For constipation, what should I change first? What to do before turning to laxatives
This answer is a draft. It stays unpublished until legal review and source verification are complete.
In Japan's national health survey, constipation ranks near the top of self-reported symptoms among women, and laxatives are a year-round staple of drugstore (Matsumoto Kiyoshi, Welcia, etc.) shelves. Many people believe "if I do not go every day, I am constipated", or take a stimulant laxative every day. There is a lot here worth looking at again.
The basics of constipation and daily guides
| Item | Content |
|---|---|
| Definition (clinical practice guideline) | "A state in which stool that should be passed cannot be passed in sufficient quantity and comfortably." Frequency is not part of the definition |
| How many people | In the Comprehensive Survey of Living Conditions, about 3–4% of the population report constipation; about twice as many women as men; a sharp rise over 70 |
| Dietary fibre target | Adult men 21 g or more, women 18 g or more per day (Dietary Reference Intakes for Japanese, 2025 edition). Actual average intake is about 14–15 g, so short |
| Fluids | Around 1.2 L besides meals. A glass of water right after waking can start the bowel moving |
| Bowel reflex | Most likely within 30 minutes after breakfast. Making a habit of sitting on the toilet at this time is the first move |
| Sitting position | Knees higher than the hips, leaning forward (use a footstool): the rectum straightens and stool passes more easily |
| Exercise | Reports that 20–30 minutes of walking a day improves bowel movement |
Types of OTC laxative and how to use them
| Type | Examples | Use |
|---|---|---|
| Stimulant laxatives | Senna, sennoside, bisacodyl, daiō (rhubarb root, common in Japanese herbal laxatives) | Occasional use (up to 2–3 times a week). Daily use makes them less effective, with abdominal pain and dependence problems. The most widely taken type, and the one needing most care |
| Osmotic (saline) laxatives | Magnesium oxide (酸化マグネシウム, sanka-maguneshiumu) | Softens the stool. People with reduced kidney function and older people should watch for high blood magnesium; for long-term use, ask a doctor |
| Bulk-forming and gut-flora products | Fibre preparations, lactic acid bacteria, bifidobacteria (整腸剤, seichōzai) | Gentle. Take with fluids |
| Suppositories and enemas | Glycerin enemas and the like | For emergencies when you just need to go. Not for regular use |
- There are two kinds of fibre: soluble (seaweed, oats, fruit, barley) softens the stool; insoluble (vegetables, beans, brown rice) adds bulk. Some people get harder stools if they only add insoluble fibre, so take both.
- Fermented foods (yoghurt, nattō, miso, nukazuke rice-bran pickles) and oligosaccharides (onion, banana, soya) feed the gut bacteria.
- Do not hold it in: repeatedly ignoring the urge dulls the rectum, and you feel the urge less.
- Symptoms where seeing a doctor comes first: blood in the stool or black stool, sudden weight loss, severe abdominal pain or vomiting, persistently thin stools, constipation that newly starts after 50, colorectal cancer in the family. Colorectal cancer screening (faecal occult blood test) is recommended once a year from age 40.
[Verify] Update the prevalence figure to the latest year of the Comprehensive Survey of Living Conditions. Check the fibre target and average intake against the Dietary Reference Intakes 2025 edition and the National Health and Nutrition Survey.
Misunderstanding 1｜If I do not go every day, I am constipated
Once every 2–3 days is not constipation if it passes comfortably and without discomfort. Conversely, going every day but with hard stools, a remaining feeling or straining is constipation.
Misunderstanding 2｜Just eat lots of vegetables and it is solved
Some people get harder stools when they only add insoluble fibre. Add soluble fibre, fluids and some fat as a set.
Misunderstanding 3｜OTC laxatives are fine to take every day
Daily use of stimulant laxatives leads to reduced effect, abdominal pain and a sluggish bowel. Occasional use is the rule. If you need one every day, ask a doctor.
Misunderstanding 4｜Mornings are busy, so I will sit on the toilet at night
The bowel reflex is most likely after breakfast. Getting up 5 minutes earlier to sit works better than 30 minutes at night.
Misunderstanding 5｜It is just age, nothing to be done
Constipation in older age often has fluids, exercise or medicine side effects (painkillers, anticholinergics and so on) behind it, and improves when these are reviewed. Constipation that starts suddenly may also be a sign of illness, so ask a doctor.
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Sources
- Japanese Society of Gastroenterology [日本消化管学会], *Evidence-based clinical practice guidelines for bowel dysfunction 2023: chronic constipation* [便通異常症診療ガイドライン2023 慢性便秘症]
https://www.jsgs-ns.jp/
- Ministry of Health, Labour and Welfare, *Dietary Reference Intakes for Japanese (2025 edition)* [日本人の食事摂取基準（2025年版）] (dietary fibre targets)
https://www.mhlw.go.jp/stf/newpage_44138.html
- Ministry of Health, Labour and Welfare, *Comprehensive Survey of Living Conditions* [国民生活基礎調査] (rate of reported symptoms: constipation)
https://www.mhlw.go.jp/toukei/list/20-21.html
⚠️ Editorial note: the source URLs above were identified by search. Our working environment cannot reach go.jp domains, so the contents have not been checked against the text. Verify every source before publication and record who checked it and when.
About this article
What we share here are ideas and everyday practices passed down among people living in Japan, together with general information drawn from public sources. They are not official recommendations, and they are not professional instruction. Practices vary between households and regions.
This is general information. Results vary from person to person and depend on your own conditions and surroundings.
Please decide for yourself, using your own judgement, whether any of this suits your situation. We cannot accept responsibility for any damage, loss or injury arising from following this article.
This article is not meant to diagnose or manage any specific medical condition. If you are worried about your health, see a doctor rather than relying on your own judgement.
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