paid in cash.
How it works, step by step: fees, MediSave and insurance.
What is the outlook?
Diet and routine changes Days to a few weeks
Some people notice a difference within a few days
Laxatives Most work within 3 days
Some people need laxatives long term, with the medicine and dose reviewed regularly
Long term Ongoing
Many people manage well by keeping to the same habits
What are the risks and complications?
Long-term constipation and straining can lead to haemorrhoids and anal fissures. Hard stool can build up in the rectum, called faecal impaction, causing liquid stool to leak around it. The most important risk is missing another cause, which is why warning signs are always checked.
- Haemorrhoids or anal fissures from straining and hard stools
- Faecal impaction, where hard stool builds up in the rectum and liquid stool leaks around it
- Missing a different cause if warning signs are not checked
- Side effects of laxatives, such as bloating or cramps
- Risks of surgery when it is needed, including leakage, diarrhoea, blockage and symptoms that persist
How much does it cost in Singapore?
The cost depends on the treatment you need and how complex it is. MOH publishes fee benchmarks for most surgical procedures, and Dr Wong's fees are guided by them. After your consultation the clinic gives you a written estimate before you decide. See fees, MediSave and insurance.
Medically reviewed by Dr Wong Nan-Yaw
MBBS (NUS), FRCS (Edinburgh). 33 years in medicine (since 1993), 23 years as an accredited specialist (since 2003) and 18 years in private practice at Mount Elizabeth (since 2008). Last reviewed 6 November 2026.
Frequently asked questions
How often should I open my bowels?
Normal ranges from about three times a day to three times a week. What matters more is a change from your usual pattern, hard stools, straining, or a feeling of not emptying.
Do I need a colonoscopy for constipation?
Not always. A colonoscopy may be recommended for warning signs such as bleeding, unexplained weight loss or anaemia, a persistent change in bowel habit, a strong family history of bowel cancer, or when screening is due.
Is it safe to take laxatives long term?
Laxatives are best used with a plan. Osmotic laxatives are the usual first choice. If you find you cannot go without them, talk to your doctor about adjusting or slowly reducing them.
When is surgery considered?
Rarely. Surgery is considered only after diet, laxatives and, where relevant, biofeedback have not helped, and after specialist tests show a cause that surgery can address, such as a rectocele that is causing symptoms, a rectal prolapse or a very slow colon. Finding one of these on a test does not by itself mean an operation will help.
References and further reading
Related
Colonoscopy
Colonoscopy for screening and investigation by Singapore colorectal surgeon Dr Wong Nan-Yaw. Bowel prep, what to expect, cost, recovery and MediSave.
Irritable bowel syndrome
Irritable bowel syndrome diagnosis and care by colorectal surgeon Dr Wong Nan-Yaw, with symptom management and when tests are needed.
Rectal prolapse
Rectal prolapse diagnosis and repair by colorectal surgeon Dr Wong Nan-Yaw, with abdominal and perineal options, recovery and cost.