Online Constipation Treatment

Many cases of uncomplicated constipation can be assessed online. The clinician will review how long symptoms have been present, stool frequency and consistency, abdominal symptoms, medicines, diet, fluid intake, pregnancy status and whether there are any warning signs.

Severe abdominal pain, persistent vomiting, marked abdominal swelling, inability to pass wind, rectal bleeding, unexplained weight loss or suspected bowel obstruction requires face-to-face assessment.

No. Treatment depends on symptom duration, stool consistency, likely cause, current medicines and whether simple diet, fluid and activity measures have already been tried.

Several medicines can contribute to constipation, including opioids, anticholinergic medicines, iron, some antidepressants and some antacids. Addressing the cause may be as important as adding a laxative.

Constipation can mean passing stools less often than usual, having hard or lumpy stools, straining, feeling unable to empty fully or needing excessive effort to pass stool.

Common causes include low fibre intake, low fluid intake, reduced activity, changes in routine, pregnancy, medicines and some medical conditions. Sometimes no single cause is identified.

Short-term constipation may settle within days after lifestyle changes or laxative treatment. Persistent, recurrent or newly developed constipation without a clear cause should be reassessed.

Faecal impaction occurs when a large amount of hard stool becomes stuck in the rectum or bowel. It can cause abdominal discomfort, overflow diarrhoea or difficulty passing stool and may need a specific treatment regimen rather than routine constipation dosing.

Macrogol is an osmotic laxative. It draws water into the bowel, helping soften stool and make it easier to pass.

For common adult macrogol sachets, the usual dose is 1 to 3 sachets daily in divided doses, adjusted according to response and the exact product instructions.

Macrogol usually takes around 1 to 2 days to start working, although response varies between individuals.

Dissolve the sachet in the amount of water stated on the pack and drink it. Continue drinking normal fluids during the day because the water used to dissolve the sachet does not replace usual fluid intake.

Yes. NHS advice recommends taking other oral medicines at least 1 hour before or 1 hour after macrogol because absorption of some medicines can be affected.

Possible effects include bloating, wind, abdominal discomfort, nausea and diarrhoea. Reducing the dose can help if stools become too loose.

Lactulose is an osmotic laxative that draws water into the bowel and softens stool. It is commonly used when a softer stool is needed or when another laxative is unsuitable.

The NHS lists 15 ml twice daily as the usual adult starting dose for constipation, adjusted according to response.

Lactulose usually takes at least 2 days to work, so it is not the best option when rapid relief is required.

Measure the dose using the supplied cup or spoon. It can be taken with or without food and may be mixed with water or fruit juice if preferred.

Wind, bloating, abdominal discomfort and diarrhoea can occur, particularly when treatment is first started or the dose is too high.

Yes. NHS advice recommends maintaining good fluid intake while taking lactulose because inadequate fluid intake can worsen constipation.

Senna is a stimulant laxative. It stimulates the muscles of the bowel to help move stool through the gut.

For self-treatment, the usual adult dose is 7.5 mg to 15 mg at bedtime, usually one or two standard-strength tablets depending on the product.

Senna usually takes around 8 hours to work, which is why it is commonly taken at bedtime for an effect the following morning.

Senna is generally used for short-term constipation. NHS advice is to use it for only a few days and not longer than 1 week unless it has been prescribed for longer.

Abdominal cramps and diarrhoea are common adverse effects. Long-term or excessive use can contribute to fluid and electrolyte disturbance.

Yes. Senna can sometimes turn urine a red-brown colour. This is harmless and returns to normal after treatment stops.

An osmotic laxative such as macrogol is commonly used when stools are hard because it increases water in the stool. The most suitable treatment depends on the individual situation.

A stimulant laxative may be added when stool is soft enough but still difficult to pass or bowel movement remains inadequate. Combination treatment should be tailored to symptoms rather than used automatically.

Two osmotic laxatives are not usually combined routinely. If one is ineffective or poorly tolerated, switching or adding a laxative from another class may be more appropriate.

Yes. Adequate fluid intake, regular activity, responding promptly to the urge to open the bowels and gradually increasing dietary fibre where appropriate can help.

The aim is to achieve comfortable, regular bowel movements with soft, formed stools and minimal straining. The laxative dose can often be adjusted according to response.

Reduce or stop the laxative according to the treatment plan and maintain hydration. Persistent or severe diarrhoea should be reviewed, particularly in older adults or people at risk of dehydration.

Some people need longer-term laxative treatment, particularly when constipation has an ongoing cause. Long-term treatment should be reviewed to ensure the medicine, dose and underlying diagnosis remain appropriate.

If symptoms persist despite correct treatment, further assessment may be needed to review the diagnosis, medicines, diet, faecal impaction or other bowel conditions.

Urgent assessment is needed for severe or worsening abdominal pain, persistent vomiting, marked abdominal swelling, inability to pass wind or stool, significant rectal bleeding, collapse or suspected bowel obstruction.

Small amounts of bright blood can occur with haemorrhoids or an anal fissure, but new, persistent, unexplained or significant rectal bleeding should be medically assessed.

Unexplained weight loss with a change in bowel habit is a warning sign and requires medical assessment rather than repeated self-treatment with laxatives.

Pregnancy should be disclosed before treatment. Macrogol and lactulose are commonly used options in pregnancy when needed, while treatment should still be selected according to symptoms and individual suitability.

Some macrogol products contain sodium or potassium and may need additional review in people with kidney disease, heart disease or dietary electrolyte restrictions. Check the exact formulation supplied.

Repeat treatment may be appropriate where the cause and regimen are established, but new persistent constipation, worsening symptoms or repeated need for escalating laxative doses should trigger clinical review.

If treatment is appropriate, the laxative will be supplied with clear directions for dose, duration, fluid intake and what to do if symptoms do not improve.