- The British Dietetic Association (BDA) recently released guidelines for managing chronic constipation.
- The BDA included 59 recommendation statements that included both food and supplements.
- Among foods included in the guidelines, both kiwifruit and rye bread showed effectiveness at helping with chronic constipation.
Chronic constipation affects up to 20% of adults in the United States, and it can both cause discomfort and affect quality of life.
Researchers with King’s College London in the United Kingdom wanted to learn more about which foods, drinks, or supplements are the most effective at relieving chronic constipation. They examined 75 clinical trials to determine what has proven to be the most helpful.
Some items the researchers found most beneficial include kiwifruit, rye bread, and high mineral-content water. They found limited benefits with probiotics and senna supplements.
The findings are co-published in the journals the
People can develop chronic constipation for many reasons, such as consuming a low-fiber diet, not drinking enough water, and having an underlying medical condition.
- infrequent bowel movements
- difficulty passing stools
- needing to strain during a bowel movement.
As chronic constipation persists, it can lead to health issues such as hemorrhoids, rectal prolapse, and fecal impaction.
There are many supplements, foods, and remedies marketed as ways to regulate bowel movements. With so many options and conflicting advice, it can be overwhelming for people to figure out which might work best.
This is where the BDA’s guidelines come in. For the first time, there are evidence-based guidelines for both healthcare providers and the general public addressing what dietary interventions may actually help those trying to manage chronic constipation.
Additionally, people concerned about their bowel Health can review the list to find out what might suit their lifestyle best to avoid constipation.
The researchers analyzed 75 randomized controlled trials to come up with their recommendations. They used trials that covered various approaches to constipation treatment, including food and supplements.
Next, the team used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system to determine both the level of evidence and the strength of each recommendation.
The last step in the process was to have a committee of experts in the field (including gastroenterologists and dieticians) to evaluate each recommendation.
The committee had to overwhelmingly approve of a statement for it to make the guidlines. The committe voted whether they agreed or disagreed, and only statements that were 85% or higher agreed upon made the guidelines.
The researchers developed a total of 59 recommendation statements addressing various dietary approaches for managing chronic constipation.
These guideline covered fiber supplements, probiotics, food supplements, and foods and drinks.
Some things people can use to help with chronic constipation include consuming kiwifruit, high mineral-content water, and magnesium oxide.
The experts recommended eating two to three kiwifruit daily for at least 4 weeks. The authors noted that kiwifruit was “more effective at increasing stool frequency.”
Kiwi contains a high amount of fiber and an enzyme called actinidin, which “aids protein digestion both in the stomach and the small intestine.”
The recommendations also include drinking 0.5 to 1.5 liters of high mineral-content water per day for 2 to 6 weeks. This type of water is high in magnesium and sulfate and works by drawing water into the intestines and softening stools, making it easier to pass them.
The group also recommends eating rye bread, but recommends eating 6 to 8 slices per day for at least 3 weeks to see benefits, which may be difficult for some people.
Magnesium oxide stood out as a nonfood item recommendation for chronic constipation since it increases stool frequency and softens stool consistency. The experts recommended taking a dose of 0.5 to 1.5 grams per day for at least 4 weeks.
The researchers found limited evidence for probiotics and senna supplements in terms of managing chronic constipation.
Supriya Rao, MD, a quadruple board-certified physician and director of the Metabolic and Lifestyle Medicine Clinic at Integrated Gastroenterology Consultants, spoke with Medical News Today about these guidelines.
“Chronic constipation affects tens of millions of adults and is especially common in women and with age,” said Rao, who was not involved in the recent work. “It’s undertreated because people feel embarrassed, assume it’s normal, or only hear generic advice like ‘more fiber and water.’”
Rao praised the guidelines and talked about the potential for them to help people understand how best to treat their constipation.
“These guidelines are a meaningful upgrade because they separate what actually helps from what’s just tradition: Specific foods and fluids with evidence, how long to trial them, and when to move on if they don’t work,” she noted.
Rao suggested that people who want to improve constipation should “pick one strategy at a time” and track their symptoms.
Ruvini Wijetilaka, MD, a board-certified internal medicine physician at Mecca Health and Medical Advisor for VSL Probiotics, likewise not involved in the recent research work for the guidelines also spoke with MNT about their importance.
Wijetilaka sees potential for the guidelines since, “unlike past vague advice [like] ‘eat more fiber’, these offer food-specific, research-backed recommendations like kiwifruit, rye bread, and high-mineral water.”
Wijetilaka said the findings will help her as a clinician to manage constipation with her patients:
“They make me more likely to recommend targeted foods with proven benefits instead of generic fiber advice. It reinforces the importance of tailoring diet to each patient and monitoring response before moving to medications.”
