Constipation with bloating but no pain: when to see a doctor, according to Dr Aravind S N

Poor lifestyle and wrong eating habits are causing constipation and bloating in many people these days. The two often occur together, and many people are unsure when to consult a doctor. Dr Aravind S N, chief consultant in internal medicine at Aster RV Hospital in Bengaluru, has explained the matter.

According to experts, constipation or abdominal discomfort without pain is a common digestive problem. When bowel movements become less frequent, stools turn hard or there are none at all, it is clear that the bowels are not clearing. Experts say this is usually caused by wrong eating habits. But if the symptoms persist or have started afresh, they should not be ignored.

Constipation and bloating can have several causes: too little fibre, not drinking enough water, physical inactivity, changes in lifestyle and holding back the urge to pass stool. Certain medicines, such as iron supplements, some antacids and opioid painkillers, can also cause constipation. According to Dr Aravind, when stool stays in the intestines longer than normal, it can cause bloating and gas, and the stomach feels full.

A 2023 study published in Internal Medicine says constipation and bloating should not be taken lightly if serious symptoms appear, such as blood in the stool, weight loss, sudden-onset constipation or a lump in the abdomen. The same applies if the problem continues for a long time even after lifestyle changes and a fibre-rich diet. In such cases, consulting a doctor is essential. According to the study, doctors will judge the severity of the symptoms and find the underlying cause through a physical examination and certain specific tests.

According to experts, gradually increasing fibre in the diet through fruits, vegetables, whole grains and pulses can improve occasional constipation. Drinking enough fluids, regular exercise and regular bowel habits can also help. Experts also said fibre should be increased only gradually, because in some people a sudden increase can worsen bloating.

Dr Aravind made it clear that a doctor should be consulted if constipation lasts more than two to three weeks, keeps returning or there is any marked change in bowel habits. According to him, the doctor will assess eating habits, medicines and bowel patterns, and may carry out a physical examination or recommend tests if needed. Not everyone with constipation needs a scan or a colonoscopy. Tests depend on symptoms, age and risk factors.

According to Dr Aravind, the absence of pain is in many cases a relief, but it does not rule out a medical problem. If constipation and bloating persist, do not improve or warning signs appear, medical advice is essential. People aged 45 or above who have new or long-lasting constipation should see a doctor, especially if they need colorectal cancer screening or have other risk factors.

Warning signs include blood in the stool, unexplained weight loss, persistent fatigue, anaemia, steadily worsening abdominal swelling and a marked change in bowel habits. According to Dr Aravind, it is essential to speak to a doctor if there is a family history of colorectal cancer (cancer of the large intestine) or inflammatory bowel disease (inflammation of the intestines).