Ulcerative Colitis Constipation: Causes and Management

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By Staff
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Although constipation can be uncomfortable, the good news is that there are some ways to manage it. Here’s what gastroenterologists recommend as a starting point.

1. Do a Medication Review

Because many types of medication — including some prescribed for UC — can cause constipation, it’s helpful to have a conversation with your gastroenterologist or a pharmacist about what could be a possible culprit, says Saidman.

For example, an anti-inflammatory drug class called 5-aminosalicylates (5-ASAs) can help reduce flare intensity and frequency, but they may also lead to constipation for some people, he adds. The most commonly used 5-ASA drug for UC is mesalamine. Also, anti-diarrheal medications may be a factor if they’re doing the job a little too well.
Other drugs that aren’t for UC but that you may be taking for other conditions might play a role, too, such as:

Sometimes, one of these meds won’t cause a problem on its own, but they may become an issue when taken in combination. That’s why doing a medication review is useful, says Saidman.

2. Focus on Fiber

The role of dietary fiber in digestive health isn’t just hype. While eating too much fiber can lead to constipation in rare cases, that’s much less of an issue than getting too little, says Saidman.

Whether you have UC or not, research suggests dietary fiber can increase stool frequency for those with constipation.
The recommended daily fiber intake for adults is 21 to 38 grams (g), with women typically needing around 21 to 25 g while men usually need 30 to 38 g. Dietary fiber softens your stool and also makes it larger and heavier — this might seem like a drawback, but bulky stool is easier to pass, and that lowers constipation overall.

3. Get More Exercise

Another way to reduce inflammation, improve blood flow in the digestive system, support that enteric nervous system, and reduce stress is to move more often, says Saidman.

“Any type of exercise stimulates the intestinal muscles, and that can have a meaningful effect on moving stool and reducing constipation,” he says.

Research suggests exercise can prevent constipation because of its benefits on gut health. That’s because it can help to boost peristalsis, which means food doesn’t take as long to move through your digestive tract.

4. Train Your Brain

While strategies that get your digestive motor running are helpful, it’s crucial to include your brain in the mix, says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. The gut-mind connection is powerful, and it can be harnessed with a bit of training.

“You can condition your bowel by setting it up so you expect to go at the same time every day,” he says. “The brain loves consistency and predictability, so if you tell the mind that this is the hour for evacuating the bowels, it will do that, and it learns quickly.”

For example, let’s say you want to have a bowel movement at 7 a.m. every day. Dr. Farhadi suggests sitting on the toilet at that time for 15 minutes, without straining or even trying to poop. Do this every day, even though nothing might happen at first. The point is that every day, you’re telling your brain that this is your bowel’s “deliver the shipment” time.

“You’d be amazed that after seven or eight days, your body begins to comply,” he says. “Your brain begins to anticipate that this is what you want, at that exact time, and it will deliver.”

5. Don’t Postpone Bowel Movements

Sometimes, constipation happens because you may have been training your brain in a non-helpful way without realizing it, says Farhadi. For example, it’s possible that whenever you’ve had mild urgency about needing to poop, you put it off to a more convenient time. By then, the bowel’s nudging sensation may be gone.

“Postponing your bowel movements until they’re at a better time is a good way to develop constipation, whether you have ulcerative colitis or not,” he adds. “That’s because you’ve been conditioning both your brain and your bowel to regard urgency as unimportant. You stopped listening to your body’s signals, and when that happens, the body may adapt by not sending those signals anymore.”

6. Talk to Your Doctor

As with any health challenge related to UC, working with your care team is important. Be sure to let your doctor know if it seems constipation is becoming chronic (lasting several weeks) and is affecting your everyday activities, Saidman says. You should also see a doctor if:
  • You have blood in your stool.
  • You’re losing weight without trying.
  • Bowel movements cause you severe pain.

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