Tips for managing constipation type IBS (IBS-C)

IBS-Constipation - Sometimes you need to do more than just eat low FODMAP!

Dr Peta Hill - Research Dietitian, 28 December 2015

Adults and children with IBS that tend towards constipation often find a low FODMAP diet alone does not sufficiently alleviate symptoms. Here are some extra tips to prevent constipation:

1.Eat a variety of fibres

Dietary fibre comes from plant foods.

Insoluble fibre is found in the skins of vegetables and fruit as well as in the bran portion of whole grain cereals. Insoluble fibre promotes regularity by adding bulk to the stool.

Soluble fibre is found in some vegetables and fruit, oats, legumes, nuts and seeds as well as the fibre supplements psyllium and Metamucil. When water is added to soluble fibre it thickens and becomes gel like, helping to soften the stool by adding a gelatinous bulk.

Resistant starch rich foods include legumes, cold cooked potatoes and firm bananas. Resistant starch may improve gut health by feeding good bacteria in the large bowel.

Including a variety of fibres in your diet will ensure you get the health benefits of all of them. Here are tips to assist you with this:

Vegetables ·Where possible, consume with the skin on
·Include a variety of colours each day
·Eat at least 3 different vegetables per day
·Spread vegetable intake over at least 2 meals/snacks
More tips on improving your intake of vegetables here
Fruit ·Where possible, consume with the skin on
·Eat a variety of colours
·Eat two serves per day (a serve is roughly the size of your fist)
Wholegrains ·Choose cereal products (breakfast cereal, cracker, bread, pasta, etc.) based on a variety of wholegrains (for example, sorghum or oat breakfast cereal, spelt sourdough bread, brown rice cracker and quinoa pasta
·Read the ingredients to determine which grain is in the product (remember, ingredients are always listed in quantity from most to least)
Nuts and seeds ·Eat daily via whole nuts and seeds, 100% nut spreads and ground nuts/seeds (e.g. LSA)
Legumes ·While many legumes are high FODMAP and best avoided during the initial strict phase of the low FODMAP diet, there are some low FODMAP options including firm tofu, ¼ cup tinned chickpeas and ½ cup tinned lentils are low FODMAP. Aim to include legumes at least 1/week in your diet

2. If your doctor recommends laxative, take them as prescribed

Laxatives contain chemicals that help increase stool motility, bulk, or frequency and are usually recommended for short-term use. When misused or overused, they can cause problems, including chronic constipation. It is important to understand how laxatives work and use them as specified by your doctor: take the specified dose, at the specified time for the specified period of time and avoid self-medicating.

3.Drink plenty of water

Drinking plenty of water will assist to keep the stool soft and pass easily.

Approximate fluid* requirements
Pre-schoolers 4-5 cups
Primary school aged children 5-6 cups
Adolescence 6-8 cups
Adults 8 cups

*Fluid includes plain water, milk and other drinks. The majority of your fluid intake should consist of water.

An adequate fluid intake is particularly important in people taking osmotic laxatives and soluble fibre supplements. An adequate fluid intake helps the laxative and fibre to be effective and decreases the possibility of side-effects.

Handy hints for improving a child’s intake of water:

·Encourage them to finish a small glass of water with all family meals and snacks

·Provide them with a water bottle in the car and encourage them to drink to-and-from activities

4. Be active every day

Exercise is essential for regular bowel movements. Aim to be active every day. For children, encourage active play by limiting screen time and encouraging them to get outdoors. For adults, pedometers can provide self-motivation through tracking steps and setting a target of at least 10000 steps per day.

5. Try to open your bowels regularly

If you have the urge to open your bowels, GO - even if it means using a public toilet or the toilet at work or school. If your child suffers from constipation and their school has a strict toilet policy (e.g. only one child can use the toilet at a time or “you should have gone at recess”), talk to the school and explain the situation and if necessary, get supporting documents from your child’s health professional(s). With very young children, encourage them to sit on the toilet after each meal for 5-minutes and try to use their bowels. Use a special toy or book to positively reinforce this behaviour.

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