Key Topics Covered
- Standard advice like fibre, fluid and exercise is the starting point.
- Slowly (not quickly) increasing fibre intake if it is too low. Drinking enough fluid to avoid dehydration. Exercising regularly. These things all help.
- But what if you already are doing these things and have constipation? That is when more specific recommendations are required.
Flaws with Standard Advice
- Self reported intake of those with constipation is that their fibre intake is similar to those without constipation.
- Increasing insoluble fibre intake can make symptoms worse, particularly if it is a quick increase or if fibre intake was already high. Sometimes it increases frequency of bowel motions, but other symptoms like bloating, painful defecation, and incomplete evacuation get worse.
- Increasing water intake makes theoretical sense since it allows more water in the stool. But research has shown that if you get a group of people with constipation to increase their water intake, it is unlikely to help many of them in regards to their symptoms. Outcomes are what we care about.
- Exercise is great for people who are sedentary. It particularly seems like gentle exercise like walking and yoga are particularly effective. People who training intensely 5+ days per week can still get symptoms though. This is not necessarily a flaw per se. It is just a variable that can only be adjusted so much.
- 2x kiwifruit per day seems to help almost all outcomes of constipation.
- It contains an enzyme called actinidin which stimulates the bowels.
- 10-20g per day. Start low and build up.
- Improves all symptoms. Mechanism appears to be mostly based on the soluble fibre content.
- Benefits improve over time – even after 4+ weeks of using it symptoms are still improving
Psyllium Husk / Metamucil
- Specific type of soluble fibre – and probably the most effective of all of these tips.
- 10g psyllium husk per day improves frequency by an average of 64% and improves all other symptoms as well
- Not a long term option, but >300mg magnesium citrate has a laxative effect. This is due to the osmotic activity of unabsorbed magnesium salts in the intestines and how this draws in water and stimulates bowels.
- Draws water into the stool making it easier to pass
- Frequent use of laxatives can lead to a lazy bowel and worse symptoms. Stool softeners do not – most can be taken indefinitely.
- Dosage can be adjusted based on bowel movements over time.
- Osmolax – polyethylene glycol – research shows that long term use is safe and effective for treatment of chronic constipation.
- Coloxyl – docusate sodium – also considered safe for long term use – as long as it doesn’t contain added senna or other stimulant laxatives.
- Not a solution that reaches to crux of the problem but can be a great interim solution – constipation related to mental health/anxiety
- Mechanism is that FODMAPs can cause gas build up, compacting stool and making them harder to pass.
- Low FODMAP diet has a lower success rate for IBS-C but can still be useful for some if nothing else has worked.
- Prune juice and pear juice are great options for constipation – but they are high in the FODMAP Sorbitol which is why they are not necessarily a first line option.
Variety of Plant-Based Foods and Fibre
- Improving gut health through a range of different kinds of fibres including prebiotics
- Just a good idea regardless for overall healthy microbiota.
- Could be an argument for alternating Metamucil with other fibre options like Benefibre (wheat dextrin)
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