There is a wide range of what counts as "normal" when it comes to bowel habits. Going anywhere from three times a day to three times a week can be perfectly healthy. Some people have always had a slow bowel and go infrequently — and if this is comfortable and not causing you distress, it does not necessarily mean anything is wrong. Constipation becomes worth addressing when it is causing you real problems: straining to go, stools that are hard and difficult to pass, a feeling of never being quite empty, bloating, abdominal pain, or a noticeable change from what is normal for you.
When those symptoms are present, constipation is generally defined as fewer than three bowel motions per week or ongoing difficulty going to the toilet for three months or more. It is far more common than people expect — affecting around 15–20% of adults. Most cases get much better with simple dietary and lifestyle changes. A specialist review is worth having if constipation is severe, getting worse over time, or not responding to things you have already tried.
Slow transit constipation is a specific type of constipation where the bowel itself is simply slow at moving things along — stools can take days to travel through, leading to infrequent, hard motions, bloating, and real discomfort. It most commonly affects younger to middle-aged women, and it can be quite debilitating. To confirm the diagnosis, a colonic transit study is done. This is usually a nuclear medicine scan — you swallow a small amount of a labelled substance and a series of scans over one to two days shows how quickly it moves through your bowel. An older alternative (the radio-opaque marker study) is still used in some hospitals and involves swallowing small markers and tracking them on X-rays over several days.
The most common culprits are ones you can often address yourself: not enough fibre in your diet, not drinking enough water, and not moving around much during the day. Some medications — particularly strong pain relievers (opioids), iron tablets, and certain antidepressants — can make constipation significantly worse. Underlying health conditions like an underactive thyroid (hypothyroidism), diabetes, and some neurological conditions can also slow the bowel. It is also important to distinguish between slow transit (where stool moves slowly through the bowel) and obstructed defaecation — a pelvic floor problem where stool reaches the right place but there is difficulty pushing it out. These are different conditions that need different approaches.
Treatment builds up gradually, starting with the simplest steps. First: increasing dietary fibre to around 25–30 g a day, and drinking 1.5–2 litres of fluid a day. If that is not enough, an osmotic laxative — such as macrogol (sold as Movicol or Osmolax) — is a safe and gentle first medication that draws water into the bowel to soften stools. Stimulant laxatives (like senna or bisacodyl) can be added if needed. For people with confirmed slow transit constipation who are not getting better with laxatives, a prescription medication called prucalopride (listed on the PBS) can help by stimulating the bowel to move more actively. For a small number of people with very severe, treatment-resistant slow transit constipation who have genuinely exhausted every medical option, surgery — a procedure called a subtotal colectomy with ileorectal anastomosis, where the large bowel is mostly removed and the bowel is rejoined — can offer significant relief. This is not a decision that is made quickly or lightly, and it is always made collaboratively with your gastroenterologist.
Mr Nguyen takes a careful, step-by-step approach to constipation — always making sure simpler options are genuinely given a proper try before considering anything more involved. If slow transit constipation seems likely, he will arrange a colonic transit study to confirm it objectively before making treatment decisions. Surgery is only considered as a last resort, after every medical option has been truly exhausted, and always in close partnership with your gastroenterologist. The goal is always to find the solution that is right for you as an individual — not to rush to anything unnecessary.
It is worth seeing a specialist if you have developed new or worsening constipation after the age of 45, if constipation comes along with rectal bleeding, unexplained weight loss, or low iron levels, or if it is significantly affecting your quality of life. A colonoscopy is often recommended to check for any structural cause before putting the symptoms down to a functional issue. Please do not put it off — these things are always worth getting checked.
Your GP will send a referral and most patients are seen within one to two weeks. At the consultation, Mr Nguyen will take a thorough history, examine you, and arrange any investigations needed — often a colonoscopy first to rule out a structural cause, and sometimes additional tests such as a colonic transit study or anorectal physiology if a functional problem is suspected.
Treatment is almost always stepwise. The first step is optimising the simple things — dietary fibre, fluids, regular toileting habits, and the right combination of laxatives. Most people improve substantially at this stage. If symptoms continue despite a proper trial, Mr Nguyen will discuss the next options, which may include biofeedback therapy or, in carefully selected cases, surgery — always in partnership with your gastroenterologist. You will be reviewed at each step so progress can be checked and the plan adjusted if needed.
Not necessarily — there is no single "correct" number of times to go. If your bowel motions are comfortable to pass and you are not experiencing bloating, pain, straining, or distress, going less often may simply be your normal. What matters more than the number is whether something has changed for you, or whether it is causing you discomfort or worry. If it is — that is worth a conversation with a doctor.
Slow transit constipation is confirmed with a colonic transit study. In most centres now, this is a nuclear medicine (scintigraphic) scan — you swallow a small amount of a labelled substance and scans are taken over one to two days to track how it moves through your bowel. An older alternative, the radio-opaque marker study, involves swallowing small markers and taking X-rays over 5–7 days to see where they end up. Both approaches can show whether your bowel is genuinely slow at moving things along.
Osmotic laxatives like macrogol (Movicol, Osmolax) are safe to take every day for an extended period — there is no harm in ongoing use. Stimulant laxatives (like senna) are generally used less regularly, or combined with an osmotic agent, rather than on their own every day long-term.
Prucalopride is a prescription tablet that works by stimulating the muscles of the colon to contract more actively — it essentially gives your bowel a gentle nudge to move things along. It is available on the PBS for people with chronic constipation that has not responded to at least two different laxatives. It works well for roughly one in four people with slow transit constipation — not for everyone, but worth trying in the right situation.
Surgery for constipation — a procedure called subtotal colectomy with ileorectal anastomosis, where most of the large bowel is removed and the bowel rejoined — is only considered as a genuine last resort, for people with severe, confirmed slow transit constipation who have tried everything else. It is not a decision made quickly. It involves a thorough discussion with you, your gastroenterologist, and Mr Nguyen, to make sure it is truly the right choice for your situation. When it is appropriate for the right person, it can make a meaningful difference to quality of life.
If constipation is affecting your life and you would like a proper assessment, Mr Ba Nguyen is glad to help. He consults at his rooms in Heidelberg and operates at Warringal Private Hospital and Epworth Eastern, Box Hill. A GP or specialist referral is needed to make an appointment.