Index

Recent
{{a.title}}

Constipation (Adults)

NICE CKS Constipation. Last revised: Jun 2025.

Guidelines

Advise the following to all patients:

Eating a healthy balanced diet containing whole grains, fruits and vegetables
Increase fibre intake (30g per day)
Drink adequate fluids
Increase activity and exercise levels (if below recommended levels)
Advice on toileting routines
- Regular, unhurried toilet routine, giving time to ensure that defecation is complete
- Respond immediately to the sensation of needing to defecate

If lifestyle measures (above) are ineffective, offer treatment with oral laxatives:

Step 1: bulk-forming laxative (e.g. ispaghula)
- Note that a bulk-forming laxative requires the person to drink adequate fluid for it to work

Step 2: add or switch to osmotic laxative (1st line: macrogol, 2nd line: lactulose)

Step 3: consider prucalopride
- To be used in chronic constipation
- If at least 2 different laxative classes have been tried at the highest dose for at least 6 months

If stools are soft but difficult to pass or there is a sensation of inadequate emptying → add a stimulant laxative

Once the patient is able to produce soft, formed stool without straining at least 3 times per week, gradually reduce and stop the laxatives.

1st line: osmostic laxative + stimulant laxative

Do not offer bulk-forming laxatives

Step 1:

Hard stools → oral macrogol (high-dose), then add a stimulant laxative if ineffective after a few days
Soft stools → oral stimulant laxative

Step 2 (if oral laxative is ineffective):

Suppository (bisacodyl for soft stools, glycerol +/- bisacodyl for hard stools)
Mini enema (docusate or sodium citrate)

Step 3:

Enema (sodium phosphate or arachis oil)

References

NICE CKS Constipation

Background Information

Guidelines

References

Author: Adams Lau
Reviewer:
Last edited: 11/08/25

1. By accessing or using this website, you agree to comply with and be bound by these terms and conditions. If you do not agree with any part of these terms and conditions, you must not use this website.

2. Use of the website: This website is for informational and educational purposes only and is intended for medical professionals. You agree to use the website in a lawful manner and to refrain from activities that may disrupt its functionality or compromise its security.

3. Intellectual property: All content on this website, including but not limited to text, graphics, logos, images, and code, is the property of Guideline Genius LTD unless otherwise stated. Unauthorised reproduction, distribution, or use of the website's content is strictly prohibited without prior written consent.

4. Subscriptions and payments: Certain sections of the website may require a subscription for access. By subscribing, you agree to pay any fees specified during the subscription process. All fees are non-refundable unless otherwise specified.

5. Accuracy and updates: While we strive to ensure the accuracy of the information on this website, we do not guarantee that the content is error-free or up-to-date. Guideline Genius LTD reserves the right to modify or update the content of this website at any time without prior notice.

6. Third-party links: This website may contain links to third-party websites for your convenience. Guideline Genius LTD is not responsible for the content, accuracy, or availability of these external sites.

7. Disclaimer of liability: Guideline Genius LTD disclaims any liability for damages resulting from the use of or reliance on this website or its content. Your use of the website is at your own risk, and we shall not be held liable for any direct, indirect, or consequential damages.

8. Termination: We reserve the right to terminate your access to the website at our discretion, without notice, for any breach of these terms.

9. Governing law: These terms and conditions shall be governed by and construed in accordance with the laws of England and Wales.

Medical disclaimer

1. No advocacy or endorsement: Guideline Genius LTD does not advocate or endorse the use of any specific drug, therapy, medical intervention, or any other content mentioned on this website, including but not limited to diagnostic tools, procedures, or treatment recommendations. All content is for informational and educational purposes only and does not constitute medical advice or diagnosis.

2. Professional responsibility: As a medical professional, you retain full responsibility for the care and treatment of your patients. You should use your own clinical judgment, expertise, and knowledge of local regulations when interpreting and applying the information provided on this website.

3. Scope of information: This content does not aim to cover all possible diagnostic methods, treatments, follow-up protocols, drugs, contraindications, or side effects. Medical standards and practices evolve as new data become available, and we strongly recommend consulting multiple reputable sources to validate the information provided.

4. Verification of information: You are advised to independently verify all diagnoses, treatments, and follow-up plans to ensure they are appropriate for your patient and compliant with the regulations in your region. When dealing with prescription medication, always consult the product information sheet and the British National Formulary to verify conditions of use, dosage schedules, indications, forms of administration, adverse effects, contraindications, cautions, and any circumstances under which the medication should be avoided.

5. Accuracy and updates: Information on this website is provided on an "as is" basis without representations, warranties, or conditions regarding its accuracy, completeness, or timeliness. While we strive to provide up-to-date content, Guideline Genius LTD and its contributors do not guarantee the information will always reflect the latest medical standards or practices.

6. Liability disclaimer: To the fullest extent permitted by law, Guideline Genius LTD disclaims all liability for any loss, injury, or damage arising from the use of this website's content. All implied warranties and conditions, including those of satisfactory quality, fitness for a particular purpose, and use of reasonable care and skill, are excluded.

7. Local guidelines: Where regional or local guidelines are applicable, users should refer to those resources for contextually relevant information. Guideline Genius LTD disclaims all liability for reliance on content not specifically aligned with your local medical guidelines or practices.

8. Emergency situations: In case of a medical emergency, contact your local emergency services or healthcare provider immediately.