"What if you're doing everything you're supposed to do for constipation, but nothing is working?!"
Well, first of all, take a deep breath, relax, and realize that you're not all alone here - and you're definitely not helpless, even if it sometimes feels that way. Constipation tends to be one of the more frustrating IBS symptoms, and it does take longer to resolve through lifestyle changes than diarrhea. But - there are many, many ways to help alleviate constipation successfully, it just takes a little patience and persistence.
What's the best way to take control of IBS constipation? Avoid The Five Constipation Frustrations.
1. Soluble Fiber Supplements Are Overnight Wonder Drugs, Right?
Soluble fiber supplements (like Tummy Fiber Acacia) can work wonders for constipation, yes. But they are NOT an overnight solution, and they're definitely not drugs. It makes a great deal of difference how you take a soluble fiber supplement, and it's well worth the time and effort to do it right. (Here's a great resource page about soluble fiber supplements if this is all brand new territory for you.)
First of all, these are the best ways to NOT get the results you want from a soluble fiber supplement:
* Try one at a low dose for a few days, then give up because there's no change.
* Go from zero to the maximum dose in one week flat, then give up because it's not working and now you're all bloated and gassy as well.
* Start taking one at the same time you stop taking laxatives, enemas, or colon cleanses you've been using regularly, then give up because your constipation is suddenly worse, not better.
The cardinal rule with a soluble fiber supplement (SFS) is to start at a low dose (for Acacia, just 1/2 a level measuring teaspoon, twice daily), and increase gradually. Constipation often requires a much higher daily dose of a SFS than diarrhea, and it can take several weeks, or even a few months, to slowly work your way up to the maximum daily dose. SFS are not laxatives, and they will not give "overnight relief", so taking a low dose of one for a few days will not alleviate your symptoms. What it will do is begin to acclimate your gut to a higher daily dose of fiber, and this is the goal. Don't give up as soon as you start - just realize that using a SFS is a slow, steady process. You will see improvements along the way.
It's tempting to think that if you need to reach the maximum dose to see the best results, you can just force your body to adjust to a high dose as fast as possible. After all, if your constipation will resolve on a SFS dose of, say, 25 grams a day, and it might typically take someone, say, 8 weeks to reach that dose, you'll be way ahead of the game if you race your way up to that dose in your very first week - right? Nope - wrong.
By definition, if you have IBS, you do not have a normally functioning gut. No matter how your IBS symptoms manifest (constipation or diarrhea, bloating or pain) your GI tract - and specifically, your gastrocolic reflex - is hyper-reactive to normal stimuli. Your goal should always be to keep your gastrocolic reflex stable so you can soothe and regulate your gut function.
Suddenly overloading your bowel with a fiber dose that is possibly ten times what you were taking before you started a SFS will do nothing but give you bloating and gas, as your GI tract struggles to deal with all of this unexpected fiber. Fiber is, after all, an undigestible carbohydrate, and your body needs to work to process it through your digestive tract.
Asking your gut to go from no soluble fiber supplement to a maximum daily dose too quickly is like trying to become a marathon runner by sprinting as hard and as fast as you can without rest. It won't work, you'll be frustrated, and you'll give up. Instead, go slowly, increase your dose gradually, and give your body the time and gentle approach it needs to adjust to the SFS increase. You can't beat your colon into submission with IBS, you need to kindly, patiently, and consistently coax it into normal motility. A SFS can help do this for you if you give it a fair chance.
If you've been regularly using laxatives, or artificially increasing colon motility through other means (enemas, colon cleanses, harsh stimulant herbs such as senna, cascara, aloe) the odds are pretty good that your bowel is dependent on them. If you suddenly stop using them, bowel motility might shut down and your constipation will seriously worsen. This would be the case even if you didn't add a SFS at the same time.
It is definitely possible to transition from a laxative or other unnatural methods of alleviating constipation to a soluble fiber supplement. But, you can't simply switch from one to the other in a single day and expect equivalent results. What you can do is keep taking your usual dose of laxatives while you begin your SFS and start to gradually increase your SFS dose. When you've been able to reach a fairly high daily dose (say, 2-3 tablespoons of the Acacia) you can start to gradually decrease your laxative.
Keep increasing the SFS and continue decreasing your laxative, taking each step slowly and carefully. This is not likely to be a fast process, but the slower and steadier you go the more likely it is to have a highly successful result. I've heard from numerous people who transitioned off of laxatives, senna, enemas, and even prescription constipation drugs and onto a soluble fiber supplement, with terrific results. But it took anywhere from one to six months, depending on how long their bowels had been dependent on the laxatives. Good things can be well worth the wait, and this is one of those situations where patience is truly a virtue. IBS is a lifelong problem for most people, so giving yourself a few months to make a tremendous improvement is not really taking too much time in the grand scheme of things.
2. Insoluble Fiber Foods Are IBS Triggers, So I Won't Eat Any!
The second of our Five Constipation Frustrations is another example of how taking something to an extreme, instead of in moderation, can make IBS worse instead of better.
Insoluble fiber foods (like bran, raw fibrous veggies, salad greens, unpeeled fruits) are very powerful GI tract stimulants, and for those of us with over-reactive guts due to IBS they can spell big trouble. For people with normal bowel function, insoluble fiber can relieve constipation and poses no problems. For constipation from IBS, however, insoluble fiber can trigger violent GI spasms that are very painful. Additionally, these spasms can actually seize up the colon muscles in a type of "charley horse", which results in slower (or no) bowel motility and worsens constipation.
For this reason, insoluble fiber needs to be treated with care. Here's the catch. For general good health, and for healthy bowel function overall, insoluble fiber foods need to be eaten as generously and as frequently as possible. While you can break the cycle of IBS attacks by eating nothing but soluble fiber foods for a few days, this is a short-term approach to simply calming your gut and the spasms. Once you've stabilized, you cannot simply continue to eliminate insoluble fiber foods from your diet on a daily basis. This is a mistake made by many people who glance over the insoluble fiber cautions without taking the time to read the information thoroughly and to follow recipes that exemplify the diet (all of which safely add insoluble fiber foods to a soluble fiber foundation, as per the IBS diet guidelines).
For people with IBS, and especially IBS constipation, insoluble fiber foods require a balancing act. I really can't emphasize strongly enough that they cannot be avoided altogether. They are potential triggers, but you must eat them, and if you do so carefully, according to the Eating for IBS guidelines, you should be able to incorporate a wide variety of insoluble fiber foods into your daily diet. Take this approach slowly and cautiously, but do take it. If you simply avoid all insoluble fiber foods completely you will worsen your constipation in the long-term. By adding it gradually, safely, and in slowly increasing amounts, you'll help alleviate constipation while still keeping your gut calm and bowel motility stable. As always with IBS, avoid going to extremes, be kind and considerate to your GI tract, and it will be much more likely to return the favor to you.
3. I don't eat anything at all when I'm constipated, because I don't want to make things worse.
As counter-intuitive as it may seem, you actually need to keep eating in order to help resolve constipation. The very act of eating, in and of itself, triggers your gastrocolic reflex, which in turn signals your colon to start contracting. The rhythmic waves of contractions - called peristalsis - are necessary to produce regular bowel movements. If you simply stop eating, your bowel will lose its signals to contract, and constipation will worsen.
What's most helpful is to eat small amounts frequently, making sure that you safely incorporate insoluble fiber foods. Try to keep to a regular schedule of light meals and snacks, so your body becomes accustomed to (and expects) food at predictable times. This will help get your gut in tune with a regular schedule of elimination as well.
As an aside, making sure that you're also on a consistent bedtime/wakeup routine will also help constipation. Your gut normally "wakes up" with you, and peristalsis increases shortly after you get out of bed and start moving around in the morning. Keeping to a set schedule of sleep (and getting enough of it!), plus following the same wakeup time every morning, will help your gut stay in a properly functioning pattern. With IBS, you're waging a daily battle against bowel dysmotility, so your goal is try and make every factor that influences bowel function - diet, stress, sleep, excercise - a gentle but persistent nudge towards regularity, in every sense of the word.
4. I drink eight glasses of water a day - that's plenty, right?
For most people without IBS, yep - this much water can be plenty. For people with IBS, it may take twice as much water - every single day - to help rein in constipation. It's not just your bowel, actually, but your entire GI tract, that needs water to function properly. Soluble fiber, the foundation of the IBS diet and a terrific tool for managing all IBS symptoms, needs plenty of water in order to regulate bowel function. Soluble fiber also normalizes water levels in the gut, which in and of itself helps constipation. But, there has to be enough water in the gut in the first place for soluble fiber to work its magic. Together, fiber and water maintain gastrointestinal muscle tone, dilute toxic wastes in the GI tract, bind irritants, bring oxygen to the tissues, and help maintain the correct balance of intestinal flora.
With constipation, the slower your gut motility is, the longer it takes for the transit of matter through your colon. The longer this takes, the more time there is for the colon to absorb too much moisture out of the matter, and this makes constipation even worse. Drinking plenty of water (especially in conjunction with a soluble fiber supplement) will help alleviate this.
It's pretty difficult to drink too much water, so make it your goal to drink 16 full glasses of water each day, and if you can make it a little bit more, even better. It's easiest to just space out your water throughout the day, especially between meals. Keep a water bottle or glass at hand at all times when you're at home or work, carry a water bottle with you if you're out and about or at school, and keep water bottles in your car for when you're on the go.
If you're suddenly increasing your water intake, then yes, you will be running to the bathroom an awful lot. But hang in there, because it won't take more than a week or so for your bladder to adjust. The really interesting thing is that you'll likely find if you don't keep up with your new water increase once you've adjusted, you will suddenly find yourself very irritable and thirsty. Most people function better overall when they're drinking quite a bit more water than they may think they need.
5. I know exercise is important for constipation, so I get at least 20 minutes of walking in each day.
Exercise is more than important for constipation-prone IBS folks - it is absolutely critical. Exercise in general regulates bowel function and increase the efficiency of your entire digestive process, and it also reduces muscle tension. Exercise works your muscles (including internal muscles, like your colon), releasing the energy stored from involuntary contractions under stress, and allowing relaxation. With IBS, a relaxed colon is a happy colon.
The catch here is that moderate activity - which would help regulate constipation in a normal person - might not be nearly enough for constipation from IBS. You may well need a solid hour - or two - of exercise on a daily basis. You might also need a strenuous aerobic exercise, and not just walking or gentle workouts. This is particularly true if you are sedentary throughout the rest of the day (desk jobs are not good for the gut!).
Why would an intense workout be better for constipation than a series of shorter, lighter activities? The production of adrenaline that fast-paced, vigorous exercise produces actually results in something close to the "fight-or-flight" reaction of your body. Part of this reaction is an increase in peristaltic movement and a bowel movement. Light exercise won't necessarily produce the same results.
I know it can be difficult, if not impossible, to find this much time on a day-in, day-out basis for exercise. But if you can make the attempt, please try. Obviously, any exercise is better than none at all, so don't give up shorter, lighter workouts if that's all you can fit in. However, if you are able to try at least a couple full-fledged, all-out, hard-core workouts each week, even if it's just for a trial run, you may see such benefits to your bowel that you become determined to find a way to make this a habit. Just make sure to drink plenty of water afterwards!
Tip Takeaway: Constipation is one of the more frustrating IBS symptoms, and it does take longer to resolve than diarrhea. But there are many ways to successfully relieve IBS constipation with a little patience and persistence, particularly if you can avoid the pitfalls of the Five Constipation Frustrations.