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Constipation is one of the common complaints for which a person consults a doctor. Prevalent in women, children and elderly, it requires no or minimal treatment such fiber supplements or other dietary modification.


Treatment of chronic constipation begins with lifestyle modifications, if appropriate and therapy with fiber. The best food for constipation is the one that has high fiber content and this includes fruits, vegetables, legumes and whole grains.

According to Rome III criteria, a person is said to be constipated if two or more of the following are present for at least 3 months with the onset of symptom at least 6 months prior to the diagnosis:

  • Straining more than 25% of the time during bowel movement
  • Hard stools more than 25% of the time
  • Incomplete evacuation more than 25% of the time during bowel movements
  • Less than 3 bowel movements per week
  • Sensation of Anorectal obstruction more than 25% of bowel movements
  • Manual evacuations to facilitate more than 25% of bowel movements

This definition provides criteria for functional constipation. Functional constipation is constipation without any underlying cause. Constipation can also occur due to a variety of underlying causes including inadequate dietary fiber, structural abnormalities, medical conditions and medications. This group of constipation is called secondary constipation.

Treatment of constipation

If constipation is due to secondary constipation the underlying cause is treated or eliminated. The treatment of functional constipation is categorized as follows:

General measures

  • Reassurance
  • Lifestyle modifications
  • Psychological support
  • Increased fluid intake
  • Dietary changes and increased intake of fibers

Specific therapy

  • Fiber supplements
  • Osmotic laxatives
  • Stimulant laxatives
  • Stool softeners and emollients
  • Enema and suppositories
  • Prokinetic agents

Other forms of therapy

  • Defecation training
  • Anorectal biofeedback
  • Acupuncture
  • Surgery

In a person complaining of constipation, secondary constipation has to be ruled out. Once it is done, the person is said to be having functional constipation. The treatment of functional constipation begins with certain general measures which are mentioned above. Dietary changes with increased intake of fiber and increased fluid intake are the two things that are advised in all patients as the first step in the treatment of constipation.

Fiber content of food and bowel movements

The best food for constipation is the one with high fiber content. The concept of deficiency of dietary fiber contributing to constipation was put forward in the early 1970s after a study was done in rural Africans. Since then, studies have shown that increasing the intake of fiber relieves constipation. Every gram of wheat fiber ingested yields 2.7 g of stool expelled.

Dietary fiber appears to be effective in relieving mild to moderate but not severe constipation. The minimal dietary fiber intake to aid bowel movements should be 12 g per day. All constipated individuals should be advised initially to increase their dietary fiber intake as the simplest, most physiologic and cheapest form of treatment. They should be encouraged to eat whole wheat bread, unrefined cereals, plenty of fruits and vegetables.

Because of the side effects, adherence with fiber supplementation is low especially during the first few weeks of treatment. The side effects include abdominal distention, bloating flatulence and poor taste.  To improve adherence, patients should be instructed to increase their dietary fiber intake gradually over several weeks to approximately 20-25 g per day. A person should consume 1 gm of fiber for every 100 calories of food he consumes. If the results of therapy are disappointing, commercially packaged fiber supplements should be tried.

Fiber present in diet could be soluble or insoluble fiber. Soluble fiber absorbs water and forms a gel like substance and makes the stool soft. Insoluble fiber does not absorb and it just increases the bulk. Both types of fibers are present in all plant foods. Along with fiber one should drink plenty of water. Otherwise fiber alone can lead to constipation.

Diet to relieve constipation

The best foods for constipation are those with high fiber content that increase the bulk of the stool. Food containing high fiber content and bulk forming fiber supplements increase the retention of water, leading to softer stool consistency, increased stool volume and increased motility of the gut.  Fruits, vegetables, legumes and whole grains are rich in fiber. The best foods for constipation include-

Fruits

One should eat at least 3 or more fruits every day to have good bowel movements. Whole fruits with the skin have the most fiber. The fruits which are rich in fiber are

  • Figs &Dates
  • Banana
  • Grapes
  • Prunes
  • Papaya
  • Peaches
  • Apricot
  • Pineapple
  • Pears

Vegetables and legumes

  • Beans
  • Broccoli
  • Cabbage
  • Greens
  • Asparagus
  • Peas
  • Carrots

Whole grains

  • Whole wheat
  • Brown rice
  • Barley
  • Millet

Prunes

Doctors usually advise the patients to eat prunes or drink prune juice for relief of constipation.  It is one of the most popular home remedies for constipation. Prunes are dried type of plum. Prunes are rich in fiber, vitamin A and potassium. A quarter cup serving of prunes provides 12% of the recommended daily intake of fiber. Prunes contain both soluble and insoluble fiber. Thus prunes are obviously the first choice in the treatment of constipation. Prune juice is made by soaking prunes in water. Prune juice is as effective as over the counter laxatives in providing relief from constipation.

Flaxseed

Flaxseeds are tiny seeds from the flax plant. Flaxseed is a rich source of fiber, omega 3 fatty acid, vitamins and minerals. Ground flaxseeds can be taken for relief of constipation. These are available in any grocery store.

Pears

Pears are excellent source of fibers and vitamin C.  Pear juice is commonly given as home remedy for constipation. The fiber present in pears is mostly insoluble fiber and they add to the bulk of the stool and are very effective in the treatment of constipation. 

Apples

Apple juice is a common home remedy for constipation. Pectin which is present in high quantities in apple increases the bulk of the stool and helps in bowel movements.


Bananas

Ripe bananas relieve constipation. They contain high amount of pectin which aids bowels movements and relieve constipation. But one should remember than green bananas should be avoided as they cause constipation. One or two ripe yellow bananas per day are enough for good bowel movements.

Whole grain/bran

These are rich in fiber and helps to speedup the colon and increase the stool output and bowel frequency. One of the common home remedies of constipation is whole wheat bread. Muffins made with whole wheat or bran, oatmeal cookies and whole wheat crackers are good sources of fiber and are very effective in the treatment of constipation.

  • Sleisenger and Fordtran’s Gastroinetstinal and Liver Disease – 8th Edition
  • Photo by shutterstock.com
  • www.cspinet.org/nah/wwheat.html
  • www.dietitian.com/fiber.html
  • www.gov.mb.ca/healthyliving/nutrition/pubs/constipation.pdf