Dietary and Lifestyle Considerations
Diet and lifestyle changes are first-line therapy for chronic constipation (Rao 2014; Jamshed 2011). Increased dietary fiber and water intake and physical activity are typically recommended before laxatives or other medications (Rao 2014; Leung, Riutta 2011; Lee 2014).
Eat a High-Fiber Diet
Ninety percent of Americans do not consume the recommended daily amount of fiber. The average fiber intake for Americans is only about 16 g daily, but the suggested intake is 22 g for women over 50 and 28 g for men over 50 (USDA 2010; King 2012; Schmier 2014; Chiba 2015; McRorie 2015). Increasing fiber intake is a simple, cost-effective solution in many cases of constipation (Schmier 2014).
In a trial in 117 people with chronic constipation, a diet containing 25 g of fiber per day for two months resulted in increased stool frequency and decreased laxative use. The improvement was more pronounced in a subgroup of participants instructed to drink 2 L of mineral water per day compared with those told to drink as much water as they wanted (Anti 1998). Another preliminary trial found that eating a breakfast cereal containing 5.4 g of fiber (mainly from wheat bran) daily for two weeks had beneficial effects on bowel function in people whose regular diets included less than 15 g of fiber per day; improvements in constipation, bloating, sluggishness, and digestive discomfort were noted (Lawton 2013). Many other trials of various forms of supplemental dietary fiber have demonstrated improved bowel movement frequency and clinical benefit in constipation (Xu 2014; Yang 2012; Woo 2015; Quartarone 2013; Dahl 2003; Rao 2015).
Specific Foods to Help with Constipation
In addition to consuming plenty of dietary fiber and staying adequately hydrated, a few specific foods may improve bowel regularity.
Prunes. Prunes (dried plums) have long been used to treat constipation. It is thought that their laxative effect is in part due to their high concentration of sorbitol, a slowly digested sugar that has an osmotic effect and holds water in the intestines (Stacewicz-Sapuntzakis 2001).
Kiwifruit. Kiwifruit is a traditional laxative food. Several clinical trials have found that eating kiwifruit can relieve constipation (Rush 2002; Chan 2007; Chang 2010).
Olive and flaxseed oil. A preliminary study tested the effects of mineral oil, olive oil, and flaxseed oil in 50 dialysis patients with constipation. The participants were given one of these three oils to take daily for four weeks, at a dose of about 1 tsp per day. All three oils reduced constipation scores, with olive oil demonstrating some superiority to flaxseed oil. These results suggest edible oils might be a useful alternative to mineral oil for the treatment of constipation (Ramos 2015).
Increase Water Consumption
Increasing fluid intake is an effective treatment for constipation (Markland 2013). In addition, water and fiber appear to work best together (Anti 1998). Water restriction has been demonstrated to rapidly reduce bowel movements in healthy people (Klauser 1990), and low fluid consumption has been associated with an increased risk of chronic constipation (Markland 2013). In individuals living in nursing homes, low fluid intake is an important factor that predisposes to constipation (Robson 2000). Hydration may be an especially important consideration in those with Parkinson’s disease, a condition associated with elevated risk of constipation (Ueki 2004).
High-mineral-content water may be more helpful in treating constipation than typical lower-mineral water. In a four-week study, women with chronic constipation were given 1.5 L of drinking water per day. They were divided into three groups based on the composition of the water received, which contained either 1 L, 0.5 L, or none of a high-mineral natural spring water. By week two of the study, the women whose daily water included 1 L of mineral water had better stool consistency and less use of laxatives than women in the other two groups. Response to treatment corresponded to concentrations of magnesium and sulfate in the mineral water (Dupont 2014).
Increase Physical Activity
A sedentary lifestyle is a major contributor to many chronic diseases, including constipation (Booth 2012; Sandler 1990; Khatri 2011), and a recommendation of regular exercise is part of standard management of constipation in adults (Rao 2014; Borre 2015). In a study in which experimental bed rest was imposed on healthy men for 35 days, 60% developed constipation (Iovino 2013).
Other studies have found that exercise interventions can successfully improve chronic constipation (Beradze 2011). In one such study in 43 participants with chronic constipation, 30 minutes of brisk walking twice weekly plus a daily 11-minute strength and flexibility program for 12 weeks led to significant reductions in most constipation symptoms (De Schryver 2005).
In a study designed to determine the ideal posture for ease of defecation, 28 healthy adults adopted three different defecation postures, each for six consecutive bowel movements, and recorded the time and ease of defecation. The first posture was seated on a standard toilet; the second was seated with feet resting on a 10 cm-high footstool; and the third was squatting, using a flat container. For all of the participants, squatting was associated with the shortest time spent moving stool and the easiest sensation of bowel emptying (Sikirov 2003). According to the study authors, the straightening of the recto-anal angle that occurs with squatting is the natural posture for defecation (Sikirov 1989; Sikirov 2003).
Squatting may not be reasonable or possible for many people with constipation, especially older people. Toilet accessories that approximate the squatting position are available commercially but their usefulness has not been proven.
Comprehensive Lifestyle Changes
Researchers assessed a chronic constipation education program in 35 chronically constipated women. The program guidelines were: consume 25‒30 g of fiber per day by eating fruits, vegetables, and whole grains; drink 1.5‒2 L of fluids per day, preferring water and avoiding diuretic drinks such as alcohol; incorporate regular exercise in the form of walking, with a goal of 3.5‒5 hours per week; use the toilet at the same time each day whether or not there is an urge; and use a squatting posture to promote proper defecation. After three months, measures of constipation symptoms and severity had improved significantly (Ayaz 2014).