Constipation with ibs

[barber123]

Hi. I have ibs and follow the low FODMAP diet. However I struggle with constipation. I take Movicol which softens the stools but I need a stimulant. Literally, if I have breakfast, I have to sit there for an hour and wait for a slight urge to go. Otherwise, I will not open my bowels at all that day. This is becoming a pain as I don't have time to sit there for the hour everyday?
Any help from the experts would be appreciated!
My doctor has said to up my movicol from one sachet to up to 6 a day. He is adamant that movicol is also a bowel stimulant but I thought it was just a softener? Any expert advice greatly appreciated

[Dr Claire Mansfield]

There can often be a psychological aspect to IBS, where psychological distress, i.e. stress or anxiety, can manifest as a physical symptom in the body. It might be helpful to consider whether you can make any changes in your life that could benefit your psychological and emotional health.

There are also behavioural aspects to bowel retraining that can help with constipation. It is great that you are waiting for the sensation of needing to go. Sometimes we are busy and ignore those sensations or put them off. Ensuring that you have a regular routine where you are not rushed, stressed or self-conscious when you go to the toilet is important. There are also ways of sitting on the toilet that can help. Also making sure that you are drinking enough fluid and exercise are also important. It might help to keep a diary so that you can track your stress levels and emotional well-being, how you eat, drink and exercise, and how these relate to your bowel movements. Good luck, Claire Mansfield

[Lee Martin]

Great advice from Claire on this thread.
From the dietary point of view: How long have you been following the low FODMAP diet and have you completed the reintroduction stage? A diet that restricts FODMAPs can also restrict fibre and other elements of foods that may be useful for relieving constipation. Some FODMAPs are like natural laxatives e.g. sorbitol therefore having a balance between consuming FODMAPs to control other symptoms of IBS and consuming enough tolerated FODMAPs to help relive constipation is something that may be useful for you.

Some people find a regular amount of linseeds in the diet can help relive constipation and there is some limited research evidence for the effectiveness of this intervention. Make sure you consume the recommend amount of fluid each day i.e. 6-8 glasses of fluid.

As Claire mentioned exercise and stretching can be useful lifestyle interventions too.

[barber123]

Hi thank you for both of your replies. I will take your comments on board. Lee - I have been following low FODMAP for over a year. Unfortunately I still have intermittent nausea, so have been delaying the reintroduction phase. However, it seems better controlled now, so I have just received your book and will be doing the re introduction very shortly. Hopefully I will be able to tolerate wholemeal bread and pasta. I seem fine with white bread and pasta and oddly gluten free pasta plays me up with bloating. I have also learnt that I cannot tolerate real coffee or garlic or high levels of fructose and knowing this has helped with the nausea and bloating.
Do the linseed bulk the stool or help u to go?
The fact that I just don't get the urge to go unless I sit there for the hour - is that normal?? Someone posted on a FODMAP Facebook page that they have Functional Defecation Dissorder. Is this something that I could have and need to look into?

[Julie Thompson]

Hi
Some good responses on this question already so I don't have much to add. Linseed's act as a gel in the bowel and hold onto fluid to prevent it being absorbed into the body, this makes stools easier to pass and they can also help with bloating. You should start with a tablespoon a day and can build up to a maximum of 4 tablespoons. Do ensure you have a glass of fluid with each dose to help it move through your bowel. They can be added to cereals, soup or salads. They can take up to 2 months to be effective occasionally.

Lee is correct and IBS-C sometimes needs a focus on fluid and fibre on the low fodmap diet, sometimes the diet doesn't resolve the constipation - but it can be really useful for other symptoms of IBS-C. Some people may have an 'outlet' problem with IBS-C, which can be helped with other treatments, please see here for further information and discuss with your doctor if you feel you need to try other treatments https://www.theibsnetwork.org/constipat ... stipation/

Kind regards

Julie

[barber123]

Thanks Julie.
Lee martin - Are you able to advise on high fibre foods that are low FODMAP? Many thanks

[Lee Martin]

You may find more benefit from high FODMAP foods rather than low FODMAP foods. If you need some guidance for reintroducing then take a look at this resource https://reintroducingfodmaps.com/ (updated 4/4/17:19.08; sorry I just noticed your previous post where you mention have got my book, if you have any questions on the reintroduction stage you can email me from the address in the book)

Otherwise I like these articles which gives some different ideas on low FODMAP foods higher in fibre content: http://www.ibsfree.net/news/2014/4/24/g ... odmap-diet
http://fodmapmonash.blogspot.co.uk/2014 ... -diet.html
http://fodmapmonash.blogspot.co.uk/2016 ... fibre.html
http://fodmapmonash.blogspot.co.uk/2016 ... fibre.html

[Dr Neil Galletly]

Very sensible advice on diet and lifestyle from the experts on the thread already. The low FODMAP diet is great for the bloating and windy symptoms of IBS, and can be really useful for diarrhoeal symptoms with IBS but it is less useful for constipation symptoms with IBS. Basically, high FODMAP foods are foods which your gut will struggle to break-down and absorb - and so instead they may get fermented by bacteria in the gut. This fermentation can produce gas (causing pain and windy symptoms) and chemical by-products that help draw water into the stool causing diarrhoeal symptoms.

As for laxatives, you are absolutely correct, Movicol is not a stimulant laxative. It is what we call an osmotic laxative - it keeps poo watery and soft making it easier to push out. Senna and bisocodyl are stimulants but the trouble is your bowel can need higher and higher doses so they are not a great choice. If diet and lifestyle changes and stool softeners such as Movicol are not helping, you may want to ask your GP about referral to a Gastroenterologist. There are some newer medicines that can help provide some stimulation to the gut while also helping with painful symptoms that may benefit you

[barber123]

That's great thank you all for your responses. Very helpful