Simple Suggestions to Help Support Bowel Motility
By Noelle Patno, PhD
This is part two of a two-part series; read the first part on possible causes of constipation.
For mild and occasional constipation, consider these potential, evidence-based, approaches:
- Water intake: You may be familiar with the recommendation of drinking 8-10 glasses a day, which corresponds to 64-80 ounces of water per day. Did you know that the Institute of Medicine (IOM) actually recommends 3.7 liters per day for men or 2.7 liters per day for women over 19 years old,5 which corresponds to a whopping 125 ounces (91 ounces for women) or approximately 16 (or 11 for women) glasses a day? Technically, that actually includes all the water in other beverages as well as food such as fruits, vegetables, soups, smoothies, and other liquids. When in doubt, try water first.
- Mineral intake: Consider reducing consumption of salt, processed foods, and calcium (dairy and others) while increasing dietary potassium (coconut water, spinach, tomatoes, cantaloupe, papaya, carrots, beets, winter squash, bananas) and magnesium (green leafy vegetables, seeds).2
- Fiber intake: The US Department of Health and Human Services and US Department of Agriculture recommendation is 38 grams for men and 25 grams for women (ages 50 and younger).4 Fiber is naturally present in many vegetables and fruits (try berries, greens, apples, pears) as well as beans, legumes, seeds, and cereals (try oats and flaxseeds).2 Prunes are included in this category, which has some scientific support.7 However, fiber can aggravate symptoms, especially if dehydration is the cause.2 In fact, fiber may increase bloating and distention9 and can cause flatulence, due to bacterial breakdown and production of gas. To mitigate unwanted effects, fiber intake should be increased slowly, such as a half teaspoon at a time.
- Fiber supplementation may help support bowel frequency. For example, psyllium fiber has been shown in a systematic review to increase stool frequency in patients with constipation, but there was not sufficient evidence for recommending calcium polycarbophil, methylcellulose, and bran.9,10
- Exercise: The Institute of Medicine (IOM) recommendation is 150 minutes of moderate intensity physical activity, muscle-strengthening two or more days per week for adults, and at least one hour of physical activity per day for youths 6-17 years.5 Exercise is one solution that can help mitigate constipation according to one publication11 and can help with bloating or distention as well.8
- Did you know that the motor activity of the colon, the lower intestine, is actually highest in the morning?12 Drinking water after waking up, exercising, eating a balanced breakfast and going to the restroom after breakfast might be the recipe to help get things moving!
- Laxatives and stool softeners: Besides fiber, your healthcare practitioner can recommend laxatives and stool softeners that can provide relief from occasional constipation. Lactulose is considered to be effective at improving stool frequency and consistency.9 The laxative lactulose may actually be considered a prebiotic; as it is consumed by bacteria and confers a benefit to the host.13 Lactulose may be consumed by several types of bacteria, including those in the genuses Bifidobacteria14 and Lactobacillus,15 all associated with individuals having healthy microbiomes. Resistant starch, starch that is resistant to digestion, is a potential prebiotic because it is consumed by amylolytic bacteria and may help with constipation.16 The FDA is currently reviewing sources of isolated and synthetic fibers for health benefits as well, but as mentioned, psyllium seems to have the most evidence and efficacy at this time for promoting bowel motility. Note that it is critical to consume psyllium fiber with sufficient water; aim for 8 ounces.
Are there probiotics that help with constipation?
While there exist gastroenterology recommendations for specific probiotic usage in diarrhea, at this time, there is not sufficient evidence regarding probiotic efficacy in reducing constipation. Integrative gastroenterologists may recommend experimenting with fermented foods like sauerkraut, kimchi, or use of prebiotics from onions, oats, Jerusalem artichoke, chicory root, raw honey, and ground flaxseeds.2
It’s important to recognize the suggestions above are recommendations to support everyday bowel motility. For severe or persistent symptoms of constipation, contact your healthcare practitioner.
For the average healthy person, staying hydrated, maintaining a healthy and balanced and anti-inflammatory diet, eating at regular intervals,2 engaging in regular exercise may be sufficient to support bowel motility. Stay regular and stay relaxed for health and happiness.
- Haug TT et al. Are anxiety and depression related to gastrointestinal symptoms in the general population? Scand J Gastroenterol. 2002;37(3):294-298.
- Koff A. Nutrition strategies for the treatment of IBS and the prevention of digestive complaints. In: Integrative Gastroenterology. Mullin G. New York, NY: Oxford University Press, Inc; 2011.
- Basic Report on Nutrient data for Kale, raw, 11233. USDA National Nutrient Database for Standard Reference Legacy April 2018 Software v.18.104.22.168 2018-07-24. https://ndb.nal.usda.gov. Accessed August 13, 2018.
- S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. http://health.gov/dietaryguidelines/2015/guidelines/. Accessed August 10, 2018.
- Institute of Medicine. 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C.: The National Academies Press. https://doi.org/10.17226/10490.
- Tungland BC et al. Nondigestible oligo- and polysaccharides (dietary fiber): their physiology and role in human health and food. Comprehensive Reviews in Food Science and Food Safety. 2002;1(3):90-109.
- Attaluri A et al. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011;33:822.
- Bharucha AE et al. American Gastroenterological Association technical review on constipation. 2013;144:218.
- Ramkumar D et al. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005;100:936.
- American College of Gastroenterology Chronic Constipation Task Force. An evidence-based approach to the management of chronic constipation in North America. Am J Gastroenterol. 2005;100 Suppl 1:S1.
- Müller-Lissner SA et al. Myths and misconceptions about chronic constipation. Am J Gastroenterol. 2005;100(1):232-242.
- Wald A. Management of chronic constipation in adults. www.uptodate.com. Talley N and Grover S. Topic last updated Jan 10, 2018. Accessed July 23, 2018.
- Gibson GR et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastro Hepat. 2017;14:491-502.
- Preter VD et al. Effect of lactulose and Saccharomyces boulardii administration on the colonic urea-nitrogen metabolism and the bifidobacteria concentration in healthy human subjects. Alimentary Pharmacology & Therapeutics. 2006;23(7):963-974.
- De Souza Oliveira RP et al. Use of lactulose as prebiotic and its influence on the growth, acidification profile and viable counts of different probiotics in fermented skim milk. International Journal of Food Microbiology. 2011;145(1):22-27.
- Cassettari VMG et al. Combinations of laxatives and green banana biomass on the treatment of functional constipation in children and adolescents: a randomized study. Jornal de Pediatria. January 2018.
About Noelle Patno, PhD:
Noelle Patno, PhD, is the Nutritional Scientist for Digestive Health at Metagenics. After pursuing chemical engineering at Stanford and engineering at Abbott, she sought an education in preventive nutrition from a basic science perspective by pursuing her PhD in Molecular Metabolism and Nutrition from the University of Chicago. Her current role involves researching and developing probiotics, prebiotics and other nutritional solutions and programs for promoting digestive health and overall health.