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12 Tips For Managing Constipation

Last updated on May 7th, 2016 Authored by Alana Scott     Reviewed by Patsy Catsos (RD)

Struggling to go to the toilet on a daily basis is draining and can be downright painful. Constipation is a serious issue for many people living with Irritable Bowel Syndrome (IBS), however, there are plenty of strategies to help ease your toileting troubles. I had the pleasure of talking to Patsy Catsos (USA based registered dietitian) about constipation, the low FODMAP diet and other strategies to relieve symptoms. Patsy Catsos specialises in helping patients who suffer from IBS or other gastrointestinal issues. She is also an expert in the low FODMAP diet and you can find her low FODMAP resources here.

Please note that with any medical condition it is important to seek advice from your team of medical professionals. A registered dietitian and doctor will be able to create a tailored management plan to help relieve your constipation. The information provided in this article does not replace medical advice.

Is the low FODMAP diet as effective for constipation related IBS, as it is for diarrhoea related IBS?

As a dietitian, Patsy has helped thousands of people with IBS by teaching them how to manage their symptoms using the low FODMAP diet. According to her experience, Patsy believes that “the low FODMAP diet is quite helpful for both extremes. However, the response to diet sometimes is not as complete in the patients who have constipation. They typically experience a lot less bloating, distension, and abdominal discomfort even if their bowel pattern isn’t 100%”. This means that patients who suffer from constipation often need the low FODMAP diet and some other management strategies to gain good symptom relief. After starting the low FODMAP diet, it is important that you wait before implementing new constipation management strategies. If you try multiple strategies together, it will be hard to tell if it is the diet or something else that is working.

12 Tips To Help Manage Constipation:

  1. Improve overall diet. Before starting on a low FODMAP diet, try to resolve your constipation through improving your overall diet. This includes checking that you are drinking enough water, eating regular meals, and consuming enough fibre, or have tried increasing your fibre intake. Sometimes these strategies are enough to resolve the constipation without implementing a restrictive diet. If you have completed these steps, then talk to a dietitian about the low FODMAP diet.
  2. Check medications and supplements for side effects. Some medications and supplements (like painkillers or calcium and iron supplements) can be constipating. Your dietitian and doctor can help you check your medications and supplements, and then create a management plan to reduce their side effects.
  3. Increase fibre intake. If your low FODMAP diet isn’t providing complete relief, try consuming more good low FODMAP sources of fiber. Patsy Catsos has a ‘food first’ policy, where she believes in using whole foods over fibre supplements if possible. She recommends that patients increase their consumption of high fibre low FODMAP foods like canned chickpeas and lentils, as well as chia seeds. Chia seeds are one of Patsy’s favourite high fibre foods as their gel-forming capacity makes them effective at forming stools that are easier to pass. Just remember that the low FODMAP serve for chia seeds is two tablespoons (1). When introducing high fibre foods (like chia seeds) into your diet, remember to start with a small portion and slowly increase your serve to give your body time to adjust. If high fibre whole foods are not effective, then Patsy suggests looking into a psyllium husk fibre supplement.
  4. Regular exercise. Light daily exercise, like a gentle walk, can help reduce constipation. Exercise helps stimulate the natural contraction of intestinal muscles, which can help efficiently move stools through your digestive system (2).
  5. Consume prebiotic foods and consider a probiotic supplement. Up to 60% of the bulk of our stools consists of biomass from bacteria (3). Patsy suggests that gut bacteria can influence bowel movements and that prebiotics and probiotics can help. Prebiotics help feed our healthy gut bacteria, which means you need to consume moderately-low FODMAP prebiotic foods (like canned lentils, broccoli, almonds, and unripe bananas), resistant starch and high fibre foods as tolerated. The low FODMAP diet restricts the intake of many high FODMAP prebiotic foods, which is why the strict low FODMAP diet is not a lifetime diet (Varney, 2016).Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (5). Patsy suggests probiotics are helpful because they introduce beneficial bacteria into our digestive systems, which can add useful bulk and consistency to stools, among their other many benefits. When choosing a probiotic supplement, you want to select a brand that is evidence based and proven to be useful in reducing IBS symptoms. VSL#3 and Align are two such brands, according to the consensus opinion at the 2015 Yale-Harvard Workshop on Probiotic Recommendations (6).
  6. Consider a magnesium supplement.  According to Patsy, many people lack magnesium in their diets, especially if they are limiting their nut and seed consumption. Magnesium is known to have a laxative effect and can help with constipation (9). Consult your doctor or dietitian for help choosing an appropriate form and dose of magnesium.
  7. Learn about toileting posture. Proper toileting posture can help relieve and prevent constipation. When you sit on the toilet with your feet flat on the ground your colon is slightly curved, which makes passing a stool harder. Changing the position of your legs can help straighten the colon making it easier to pass a stool quickly and completely. Here are some toileting tips from the Bowel & Bladder Foundation:
    1. Lean forward when you are sitting on the toilet and rest your arms on your thighs.
    2. Make sure your knees are bent higher than your hips. You can do this by placing a footstool, telephone books or something sturdy underneath your feet. Make sure your feet are resting on something sturdy.
    3. Breath deeply, relax and push gently.

    (Bowel & Bladder Foundation, 2016).

  8. Get an evaluation by a pelvic floor specialist. Not all causes of constipation are dietary related. Sometimes people have dyssynergic defecation, which is where the muscles and nerves in the pelvic floor don’t work together effectively, making it hard to have a proper bowel movement (8). A physical therapist can evaluate you for dyssynergic defecation. A treatment plan can then be developed using biofeedback and exercises to help teach you how to have an effective bowel movement (8).

Are you ready to take control of your gut symptoms?

YES I WANT TOO!

No thanks, my gut is perfect.

  1. Make time for your toileting routine. Not taking enough time for your toileting routine can make constipation worse. According to Patsy, “People tend to be stressed and rushed to get out the door in the morning,” which is when many people would normally have a movement. If it is important for you to be in a comfortable place to have a good bowel movement, allow some extra time for your toileting routine.
  2. Don’t under-estimate the effect stress has on your constipation. Stress can interfere with our bowel movements. Consider what happens to your bowel movements when you travel. Patsy suggests that our bodies might interpret the different travel routine as a form of stress, and that sometimes you just have more trouble with constipation when you are out of your element. Taking time to relax and de-stress on a daily basis could help reduce your constipation issues. Also make an effort to get your usual amount of fluids, dietary fibre and exercise when travelling.
  3. Consider medical hypnotherapy. Medical hypnotherapy has been proven to be effective at treating IBS symptoms in some patients (10). Hypnotherapy sessions for IBS involve progressive relaxation, and then suggestions of soothing imagery and sensations focused on the individual’s symptoms (10). Patsy believes that her constipation-predominant patients can benefit a lot from hypnotherapy when combined with other management treatments.
  4. Talk to your doctor about medication. If dietary and lifestyle changes do not effectively relieve your constipation issues, then you should talk to your doctor about a stool softener or laxative to help you stay regular.

Final Thoughts

The low FODMAP diet can be effective at reducing IBS and constipation related symptoms, however, you may find you need some additional management strategies for long term constipation relief. A knowledgeable dietitian can help you create a tailored constipation management plan that suits your body.

Author: Alana Scott

In 2013, Alana was diagnosed with Irritable Bowel Syndrome. She also suffers from coeliac disease, is allergic to nuts and is intolerant to dairy products. This means she understands how difficult it can be to cook with multiple food intolerances. Her exp... Read More

Professional Reviewer: Patsy Catsos (RD)

Patsy Catsos is a USA based registered dietitian, an author and a FODMAP expert. The focus of her Portland, Maine practice is digestive health, including irritable bowel syndrome, gluten-related disorders, and inflammatory bowel disease. Patsy completed h... Read More

SHOW REFERENCES

1. Monash University App. Food Guide. The Monash University Low FODMAP Diet App. 2015: Version 1.3(180). Date retrieved: 2016-02-03. Retrieved from :http://www.med.monash.edu/cecs/gastro/fodmap/iphone-app.html. Accessed: 2016-01-15. (Archived by WebCite® at http://www.webcitation.org/6Wog73c8B)

2. Web MD. Exercise to Ease Constipation. Web MD. 2016. Retrieved from:http://www.webmd.com/digestive-disorders/exercise-curing-constipation-via-movement. Retrieved on: 2016-02-04. (Archived by WebCite® at http://www.webcitation.org/6f3WcaMwd)

3. Guarner, F. & Malagelada, J. Gut flora in health and disease. The Lancet. 2003: Volume 361: Issue 9356, p. 512-519. DOI: http://dx.doi.org/10.1016/S0140-6736(03)12489-0 Retrieved from:http://www.ncbi.nlm.nih.gov/pubmed/12583961. Retrieved on: 2016-02-16. (Archived by WebCite® at http://www.webcitation.org/6fLjZnK7Y)

4. Varney J. Prebiotics and probiotics: what are they and should I be including them on a low FODMAP diet?. Monash Low FODMAP Blog. 2016-01-03. Retrieved from:http://fodmapmonash.blogspot.co.nz/2016/01/prebiotics-and-probiotics-what-are-they.html. Retrieve on: 2016-02-04. (Archived by WebCite® at http://www.webcitation.org/6f3WEP1KK)

5. Hill, CG., Guarner, F., Reid, G., Gibson, G., Merenstein, D., Pot, B., …Sanders M. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology & Hepatology. 2014: Volume 11: Issue 8: p. 506-514. Doi: 10.1038/nrgastro.2014.66. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24912386. Retrieved on: 2016-02-23. (Archived by WebCite® at http://www.webcitation.org/6fWUfhA2w)

6. Floch, MH., Walker, WA., Sanders, ME., Nieuwdorp, M., Kim, AS., Brenner, DA., …Brandt, LJ. Recommendations for Probiotic Use–2015 Update: Proceedings and Consensus Opinion. Journal of Clinical Gastroenterology. 2015: Volume 49: Issue 1: p. 69-73. DOI: 10.1097/MCG.0000000000000420. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/26447969. Retrieved on: 2016-02-23. (Archived by WebCite® at http://www.webcitation.org/6fWTiikQs)

7. Bowel & Bladder Foundation. Toilet Positions. Bowel & Bladder Foundation. 2016. Retrieved from:https://www.bladderandbowelfoundation.org/resources/toilet-positions/. Retrieved on: 2016-02-04. (Archived by WebCite® at http://www.webcitation.org/6f3XJtlby)

8. IFFGD.Dyssynergic Defecation: Questions and Answers About a Common Cause of Chronic Constipation. International Foundation for Functional Gastrointestinal Disorders. 2016a. Retrieved from:http://www.iffgd.org/site/gi-disorders/functional-gi-disorders/dyssynergic-defecation/. Retrieved on: 2016-02-04. (Archived by WebCite® at http://www.webcitation.org/6f3VwTZzq)

9. Web MD. MAGNESIUM.  Web MD. 2016b. Retrieved from :http://www.webmd.com/vitamins-supplements/ingredientmono-998-magnesium.aspx?activeingredientid=998. Retrieved on: 2016-02-04. (Archived by WebCite® at http://www.webcitation.org/6f3VagIpn)

10. IFFGD. Hypnosis for IBS. International Foundation for Functional Gastrointestinal Disorders. 2016b. Retrieved from:http://www.aboutibs.org/site/treatment/complementary-or-alternative-treatments/hypnosis. Retrieved on: 2016-02-04. (Archived by WebCite® at http://www.webcitation.org/6f3Yi2h4I)

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Feb 26

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End of summer veggies are the best and these roasted eggplants are call my name right now.

These are super simple too - roast the eggplant in oil, salt and pepper until golden and tender. Smother in golden sunshine tahini sauce and sprinkle with toasted seeds.

If you are low FODMAP the 1 small-medium eggplant = 4 servings.

Sunshine tahini dressing:
1 tsp garlic infused oil
1.5 tsp gluten free soy sauce
1 tbsp olive oil
1 tbsp lemon juice
2 tbsp water
3 tbsp tahini
1/2 tbsp pure maple syrup

Place in a jar and shake until well combined.

This recipe is part of our premium FODMAP recipe club (along with 700+ other low FODMAP recipes).

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Feb 22

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I'm stuck at the office and I'm staving! Definitely didn't pack enough snacks today... if I could I'd be drinking this right now.

Give me a ❤️ if you want to be drinking this too. Say hello to my low FODMAP strawberry and rhubarb smoothie.

Strawberries and rhubarb make the best smoothie buddies. It might sound like an odd combo but the tanginess of the rhubarb pairs super well with the sweetness from the strawberries to create a refreshing and vibrant drink.

1 serve 👇

🍓140 g (1 cup)fresh or frozen strawberries
🍓60 g (1/4 cup)stewed rhubarb
🍓250 ml (1 cup) low FODMAP milk 
🍓2 tsp pure maple syrup (add to taste) 
🍓1/2 tsp vanilla essence
🍓6 ice cubes (use if you are using fresh strawberries)

METHOD
Slice the strawberries in half, be super careful doing this if they are frozen. Place all the ingredients in the blender. Add the ice cubes if your strawberries aren’t frozen.

Blend until smooth. Taste and add a little bit more sweetener if it’s too tangy. The tanginess will depend on your stewed rhubarb (ours wasn’t sweetened).

Pour into your favourite glass and enjoy! 

FYI this recipe is also in our premium recipe club.

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Feb 13

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It’s brunch time! It’s also Valentine’s Day so I thought I’d treat my man to a cooked breakfast. Say hello to my Greek scrambled eggs.
 
Serves 2:

1 medium-sized ripe tomato (diced or grated)
1 tbsp fresh chives (finely chopped)
1 tbsp fresh parsley (finely chopped)
2 tsp garlic infused oil
2 tsp olive oil 
3 eggs (beaten)
Salt and pepper

Fry the diced tomato in the garlic infused oil for 2 to 3 minutes until the liquid reduces. Then add the olive oil, chives and parsley to the pan along with the beaten eggs. Season with salt and pepper. Move the egg mixture gently around the pan for 1 to 2 minutes until the eggs are cooked to your liking.

Serve on toast of your choice (we used gluten free bread). Enjoy!

Do you have a favourite brunch meal? Tell me below 👇

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Jan 29

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Who loves eating the rainbow for dinner? 🙌 I do! 

It's hot here at the moment which means rice paper rolls make a refreshing low FODMAP dinner option.

I love that you can prep all of the ingredients in advance so you don't have to slave over a hot stove in the evenings.

What's your go-to summer meal?

P.S. You can get the recipe on alittlebityummy.com or follow my profile link.
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Jan 28

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I have exciting news! I’m incredibly honoured to announce that I’ve been nominated as a semi-finalist for the 2021 Young New Zealander Of The Year award.

It’s a privilege supporting people with Irritable Bowel Syndrome and other gut issues and I can’t wait to see what 2021 brings.

I also want to say thanks to the team behind the New Zealander of the Year Awards for making these awards possible.

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Jan 18

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You know what I miss? Berry Bliss Muesli. It's crunchy and delicious with little pops of strawberry... I'm making a coeliac friendly version of this very soon.

In the meantime give me a ❤️ if you want to try this gorgeous low FODMAP version. I make this for my mum and she absolutely adores it!

Recipe on alittlebityummy.com or follow my profile link.

I'd also love to know what your favourite breakfast is so let me know in the comments 👇
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Comments

  1. Greg Donaldson says

    October 5, 2018 at 2:14 am

    Chia seeds are not easy to swallow. Put chia seeds in a high speed blender/juicer. Pulse briefly until well chopped up. Use it as you would ground flax seed, or chia pudding with oatmeal, yogurt, smoothies, etc.

    Reply
    • Alana ScottAlana Scott says

      January 25, 2019 at 12:40 am

      Great tip Greg. You can also just let them soak in liquid for a few hours until they soften and go jelly like.

      Reply

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