Having trouble with constipation? Bowel habits can vary greatly among individuals and they can be influenced by a number of factors. When it comes to constipation, the good news is that in many cases action steps can be taken to reduce the risk of “clogged pipes”.

The definition of normal bowel activity covers a wide range – anywhere from having a bowel movement once every three days to numerous times a day. Besides the frequency, the consistency of the stool can vary as well. Stool that is large and/or stiff can be difficult to pass.

Some individuals may only have constipation infrequently or never, while others may have it chronically. Side effects of some medications (some pain medications, antacids, anti-depressants, antispasmodics, antibiotics, anti-Parkinson medication, and others), and supplement products (like high dose calcium or iron) can include constipation.

Medical conditions can play a role as well. Examples might be untreated celiac disease, irritable bowel syndrome, untreated low thyroid or diabetes, bowel obstructions (like scarring from previous intestinal surgeries or polyps). Restrictive eating such as when there is extremely low food intake due to dieting or an eating disorder can lead to intestinal issues. Even a high level of emotional stress or depression can affect the bowels.

Other risk factors can include a sedentary lifestyle, a low fiber diet, and/or insufficient fluid intake. Physical movement stimulates the peristaltic motion (think squeezing muscles in the intestines) that pushes food material through the intestinal tract. Being sedentary slows that motion.

Most Americans consume well below the recommended intake of dietary fiber. For adults, the average goal is about 25-30gm of total fiber per day. For children and teens a very general guide is their age plus 5 grams per day. Many people consume no more than half this amount. Spreading the intake of fiber-containing foods more evenly throughout the day can be helpful. A daily pattern of eating three meals with healthy snacks between rather than just a couple large eating episodes can often improve bowel status.

There are two basic categories of fiber – insoluble and soluble. Keep in mind that most fiber-containing foods provide various proportions of these two.

Insoluble fiber we might also call “roughage”. It comes from sources such as the skins and seeds of fruits and vegetables, from the bran in whole grains, and from beans/lentils. This type of fiber stimulates bowel activity and often triggers some mucous in the lining of the intestinal tract to assist in the passing the stool along more quickly.

Think of soluble fiber as a soft sponge. It absorbs moisture and keep the stool contents softer and easier to push along. Good sources would be oats/oat products, barley, beans/lentils, fruit, vegetables (like the inside of a sweet potato), avocado, and some seeds like psyllium. If your daily intake of fiber has been low overall, consider adding fiber sources gradually so the tract has a chance to adapt. Otherwise you could temporarily experience some bloating and abdominal pain.

When grocery shopping, add a lot of fruit, vegetables, beans/lentils, whole grains, nuts, and seeds to your cart. Consider what fiber-based foods you could purchase for use at both meals and snacks. Think about fiber-containing ingredients you could add to other foods, like fresh fruit in your yogurt or raisins in your oatmeal. Grind nuts and rolled oats in the food processor and add to muffins, pancake or waffle batter. Add beans to a stir fry, soup, or salad.

Note that some foods and beverages can naturally stimulate the bowels – dried plums/prunes or prune juice, raisins, figs, and coffee are examples. On the other hand, some foods/supplements in larger amounts can contribute to constipation - cheese, calcium supplements, and an excessive intake of animal proteins are examples.

Drinking sufficient fluids is incredibly important since this helps to soften the stool contents for easier passage. Inadequate fluid intake might be due to sweating heavily, being in a hot/humid environment, concerns about urinary incontinence, forgetting to drink fluids consistently due to a busy schedule, or purposefully not drinking liquids because of limited access to bathroom facilities.

In most cases, these factors can be resolved to some extent to allow for more appropriate fluid intake. Keeping a water bottle handy can be helpful. Consuming fluids throughout the day is better than not drinking for a number of hours and then drinking a large amount.

For some people, including some healthy oils (oily fish, avocado, olive/canola/other oils, nut butters) can improve bowel function. Long-term use of mineral oils or laxatives is not recommended. The mineral oil can interfere with the absorption of certain nutrients and some laxatives can actually reduce peristaltic motion over time.

Magnesium supplements are sometimes used to reduce the risk of constipation, as doses over 350mg /day can cause diarrhea. Note that high doses can interfere with the absorption of some other minerals so should not be used long-term.

Consider writing down everything you eat and drink for several days, including the timing and quantities consumed. Keep track of physical activity. Look for potential risk factors for constipation such as those noted above. If the constipation continues to be a problem, and especially if you are having other symptoms, contact your health care provider to explore other possible reasons.

Pam Stuppy, MS, RD, CSSD, LD is a registered, licensed dietitian with nutrition counseling offices in York, ME and Portsmouth, NH. She is also the nutritionist for Phillips Exeter Academy, presents workshops nationally, and is Board Certified as a Specialist in Sports Dietetics. (See www.pamstuppynutrition.com for more nutrition information, some healthy cooking tips, and recipe ideas).