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Constipation - Management
What should I advise about the role of diet in preventing and treating constipation?
- In general, the diet should be balanced and contain whole grains, fruits, and vegetables. This is recommended as part of the treatment for constipation. It is also recommended for general health and promoted by the 'five-a-day' policy.
- Fibre intake should be increased gradually (to minimize flatulence and bloating) and maintained for life.
- Adults should aim to consume 18–30 g fibre per day.
- The amounts of fibre in bran and other commonly consumed foods are given in Table 3.
- Although the effects of a high fibre diet may be seen in a few days, it may take as long as 4 weeks.
- Adequate fluid intake is important (particularly with a high fibre diet or fibre supplements), but can be difficult for some people (e.g. frail or elderly).
- Fruits high in fibre and sorbitol, and fruit juices high in sorbitol, can help prevent and treat constipation.
Clarification / Additional information
- Sorbitol:
- Fruits (and their juices) that have a high sorbitol content include:
- Apples.
- Apricots.
- Gooseberries.
- Grapes (and raisins).
- Peaches.
- Pears.
- Plums (and prunes).
- Raspberries.
- Strawberries.
- The concentration of sorbitol is about 5–10 times higher in dried fruit.
- Recipes for natural laxatives (with evidence of effectiveness from randomized controlled trials) are given in Table 1 and Table 2.
Table 1. Recipe for 'Pajala porridge' (18–20 servings). This recipe is from an institution which used it for mass catering. It is included here as an example which could easily be adapted for family use.
Ingredients | Directions |
|---|
Flax seeds 0.2 L Prunes (chopped) 0.2 L Apricots (chopped) 0.2 L Raisins 0.1 L Water 2.8 L Salt 15 mL Rolled oats 0.8 L Oat bran 0.4 L | Mix everything except the oats and bran together in a large saucepan on day 1. Leave to stand overnight. Next morning, add the oats and bran and bring to the boil for 3–5 minutes while stirring. Add extra water as needed. |
Portion size: 0.18 L |
|
Table 2. Beverley-Travis Natural Laxative Mixture.
Ingredients | Directions |
|---|
Raisins 1 cup Pitted prunes 1 cup Figs 1 cup Dates 1 cup Currants 1 cup Prune concentrate 1 cup | Combine contents together in grinder or blender to a thickened consistency. Store in refrigerator between uses. |
Dose: 2 tablespoons twice a day. Increase or decrease dose according to consistency and frequency of bowel movements. |
|
Table 3. Approximate amount of fibre in examples of commonly consumed foods and fibre supplements.
Food | Typical portion (weight) | Fibre content grams (g) per portion |
|---|
Fibre supplements |
Bran (wheat) | 1 tablespoon (7 g) | 2.5 g |
Breakfast cereals |
All-Bran | 1 medium sized bowl (40 g) | 9.8 g |
Shredded wheat | 2 pieces (44 g) | 4.3 g |
Bran flakes | 1 medium sized bowl (30 g) | 3.9 g |
Weetabix | 2 pieces (37.5 g) | 3.6 g |
Muesli (no added sugar) | 1 medium sized bowl (45 g) | 3.4 g |
Muesli (Swiss style) | 1 medium sized bowl (45 g) | 2.9 g |
Fruit 'n' Fibre | 1 medium sized bowl (40 g) | 2.8 g |
Porridge (milk or water) | 1 medium sized bowl (250 g) | 2.3 g |
Cornflakes | 1 medium sized bowl (30 g) | 0.3 g |
Bread/rice/pasta |
Crispbread, rye | 4 crispbreads (36 g) | 4.2 g |
Pitta bread (wholemeal) | 1 piece (75 g) | 3.9 g |
Pasta (plain, fresh cooked) | 1 medium portion (200 g) | 3.8 g |
Wholemeal bread | 2 slices (70 g) | 3.5 g |
Naan bread | 1 piece (160 g) | 3.2 g |
Brown bread | 2 slices (70 g) | 2.5 g |
Granary bread | 2 slices (70 g) | 2.3 g |
Brown rice (boiled) | 1 medium portion (200 g) | 1.6 g |
White bread | 2 slices (70 g) | 1.3 g |
White rice (boiled) | 1 medium portion (200 g) | 0.2 g |
Vegetables |
Baked beans (in tomato sauce) | Half can (200 g) | 7.4 g |
Red kidney beans (boiled) | 3 tablespoons (80 g) | 5.4 g |
Peas (boiled) | 3 heaped tablespoons (80 g) | 3.6 g |
French beans (boiled) | 4 heaped tablespoons (80 g) | 3.3 g |
Brussel sprouts (boiled) | 8 sprouts (80 g) | 2.5 g |
Potatoes (old, boiled) | 1 medium size (200 g) | 2.4 g |
Spring greens (boiled) | 4 heaped tablespoons (80 g) | 2.1 g |
Carrots (boiled, sliced) | 3 heaped tablespoons (80 g) | 2.0 g |
Broccoli (boiled) | 2 spears (80 g) | 1.8 g |
Spinach (boiled) | 2 heaped tablespoons (80 g) | 1.7 g |
Salad vegetables |
Pepper (capsicum green/red) | Half (80 g) | 1.3 g |
Onions (raw) | 1 medium (80 g) | 1.1 g |
Olives (in brine) | 1 heaped tablespoon (30 g) | 0.9 g |
Tomato (raw) | 1 medium/7 cherry (80 g) | 0.8 g |
Lettuce (sliced) | 1 bowl (80 g) | 0.7 g |
Fruit |
Avocado pear | 1 medium (145 g) | 4.9 g |
Pear (with skin) | 1 medium (170 g) | 3.7 g |
Orange | 1 medium (160 g) | 2.7 g |
Apple (with skin) | 1 medium (112 g) | 2.0 g |
Raspberries | 2 handfuls (80 g) | 2.0 g |
Banana | 1 medium (150 g) | 1.7 g |
Tomato juice | 1 small glass (200 mL) | 1.2 g |
Strawberries | 7 strawberries (80 g) | 0.9 g |
Grapes | 1 handful (80 g) | 0.6 g |
Orange juice | 1 small glass (200 mL) | 0.2 g |
Dried fruit/nuts |
Apricots (semi-dried) | 3 whole (80 g) | 5.0 g |
Prunes (semi-dried) | 3 whole (80 g) | 4.6 g |
Almonds | 20 nuts (33 g) | 2.4 g |
Peanuts (plain) | 1 tablespoon (25 g) | 1.6 g |
Mixed nuts | 1 tablespoon (25 g) | 1.5 g |
Brazil nuts | 10 nuts (33 g) | 1.4 g |
Raisins/sultanas | 1 tablespoon (25 g) | 0.5 g |
Convenience foods |
Quorn (pieces) | 1 serving (100 g) | 4.8 g |
Chicken curry (takeaway) | 1 portion meat/sauce (150 g) | 3.0 g |
Vegetable pasty | 1 medium sized (150 g) | 3.0 g |
Potato crisps (low-fat) | 1 bag (35 g) | 2.1 g |
Pakora/bhajia (vegetable) | 1 portion (50 g) | 1.8 g |
Pizza (cheese and tomato) | 1 slice, deep pan (80 g) | 1.8 g |
|
Basis for recommendation
These recommendations are largely based on expert opinion as there is little relevant direct evidence from clinical trials of dietary fibre [Gillett et al, 2001; North American Society for Pediatric Gastroenterology Hepatology and Nutrition, 2006].
- The Department of Health recommends an intake of at least five portions of fruit or vegetables per person per day to help reduce the risk of some cancers, heart disease, and many other chronic conditions including constipation [DH, 2003].
- The laxative action of fruits such as apricots and prunes is probably due to the fibre and sorbitol they contain.
- Prunes and prune juice [Stacewicz-Sapuntzakis et al, 2001]:
- Fibre content: dried prunes contain about 6.1 g fibre per 100 g prunes; prune juice contains no fibre.
- Sorbitol content: dried prunes contain about 14.7 g sorbitol per 100 g; prune juice contains about 6.1 g sorbitol per 100 g.
- Apricots, fresh [Lo Voi et al, 1995]:
- Sorbitol content: fresh apricots contain about 0.3 g sorbitol per 100 g.
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