Key Topics Covered

Standard Advice

Fibre Containing Foods
  • 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.

Kiwifruit

Bowl of pre-cut Kiwifruit
  • 2x kiwifruit per day seems to help almost all outcomes of constipation.
  • It contains an enzyme called actinidin which stimulates the bowels.

Linseed/Flaxseed 

  • 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 

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 

Magnesium 

  • 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. 

Stool Softeners 

Osmolax Stool
  • 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  

FODMAPs 

  • 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 

30 different plant based foods example
Image Credit to Gemma Sampson – https://www.gemmasampson.com/blog/30-plants-a-week
  • 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) 

Relevant Links/Resources

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