Constipation is common at any age, but it becomes more frequent in midlife and beyond — and it’s more common in women than men.
What counts as constipation
Generally, having fewer than three bowel movements a week, or stools that are hard, dry, difficult or painful to pass, or a feeling of incomplete emptying.
Why it increases in midlife
- Hormonal changes. Progesterone slows gut movement; shifting hormone levels in perimenopause can make bowel habits less predictable.
- Pelvic floor changes. Childbirth and ageing can weaken or tighten pelvic floor muscles, sometimes leading to “dyssynergia”, where the muscles don’t relax properly during a bowel movement.
- Medications. Iron supplements, calcium, some antidepressants, opioids and certain blood pressure drugs commonly cause constipation.
- Less movement and lower fiber, often creeping in with busy schedules.
- Conditions such as an underactive thyroid or diabetes.
What helps
Fiber, gradually. Aim for about 25g a day, increasing slowly. Soluble fiber (oats, psyllium, kiwi fruit, prunes) is often best tolerated. Studies support prunes and kiwis specifically.
Fluids. Fiber needs water to work.
Movement. Even a daily walk stimulates the gut.
Routine. The gut is most active after waking and after meals. Give yourself unhurried time and don’t ignore the urge.
Position. Raising your feet on a small stool, so knees sit above hips, straightens the angle of the rectum and makes passing stool easier.
Laxatives. Osmotic laxatives such as polyethylene glycol are generally considered safe and effective when lifestyle changes aren’t enough. Check with a pharmacist, especially if you take other medications.
When to see a doctor
See a clinician for constipation that’s new and persistent, especially after 45, or comes with blood in the stool, unexplained weight loss, severe pain, or a change in stool shape. If you strain constantly despite soft stools, ask about pelvic floor dysfunction — specialised physical therapy is very effective.