Monday, 28 December 2015

IBS-Constipation - Sometimes you need to do more than just eat low FODMAP!

By Peta Hill (Paedeatric dietitian)

Adults and children with IBS that tend towards constipation often find a low FODMAP diet alone does not sufficiently alleviate symptoms. Here are some extra tips to prevent constipation:

1.       Eat a variety of fibres

Dietary fibre comes from plant foods.
Insoluble fibre is found in the skins of vegetables and fruit as well as in the bran portion of whole grain cereals. Insoluble fibre promotes regularity by adding bulk to the stool.
Soluble fibre is found in some vegetables and fruit, oats, legumes, nuts and seeds as well as the fibre supplements psyllium and Metamucil. When water is added to soluble fibre it thickens and becomes gel like, helping to soften the stool by adding a gelatinous bulk.

Resistant starch rich foods include legumes, cold cooked potatoes and firm bananas. Resistant starch may improve gut health by feeding good bacteria in the large bowel.
Including a variety of fibres in your diet will ensure you get the health benefits of all of them. Here are tips to assist you with this:

·         Where possible, consume with the skin on
·         Include a variety of colours each day
·         Eat at least 3 different vegetables per day
·         Spread vegetable intake over at least 2 meals/snacks
More tips on improving your intake of vegetables here 
·         Where possible, consume with the skin on
·         Eat a variety of colours
·         Eat two serves per day (a serve is roughly the size of your fist)
·         Choose cereal products (breakfast cereal, cracker, bread, pasta, etc.) based on a variety of wholegrains (for example, sorghum or oat breakfast cereal, spelt sourdough bread, brown rice cracker and quinoa pasta
·         Read the ingredients to determine which grain is in the product (remember, ingredients are always listed in quantity from most to least)
Nuts and seeds
·         Eat daily via whole nuts and seeds, 100% nut spreads and ground nuts/seeds (e.g. LSA)
·         While many legumes are high FODMAP and best avoided during the initial strict phase of the low FODMAP diet, there are some low FODMAP options including firm tofu, ¼ cup tinned chickpeas and ½ cup tinned lentils are low FODMAP. Aim to include legumes at least 1/week in your diet

More tips on improving your fibre intake here.

2.       If your doctor recommends laxative, take them as prescribed

Laxatives contain chemicals that help increase stool motility, bulk, or frequency and are usually recommended for short-term use. When misused or overused, they can cause problems, including chronic constipation. It is important to understand how laxatives work and use them as specified by your doctor: take the specified dose, at the specified time for the specified period of time and avoid self-medicating.

3.       Drink plenty of water

Drinking plenty of water will assist to keep the stool soft and pass easily.

Approximate fluid* requirements
4-5 cups
Primary school aged children
5-6 cups
6-8 cups
8 cups
*Fluid includes plain water, milk and other drinks. The majority of your fluid intake should consist of water.
An adequate fluid intake is particularly important in people taking osmotic laxatives and soluble fibre supplements. An adequate fluid intake helps the laxative and fibre to be effective and decreases the possibility of side-effects.

Handy hints for improving a child’s intake of water:
·         Encourage them to finish a small glass of water with all family meals and snacks
·         Provide them with a water bottle in the car and encourage them to drink to-and-from activities

4.       Be active every day

Exercise is essential for regular bowel movements. Aim to be active every day. For children, encourage active play by limiting screen time and encouraging them to get outdoors. For adults, pedometers can provide self-motivation through tracking steps and setting a target of at least 10000 steps per day.

5.       Try to open your bowels regularly

If you have the urge to open your bowels, GO - even if it means using a public toilet or the toilet at work or school. If your child suffers from constipation and their school has a strict toilet policy (e.g. only one child can use the toilet at a time or “you should have gone at recess”), talk to the school and explain the situation and if necessary, get supporting documents from your child’s health professional(s). With very young children, encourage them to sit on the toilet after each meal for 5-minutes and try to use their bowels. Use a special toy or book to positively reinforce this behaviour.


  1. Nice piece of information!!! I have about two decades of experience with extreme bleeding because of hemorrhoids . The anemia has been so bad, I once had a doctor laugh because my hematocrit (red blood cell) level was so low that he thought it was a ridiculous mistake. Over the past year, I have tried so many doctors and get tired from taking medicine and injections. I heard that hemorrhoids treatment by natural diet. If you know anything regarding that than please kindly recommend me some good diet.

    1. Hi Jessica,

      We would strongly recommend you seek the assistance from a specialist or another GP if needed to discuss your symptoms and treatment. You could also see a dietitian who may be able to assist you in meeting energy and iron requirements. I hope you can find a GP and dietitian who can support you with addressing your symptoms.

      Kind regards,
      The Monash FODMAP team

    2. Dear Jessica,
      I suffer in a similar way. I heard it may help to try a low residue diet for a time in order to give the haemorrhoids a chance to heal.
      Also, you can buy an apparatus for your toilet called a 'sitz' bath that can help to treat the pain.
      Take care!

    3. Hi All,
      I'm sorry you had the experience of that doctor laughing at you-- I have had the same response, for exactly the same reason. I was bleeding so much I was anemic, and in so much pain. I no longer have this problem-- I found a doctor of functional medicine and a dietician, went on an elimination diet and determined that I was allergic to many foods I was eating. Constipation is bad for the hemorrhoids, so resolving that is key. I found an herbal supplement online that worked really well for helping to reduce the inflammation-- hemmorid, not sure if I'm spelling correctly, but has with hazel and butchers broom in it, really really works. Very important is to find the right kind of support; if your doctor is laughing at you, it means they don't know what to do for you-- fire them and find someone who has seen this before, because you are definitely not alone, and there is help available. Best of luck!

  2. Hi,

    I have suffered from constipation for a long time. I experience all the other IBS symptoms but not so much as a younger girl. Im trying to start the Low FODMAP but there are things I feel have worsened my constipation in the past but Im not sure if its just them or a mixture of foods. Things I feel make me worst are spinach, bananas and rice. Do I just avoid them anyway? they are low FODMAP foods.