Dietary Strategies for Managing Constipation

Constipation, a condition characterized by infrequent bowel movements and difficulty passing stools, affects people of all ages. While occasional constipation is common, chronic constipation can significantly impact one's quality of life. Fortunately, dietary and lifestyle modifications can often provide relief and prevent future occurrences. One of the primary causes of chronic constipation (constipation lasting longer than 14 days) is poor lifestyle choices. In particular, a bad diet that does not contain enough fiber is a significant risk factor for chronic constipation. This article explores the role of diet in managing constipation, focusing on the importance of fiber and other dietary considerations.

Understanding Constipation

Constipation is generally defined as having fewer than three bowel movements per week. Other symptoms may include:

  • Straining during bowel movements
  • Passing hard, lumpy stools
  • Feeling as though you cannot completely empty your bowels

Normal stool is soft and easy to pass, occurring one to three times per day, or once every two to three days. Signs of constipation include stooling less often than normal, stools that are like small hard balls, stool that is wide or clogs the toilet, straining to pass a stool, and painful bowel movements.

While the causes of constipation can range from dehydration to IBS or a sedentary lifestyle, diet is almost always an important factor in alleviating constipation symptoms.

The Role of Fiber

Fiber, a nutrient found in plants, plays a crucial role in digestive health. It helps move food through the stomach and intestines, making stools easier to pass. Fiber supports the microbiome of healthy bacteria in the digestive tract and aids in gut motility, which is the coordination of muscle contractions in the intestines that pushes food along the digestive tract. The USDA recommends that healthy adults consume a minimum of 14 grams of dietary fiber for every 1,000 calories they consume.

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Types of Fiber

There are two main types of fiber: soluble and insoluble.

  • Soluble Fiber: This type of fiber dissolves in water, forming a gel-like substance in the digestive tract. This gel adds bulk to the stool and acts as a natural stool softener, making bowel movements easier to pass. Soluble fiber is often better tolerated by individuals with constipation related to Irritable Bowel Syndrome (IBS).
  • Insoluble Fiber: This type of fiber does not dissolve in water. It helps speed up the passage of food through the gut, bulking up the stools and promoting regular bowel movements.

Adding a healthy balance of foods high in both soluble and insoluble fiber can provide effective constipation relief in many cases.

Incorporating Fiber into Your Diet

To increase fiber intake, gradually incorporate fiber-rich foods into your diet over a few weeks to minimize bloating and gas. Here are some strategies:

  • Fruits and Vegetables: Include a variety of fruits and vegetables in every meal and snack. Good choices include apples, pears, cucumbers, berries, kiwi, prunes, persimmons, dates, figs, apricots, and raisins. Wash fruits and vegetables before eating to decrease environmental contaminants. If possible, use organic produce.
  • Whole Grains: Choose whole-grain breads, cereals, and pasta. Look for "whole grain" as the first ingredient on the label. Examples include quinoa, brown rice, wild rice, and millet.
  • Legumes: Add beans, peas, and lentils to soups, stews, salads, and pasta dishes.
  • Nuts and Seeds: Incorporate nuts and seeds into your diet as snacks or additions to meals. Ground flaxseed, chia seeds, and nut butters are excellent sources of fiber.

Other Dietary Considerations

In addition to fiber, other dietary factors can influence constipation.

  • Hydration: Adequate fluid intake is essential for preventing and relieving constipation. Fluid keeps things moving. Drink plenty of water throughout the day to keep stools soft and easy to pass. Aim for clear or very pale urine, which indicates good hydration. Beverages are not the only source of fluids. Soup, yogurt, popsicles, fresh fruits and vegetables, and other liquid-containing foods can also count toward goal fluids.
  • Magnesium: Magnesium is important for gut health. Slowly increase the amount of magnesium-containing foods in the diet: Nuts, Seeds, Dark leafy greens, Beans and lentils, Whole grains, Avocado, Yogurt, Fish.
  • Foods to Avoid: Certain foods can worsen constipation. Limit or avoid alcohol, refined sugars, processed grains, dairy products (if lactose intolerant), high-fat meats, and highly processed or fried foods.

Lifestyle Changes

Alongside dietary changes, lifestyle modifications can help manage constipation.

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  • Exercise: Regular physical activity helps improve the movement of stool through the colon. Aim for at least 60 minutes of exercise every day.
  • Bowel Habits: Don't ignore the urge to pass stool. Establish a regular toilet schedule, such as after meals or in the morning.
  • Relaxation: Find time each day to relax and avoid rushing when sitting on the toilet.

Treating Constipation Through Nutrition and Lifestyle Changes

  • Drink enough fluid.
  • Include high-fiber foods in the diet.
  • Add nutrition supplements, with the help of your healthcare provider.
  • Eat and drink on a regular schedule.
  • Be physically active.
  • Find time each day to relax and avoid rushing when sitting on the toilet. Mornings and after a meal may be a good time to practice toilet sitting.

Ways to Encourage Good Fluid Intake:

  • Carry a refillable water bottle during the day.
  • Flavor water with fruits, vegetables, and herbs. For example, try adding sliced cucumber and mint, strawberries and lemon slices, or lime and basil to a pitcher of water and allow it to stand for a few hours in the refrigerator.
  • Make iced or hot herbal teas (such as mint, ginger, chamomile, or hibiscus).
  • Warm broth and soups.
  • 100% fruit popsicles.

Ways to Encourage and Increase Fiber Intake:

  • Include a fiber-rich food in every meal and snack. Build up intake slowly to avoid gassiness.
  • Fruits and vegetables like apples, pears, and cucumbers that have a fibrous but tasty skin are good choices. Wash fruits and vegetables before eating to decrease environmental contaminants. If possible, use organic produce.
  • Whole grains: Look for “whole grain” as the first ingredient.
  • Choose high-fiber cereals for breakfast.
  • Look for whole grain breads with 4 grams of fiber per slice.
  • Use whole grain tortillas to make home-made pizza.
  • Substitute part of flour in recipes with whole grain flour.
  • Replace white rice with quinoa, brown or wild rice, or millet.
  • Include popcorn as a snack.
  • Fruits: Add fresh or dried fruit to cereal, yogurt, and salads.
  • Use fresh or frozen fruit in smoothies or popsicles.
  • Add dried fruits to trail mix.
  • Use fresh, canned, or baked fruit as dessert.
  • Fruits like kiwi, berries, pears, apples with peel, prunes (plum), persimmons, dates, figs, apricots, and raisins are especially helpful in preventing or relieving constipation.
  • Mash and spread on bread with nut or seed butter. Add to baked goods.
  • Vegetables: Give lots of opportunities to taste new vegetables!
  • Mix pureed vegetables into soups or pasta sauce.
  • Chop into small pieces and mix in a salsa dip, chili or on pizza.
  • Let your child choose vegetables to turn a salad into a rainbow of colors.
  • Cut into spears or slices and serve with a favorite dip.
  • Add leafy greens, carrots, avocado, spinach, beets, pumpkin, or sweet potato to a fruit smoothie.
  • Legumes: Includes beans, peas, lentils
  • Add to a favorite soup, stew, or chili.
  • Puree beans or lentil to thicken a soup or sauce.
  • Toss peas or chickpeas in a salad or pasta dish.
  • Oven roast chickpeas with a little oil and spices for a crunchy snack.
  • Puree black beans or chickpeas with oil and flavorings (garlic, lemon or lime, herbs). Use as a dip or spread for veggies, whole grain crackers or tortilla chips. Use as a spread on sandwiches.
  • Nuts and seeds: Add ground flaxseed to hot cereals, smoothies, or baked goods.
  • Use as a substitute for egg in baked goods.
  • Make a trail mix with your favorite nuts and seeds or try new ones.
  • Thicken puddings and smoothies with chia seeds.
  • Use nut and seed butters as a spread. Add to smoothies, soups, and stews.
  • Wisk equal amounts of water and sunflower seed butter, peanut butter, or tahini to make a sour cream substitute. Add more water as a substitute for cream in soups and stews.

Other Helpful Foods:

  • Try pear nectar or prune juice. Drink prune juice plain, mixed with water or orange juice, or use it to sweeten herbal tea.

When to Seek Medical Advice

If dietary and lifestyle changes do not relieve constipation, consult a healthcare professional. They can evaluate your symptoms, identify any underlying causes, and recommend appropriate treatment options. Your health care professional may order a test that tracks the movement of stool through the colon. This is called a colorectal transit study. Radiopaque marker study. Scintigraphy. Anorectal manometry. A narrow, flexible tube is inserted into the anus and rectum. After a small balloonlike device is inflated, it is pulled back out the anus. Balloon expulsion test. This test measures the amount of time it takes to push out a small, water-filled balloon in the rectum. Defecography. This test is designed to mimic passing stool. A thick substance that can be tracked with imaging technology is placed in the rectum.

Medical Interventions

Treatment for constipation usually begins with diet and lifestyle changes meant to increase the speed at which stool moves through the colon. Also, your health care professional may change the medicines you take if they may be causing or worsening constipation.

Laxatives

Laxatives are medicines that help move stool through the colon. Each laxative works somewhat differently.

  • Fiber supplements. Fiber supplements help stool retain fluids. The stool is then softer and easier to pass.
  • Osmotics. Osmotic laxatives help stool move through the colon by increasing the amount of fluids released into the intestine.
  • Stimulants. Stimulants cause the walls of the intestine to tighten, forcing the movement of stool.
  • Lubricants.
  • Stool softeners.

Enemas and Suppositories

An enema is a fluid gently pumped into the rectum to help pass stool. An enema may be used when other treatments don't work. Your health care professional may use one of these if the rectum is blocked with stool. Some are also available without prescription. A suppository is a small tube-shaped object placed in the rectum to deliver a medicine. The suppository melts at body temperature and releases the medicine.

Prescription Medicines

Your health care professional may prescribe other medicines if other treatments don't work. If constipation is caused by opioid pain medicine, you may take a prescription medicine that blocks the effect of opioids on stool movement through the colon.

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Pelvic Muscle Training

Biofeedback training involves working with a therapist who uses devices to help you learn to relax muscles and coordinate the use of muscles in your pelvis, rectum and anus. Sensors in the rectum and on the skin provide feedback as sound or light on a device as the therapist helps you go through various exercises.

Surgery

Surgery may be necessary to correct damage or irregularities in the tissues or nerves of the colon or rectum.

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