Constipation, typically defined as three or fewer bowel movements a week, with hard or dry stools that may be painful to pass, can happen to anyone. It’s often a temporary condition and not very serious. It can be caused by a low-fiber diet, not enough water, certain medications (such as some antidepressants, blood pressure regulators, and even antacids), or having another medical condition (including irritable bowel syndrome, diabetes, Parkinson’s disease, hypothyroidism, and multiple sclerosis), as well as by unknown reasons. For people with EPI, a common cause of constipation is the incorrect use of digestive enzymes, the type of medication that’s used to treat the condition, says Robert Simon, MD, a pancreatic surgeon at the Cleveland Clinic in Ohio. Pancreatic enzyme replacement therapy (PERT) helps the body break down nutrients in food, but it sometimes triggers side effects such as constipation, nausea, dizziness, bloating, and abdominal pain. If you’re experiencing constipation and have recently started PERT, you may need to talk to your doctor about adjusting the timing or dose of your medication. “Keep in mind that people who have been suffering from EPI are used to having multiple loose bowel movements, and so, when they start taking the medications, their bowel movements may decrease in frequency, and they may perceive this as constipation when in fact it’s a signal that the medication is working,” says Dr. Simon. On the other hand, if you’ve been in treatment for some time and notice that you’re becoming chronically constipated, it may be because you’ve developed a different condition unrelated to your EPI. Talk to your doctor about your symptoms so you can identify the underlying problem. In the meantime, try the following steps to find relief.
1. Ask Your Doctor Whether You Need to Adjust Your Enzyme Therapy
Taking too many digestive enzymes or taking them improperly could be triggering your constipation, says Simon. If you experience constipation, your doctor may suggest that you try lowering the dosage, he says. “But if loose stools recur because the dose is too low, then you may need to go back up a bit.” You can also tweak your dosage to match your diet. For example, if you’re at a party where you’re likely to indulge in rich and creamy foods, says Simon, you may need to take an extra capsule to minimize the strain on your pancreas. If you are eating a low-fat meal, you may need fewer enzymes, says Simon. If you have any digestive issues, including constipation, talk to your doctor to see if the enzymes need to be adjusted, says Simon.
2. Drink at Least 8 to 10 Cups of Water a Day
A major cause of constipation is not drinking enough water, says Maria Petzel, a senior clinical dietitian at the University of Texas MD Anderson Cancer Center in Houston. Most adults should drink around 8 to 10 cups of water a day, throughout the day; smaller individuals can stay well hydrated with a bit less — around six to eight cups a day. Hot liquids can also help stimulate bowel movements, says Petzel. Try coffee, tea, or warm water with lemon. Keep in mind, though, that caffeinated beverages like coffee and tea, as well as alcoholic drinks, are diuretics, meaning they lead to more urine production, so you’ll want to make sure you’re compensating with plenty of plain water. And if you’re heading out on a hot summer day, be sure to take along an extra water bottle since you’re likely to lose more fluid than usual through perspiration.
3. Boost Your Fiber Intake — Gradually
Once you’re adequately hydrated, you can start adding more fiber to your diet. But make sure you’re drinking enough water first, says Petzel. “Increasing your fiber intake without drinking enough water may make constipation worse,” she notes. Soluble fiber, found in fruits, vegetables, and oats, helps the stool retain more water, making your waste softer and easier to pass through the intestines. Insoluble fiber, found in whole grains, cereals, and seeds, adds bulk to your waste, which helps it move smoothly through your digestive tract. Women should eat 25 grams of fiber a day, and men should eat 38 grams, according to the Academy of Nutrition and Dietetics. But Petzel cautions that you should work up to that number gradually. “You don’t want to suddenly jump from 10 to 30 grams,” she says. Start by eating a high-fiber breakfast cereal in the morning, and then slowly add more whole grains to your meals: a snack of nuts and seeds, whole-wheat pasta for lunch, and a side of vegetables at dinner.
4. Try Using a Natural Laxative
Prunes are an age-old remedy for constipation. In a February 2019 study published in the journal Clinical Nutrition, researchers found that prunes increased stool frequency and were well-tolerated in people with low fiber intake who had trouble with constipation. Petzel also recommends adding ground flaxseed to your diet, since it’s also high in fiber. (Whole flaxseeds don’t have the same effect because your body simply passes the entire seed.)
5. Consider a Fiber Supplement
If you still experience constipation after increasing your water and fiber intake, talk to your doctor or dietitian about taking an over-the-counter fiber supplement, says Petzel, either in tablet or powder form. And be sure to drink extra water to help the fiber move more quickly through your intestines.
6. Be Proactive
Many people find that being physically active (which aids digestion) and making time to have a bowel movement — without rushing, and at the same time every day, if possible — can help relieve constipation. Also, talk with a doctor or dietitian about other ways to adjust your diet or lifestyle to prevent or manage constipation. If all other options fail to relieve your constipation, you may want to talk to your doctor about trying a laxative, but this should be a last-resort remedy. “The goal is to relieve constipation with either food or fiber supplements,” says Petzel. While it’s important for everyone to manage digestive problems such as constipation, it’s especially important for people with EPI to be vigilant, particularly because they may be less likely to absorb nutrients from food. But when you take charge of your symptoms, this chronic condition doesn’t have to slow you down.
