Dietary advice for constipation



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Department of Nutrition and Dietetics

Dietary advice for constipation

Patient name:

Date:

You have been given this information sheet as you are having symptoms of constipation. Please read the information contained in this sheet carefully and speak with your doctor or other health care professional if you have questions.

What is constipation?

There is a lot of variation in what can be considered a normal bowel habit. Some people will pass a bowel motion (stool) more than once a day; other people may only go once every two-three days.

Constipation occurs when stools are passed much less often than usual, or when they become difficult to pass. Stools can be hard and dry, and may be very large or small in size. You may need to strain to pass this type of stool, or have difficulty in passing all the stool you think is there.

Constipation may occur if muscle contractions at the end of our digestive tract (the large bowel) are too slow or weak, causing the stool to move slowly. Constipation may also occur when too much water is absorbed into the body from the bowel. This can make the stools dry and hard and difficult to push through. The stools can sometimes stay in the same part of the bowel for hours or days.

What causes constipation?

• Not drinking enough fluids (or dehydration)

• Lack of physical activity

• Too little fibre in the diet

• Ignoring the urge to have a bowel movement

• Incorrect use of laxatives

• Some medicines

• Irritable Bowel Syndrome (IBS) or other digestive complaints

Constipation can also occur as a result of a period of illness or following an operation.

What are the symptoms of constipation?

The symptoms may be different from person to person but constipation can cause one or more of the following:

• Having to strain when trying to pass a stool

• Passing hard stools – these may be small or large in size

• Abdominal bloating or wind

• Stomach cramps or pain

• Feeling tired or lethargic

• Headaches

• Nausea and vomiting

• Feeling irritable

• Diarrhoea (in some people) due to overflow.

What can I do to manage constipation?

If you are suffering with constipation have a think about your current diet and day-to-day life. It is important you try to:

• Eat regularly through the day. Erratic eating patterns, or missing meals and drinks can affect the movement of food throughout the whole digestive tract and can contribute to constipation. A regular meal pattern can be beneficial.

• Do not ignore the urge to open your bowels. A delay in going to the toilet can cause the stools to harden and become more difficult to pass.

• Slowly increase the fibre content in your diet. See section 1.

• Ensure a good fluid intake. Aim for at least two litres per day. See section 2.

• It is also important to look at your activity level and exercise regularly if you are able. See section 3.

1. Fibre

Fibre is the part of plant foods (fruit, vegetables, nuts, seeds and grains) that is not digested by your body and so passes unchanged through to your colon. Fibre adds bulk to your stools so can prevent constipation.

The daily recommendation for adults is 30g of fibre. If you are not eating as much as this, try to increase the amount of fibre in your diet, but do this SLOWLY. Making too many changes to increase your fibre intake all at once may cause you to suffer from excess wind, abdominal bloating and pain. An increase of two to three grams of fibre (one portion fibre foods) every few days is better than a rapid increase. See page 6 for ideas.

Good sources of fibre include:

• Starchy foods: e.g. porridge or oat bran, breakfast cereals such as bran flakes* or Weetabix™*, sweet potato, potato with skins, wholemeal bread* and pasta*, quinoa, rice bran, wholegrain rice.

• Vegetables: e.g. carrots, peas*, cabbage, parsnips, onion*, spinach, frozen mixed veg, green beans, tomatoes, canned sweetcorn*, broccoli, cauliflower,*salad.

• Fruits: fresh, canned, frozen or dried e.g. kiwi, grapes* pear*, apple*, banana, orange, berries, plums*, apricots,* prunes*, fig*, rhubarb.

• Beans and pulses e.g. baked beans*, hummus* (chickpeas), and dahl* (lentils), kidney or butter beans*

• Seeds e.g. linseeds, chia, sunflower or pumpkin seeds.

• Nuts e.g. almonds, hazelnuts, cashews* peanut butter.

Looking at Labels

When you read food labels look for the grams of fibre per serving or per 100g. A food product is: ‘high fibre’ if it contains at least 6g of fibre per 100g or a ‘source of fibre’ if it contains at least 3g of fibre per 100g.

|An example days meal plan to achieve your recommended intake of fibre: |

| | Fibre per portion |

|Breakfast |(g) |

|Portion size | |

|Porridge |50g |4.5g |

|Blueberries |80g |2.5g |

|Snack |

|Small handful almonds |30g |2g |

|Lunch |

|Jacket Potato |220g |5.9g |

|Baked Beans* |150g |5.6g |

|Orange |medium |2g |

|Dinner |

|Wholemeal spaghetti* bolognaise |75g spaghetti |6.8g |

| |(dry) | |

|Snack |

|Apple* / banana |medium |2g |

|TOTAL |32.3g |

Tips to increase your fibre intake

(Try these one at a time)

• Choose a high-fibre cereal at breakfast* e.g. porridge, Weetabix™, bran flakes, muesli,

• Add a small portion of dried fruit and linseed to breakfast cereal.

• Have a small portion of unsalted nuts as a snack.

• Mix 1tbs linseeds into your yogurt (have a glass of water with this).

• Use wholemeal bread for sandwiches and toast*

• Try a homemade vegetable soup with rye bread* or rice cakes / oat crackers for lunch.

• Use wholemeal pasta* or wholegrain rice with vegetables at dinner time.

• Add a portion of seeds or nuts to your stir-fry.

• Add pulses e.g. baked beans, chick peas, lentils, or extra vegetables into soups, bolognaise, curry or chilli.

• Try 2tbs hummus with salad sticks (carrot, cucumber, pepper or celery) for a high-fibre snack.

• Leave the skins on vegetables and fruit (wash well).

• Aim for five portions of fruit and vegetables/day. Have fruit as a snack. Frozen vegetables are as good as fresh.

• Make a smoothie with fruit and/or vegetables with water, milk or yogurt.

*These foods may increase bloating and wind – increase these with caution particularly if you have chronic or longstanding constipation, or IBS.

2: Fluid

It is very important that you increase the amount of fluid you drink as you start to eat more fibre containing foods. The fibre needs fluid to be able to become soft and expand in your bowel – this will give you a softer stool.

It is recommended that adults drink at least six to eight glasses of fluid each day (at least two litres daily). This can be taken as water, tea, coffee, squash, milk, unsweetened fruit juice and fizzy drinks. Be aware however that fizzy drinks and large amounts of fruit juice (over 150ml per day) can be high in sugar, and may cause bloating if you are susceptible to this.

Have at least one large glass of fluid with every meal, plus one to two glasses in between meals and before bed.

3: Exercise

Exercise helps to improve the function of all muscles in the body, including the muscles in the bowel. Try to fit some exercise into your daily routine - try one or more of the following for 30 minutes, five times per week:

• Walking

• Swimming

• Jogging / Running

• Dancing

• Aerobics

• Yoga / Pilates

Laxatives in constipation

Laxatives can be very helpful in managing constipation, but may not always be required. There are several types of laxative which work in different ways in the bowel. For some people, following the advice contained in this leaflet will be enough to aid a regular bowel habit. However, dietary changes may take 3-4 weeks before you see a benefit.

If you are suffering from severe or chronic constipation your doctor may recommend laxatives to help to get your bowel to move regularly. It is important to try these first before you start to make any changes to increase dietary fibre. Adding fibre into a very constipated bowel may make the problem worse.

It is important to always seek medical advice regarding laxative use; your doctor can help to determine which type of laxative will help you most as well as helping to identify or investigate any underlying cause of your constipation.

The Bristol Stool Scale

The Bristol Stool Scale is a visual table of different types of stool. This table will help you to identify the types of stool you are passing. This can be useful when explaining your symptoms to your doctor or dietitian, so they can provide the correct advice or medication. This scale can also help you monitor how you respond to any dietary changes or laxative use.

[pic]

Heaton, K W & Lewis, S J 1997, 'Stool form scale as a useful guide to intestinal transit time'. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 – 924

Summary

If you can follow the advice in this information sheet it may help to relieve your constipation. Try to:

• Eat a balanced diet and regular meals, including good sources of fibre (refer to section 1 of this sheet for examples).

• Increase your fibre intake SLOWLY to prevent symptoms of wind, pain and bloating.

• Drink plenty of fluids, aiming for at least 6-8 glasses (2 litres) daily.

• Keep active; exercise regularly if you can.

• Do not ignore the urge to have a bowel movement or delay going to the toilet if you need to open your bowels.

• If your doctor has prescribed laxative medication take this consistently as prescribed.

• Be aware that everyone is different – what is normal for one person is not the same for another, and sometimes normal bowel habits can vary from time to time.

• However, if you have an ongoing or significant change to your bowel habit, ask for more advice from your doctor.

If you are struggling to follow the dietary advice in this sheet and would like some help with this, please ask your doctor to refer you to a dietitian.

Contact Information

Nutrition and Dietetics Department

Beacon House

Gloucester Royal Hospital

Great Western Road

Gloucester

GL1 3NN

Telephone 0300 422 5506

Nutrition and Dietetics Department

Cheltenham General Hospital

Sandford Rd

Cheltenham

GL53 7AN

Telephone 0300 422 3460

March 2019 Review March 2022

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