Usually simple to fix once the right laxative is used the right way.
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Constipation means passing stools less often than is normal for you, straining, hard stools, or a persistent feeling of not having emptied properly. There is no correct number of times a week — anything from three times a day to three times a week can be perfectly normal. What matters is a change from your own pattern, and whether it is uncomfortable.
Two things make more difference than any prescription.
The first is how you sit. Sitting upright on a modern toilet works against the anatomy; a bend in the rectum stays partly closed in that position. Raising your knees above your hips on a small footstool, leaning forward with elbows on knees and letting your abdomen relax straightens it out. It is free, it works immediately, and almost nobody is told about it.
The second is that macrogol laxatives only work if you drink the full volume of water they are mixed with. Taken in a small splash, as most people do, they can make constipation worse rather than better.
One thing to be clear about: a persistent change in bowel habit over the age of 50 needs assessing rather than treating, particularly with bleeding or weight loss.
Liquid stool leaking past a hard impacted mass, so someone who is severely constipated presents with diarrhoea or soiling. Common in older adults, and in children who begin soiling their pants. Anti-diarrhoeal medication makes it considerably worse, and recognising it is the whole trick.
One of the commonest causes, and one of the most fixable:
Constipation is diagnosed from the history, which suits a remote consultation well. The purpose of assessment is to find a cause and to spot who needs more than a laxative.
Rectal examination where impaction, a mass or a fissure is suspected. Suspected impaction, severe pain, or any red flag needs assessing properly rather than treating remotely — and severe abdominal pain with vomiting and no wind passing is a hospital problem, not a laxative one.
Knees above hips on a small footstool, lean forward, elbows on knees, relax the abdomen and let it bulge. This straightens the anorectal angle, which stays partly closed when you sit upright. Do not hold your breath and strain — breathe out through pursed lips instead.
And use the natural timing: the bowel is most active in the 20 to 30 minutes after breakfast. Sitting then, unhurried, works better than trying at any other point in the day.
Frequently the whole answer. Where an opioid is genuinely needed, we prescribe a laxative alongside it from the start rather than waiting.
Needs a proper disimpaction regimen — high-dose macrogol over several days — rather than an ordinary dose. This applies to children too, where it is essential and frequently under-treated.
Go to A&E for:
Seek prompt assessment for:
Arrange an urgent appointment for:
Book a routine consultation for:
Regular walking genuinely helps, and it matters most in people who have become less mobile — which is exactly the group in whom constipation becomes entrenched.
A widespread worry, and largely misplaced. Osmotic laxatives such as macrogol can be used long term safely, and for many people that is the right approach. The genuine harms here come from chronic straining — piles, fissures, prolapse — not from the laxative used to avoid it. Long-term daily stimulant laxatives are worth reviewing, but no one should be enduring years of straining out of fear of a sachet.
Laxatives are available over the counter for a few pounds, and constipation rarely needs a doctor. Your NHS GP treats it free, and a pharmacist can advise without an appointment.
The advice that matters most is free and routinely given in the wrong order. A bulk-forming laxative such as ispaghula is first-line — but it needs plenty of fluid to work, and taken without it can make things worse. If that is insufficient, an osmotic laxative such as macrogol is next, and stimulant laxatives such as senna come after that rather than first.
Most people reach straight for senna, which works but is the wrong starting point for chronic constipation.
The most useful question is often about medication. Opioids, iron tablets, some antidepressants, calcium channel blockers and antacids containing aluminium all cause constipation, and a medication review sometimes resolves it entirely.
Where a consultation is genuinely worth paying for is a change in bowel habit rather than long-standing constipation — which is a different thing and warrants assessment rather than laxatives.
What needs prompt assessment: blood in the stool, unintended weight loss, a persistent change in bowel habit lasting more than six weeks over 50, abdominal pain with vomiting and no bowel movement, or a family history of bowel cancer. NHS bowel screening is free and worth doing when the kit arrives.
NICE Clinical Knowledge Summary, Constipation, is the principal reference. It recommends dietary and lifestyle measures first, then a stepped approach to laxatives — bulk-forming first, then osmotic, then stimulant, which underpins the ordering above.
CKS advises adequate fluid intake with bulk-forming laxatives, and cautions against them in opioid-induced constipation, where an osmotic or stimulant laxative is preferred.
CKS lists drug causes of constipation, which is the basis for the medication review point.
NICE NG12, Suspected cancer, defines the referral criteria for change in bowel habit, rectal bleeding, unexplained weight loss and iron deficiency anaemia.
NICE CG61 covers constipation-predominant IBS, and NICE TA290 covers prucalopride for chronic constipation in adults where laxatives have failed.
The NHS Bowel Cancer Screening Programme uses faecal immunochemical testing for eligible age groups.
There is no right answer — anything from three times a day to three times a week is normal. What matters is a change from your own pattern, whether the stool is hard, and whether you have to strain. Chasing someone else's normal is not a useful goal.
Change how you sit. Put a small footstool under your feet so your knees are above your hips, lean forward with your elbows on your knees, and let your abdomen relax. This straightens a bend in the rectum that stays partly closed when you sit upright on a modern toilet. It is free, it works straight away, and hardly anyone is told about it.
Almost always because it is being taken in too little water. Each sachet must be mixed with the full volume stated — and all of it drunk. Taken in a splash, it draws water out of the body and makes constipation worse. This one detail decides whether the treatment works.
This worry causes more harm than the laxatives do. Osmotic laxatives like macrogol are safe long term, and for many people continuing is the right choice. The real damage comes from years of straining — piles, fissures, prolapse. Long-term daily stimulant laxatives are worth reviewing, but nobody should be suffering to avoid a sachet.
Very likely. Codeine and co-codamol are opioids, and many people do not realise it. Opioid constipation does not wear off with time, which is why a laxative should be started at the same time as the painkiller rather than added later. Worth reviewing whether you still need the painkiller at all.
Almost certainly not. Soiling in a constipated child is overflow — liquid stool leaking past a hard mass, entirely outside their control. Telling a child off for it is both unfair and counterproductive. It needs a proper disimpaction course followed by months of maintenance treatment, and under-treatment is the usual reason it drags on.
No, and it is worth raising specifically. Needing to press around the anus or into the vagina suggests pelvic floor dysfunction — the muscles tightening rather than relaxing when you try to go. Laxatives do not fix this; specialist pelvic floor physiotherapy does, and it is regularly missed for years.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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