Feeling backed up can be uncomfortable and painful, and can stop you from living your best life. However, “a lot of relief can be found through some medicines, dietary adjustments, and behavioral changes that all complement each other,” says Brian E. Lacy, MD, a gastroenterologist at Mayo Clinic in Jacksonville, Florida, and lead author of the American College of Gastroenterology’s (ACG’s) 2021 clinical guidelines for the management of IBS. While you may want to reach for a laxative when you feel bloated and backed up, treatment guidelines suggest using them sparingly. According to the ACG, laxatives are not useful for treating IBS symptoms in those with constipation (IBS-C). Long-term use of over-the-counter laxatives can also lead to dependency (which means you need higher and higher doses to produce stools), and can also decrease your colon’s ability to contract, which can worsen constipation, according to Mayo Clinic. “We need to treat the why, not just the symptom,” says Mark Pimentel, MD, an associate professor of gastroenterology at Cedars-Sinai Medical Center in Los Angeles. “Giving a laxative is not a solution. Diarrhea is not a treatment for constipation.” Here are four diet and lifestyle strategies to help you ease IBS-related constipation, without needing to reach for a laxative.
1. Get Yourself Moving to Keep Things Moving
Exercise works wonders for our mood and our overall health — and a regimen of moderate exercise has been shown to help ease IBS symptoms, including constipation. “Exercise helps the colon move [stool], so it’s very beneficial for relieving constipation,” says Dr. Pimental. By speeding up the time it takes food to move through your large intestine, your body absorbs less water from your stool, which makes it easier to pass. What type of exercise works best? A systematic review of 14 studies published in September 2018 in the journal Neurogastroenterology & Motility found that a wide range of exercises, from yoga to walking to mountaineering, significantly improved IBS symptoms. Simply getting more steps into your day may help improve IBS constipation. In a study published in May 2020 in PLoS One, the more steps people with IBS took per day, the less severe their symptoms, including constipation, were. “You should do what you enjoy and what you’ll stick with,” says Megan Riehl, PsyD, a gastrointestinal psychologist at the University of Michigan in Ann Arbor. “The key is to keep doing it and in moderation.” RELATED: 5 Exercises for IBS Symptom Relief
2. Add the Right Kind of Fiber to Your Diet
Fiber is often recommended for people with IBS. But it’s important to keep in mind that all fiber is not created equal. In their new guidelines, the ACG recommends soluble, but not insoluble, fiber to reduce IBS symptoms, noting that this type of fiber may be particularly helpful to patients with IBS-C. Soluble fibers dissolve in water, pull water into the stool, and form a gel-like substance that helps move contents down the gastrointestinal tract. Insoluble fiber, on the other hand, does not dissolve in water, so it stays intact as it moves through your digestive system. Soluble fiber is found in many foods, including oats, peas, beans, apples, citrus fruits, carrots, barley, avocado, and Brussels sprouts. Reaching for these food more often can help ensure that stools are soft and pass painlessly and easily. Initially switching to a higher fiber diet, however, may increase gas and bloating. To help your body get used to more fiber, it can be a good idea to add these foods to your diet a little at a time. Fiber supplements are also an effective way of adding fiber to your diet. Psyllium (the primary ingredient in the fiber supplement Metamucil) is rich in soluble fiber. You may want to start with a teaspoon a day, and then gradually increase. “You really need to take 20 to 30 grams of soluble fiber to see a beneficial effect, and it needs to be a daily habit,” says Brennan Spiegel, MD, a gastroenterologist at Cedars-Sinai Medical Center in Los Angeles. “But go slowly at first because you need to build up a tolerance for it.” RELATED: Soluble vs. Insoluble Fiber: How to Know What’s Right for You if You Have IBS
3. Sip on Some Peppermint Tea
Peppermint has long been touted as a home remedy for digestive and other health woes. When it comes to IBS, there’s now some real science behind the claims. A recent meta-analysis published in January 2019 in BMC Complementary Medicine and Therapies looked at 12 different trials and found that regularly taking a peppermint oil capsule with meals helped reduce IBS symptoms, including abdominal pain, diarrhea, bloating, and constipation. And, in their new IBS treatment guidelines, the ACG recommends the use of peppermint to help relieve abdominal pain and overall IBS symptoms. “The menthol in peppermint acts on smooth muscle to relax it, so there’s biologic plausibility that it works,” says Dr. Lacy. He often asks his patients to drink a cup of peppermint tea or take a peppermint oil capsule half an hour before eating to prime their digestive muscles for a meal. “It won’t work for everyone, but it tastes good, and it has almost no side effects, so it’s a treatment worth trying,” says Lacy. RELATED: 7 Natural Remedies for IBS
4. Stay Hydrated
Hydration is important for everyone, but if your IBS symptoms skew toward the constipation end of the spectrum, it’s especially important to be mindful of your intake since water helps aid the digestion process. When your dehydrated, the intestines will draw moisture away from your stool. This can make your stool drier and harder, which can cause or worsen constipation. To stay hydrated, drink plenty of water throughout the day and especially before, during, and after exercise. It’s also a good idea to limit caffeine-containing drinks and alcohol, which can be dehydrating. While staying properly hydrated is important for health and bowel function, it won’t cure your IBS-C, says Pimentel. “It is important to increase moisture in the stool, but it’s a misnomer that you can outdrink constipation,” he explains. Managing IBS-C typically takes a multi-pronged approach that may include diet and lifestyle changes, along with medications, as well as other therapies.
