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Relieving Constipation

This is a subject that most people are embarrassed to talk about, but it is a common issue among kidney disease patients. What happens in the bathroom – or in this case, what doesn’t happen in the bathroom is not something a lot of people like to talk about… with anyone. This article will hopefully give you a little guidance on how you may be able to get some relief from constipation.

Patients are considered constipated if:

  • •You have two or less bowel movements in a week,
  • •Hard stools more than 25 percent of the time,
  • •Straining during a bowel movement more than 25 percent of the time.

The most common cause of constipation is a diet low in fiber or a diet high in fats. Other causes of constipation include:

  • •Medications
  • •Poor bowel habits
  • •Low fiber diet
  • •Abuse of laxatives
  • •Hormonal disorders
  • •Phosphate binders
  • •Fluid restriction
  • •Lack of exercise
  • •Reduced dietary fiber intake

There are two types of fiber: soluble and insoluble. Soluble fiber dissolves in water and creates softer, larger stools. Insoluble fiber does not dissolve in water. It actually takes in water, and makes stool bulkier to help bowel movements pass more easily.

Adults need 20-35 grams of fiber daily. However, for dialysis patients who have to limit their fluid intake, this may be too much since it is thought increased dietary fiber may require an increased fluid intake. Also, all patients are different so the amount of fiber needed to relieve constipation varies from person to person.

High Fiber Foods

Bran muffin                 ½ muffin
Brown rice (cooked)   ½ cup
Brocolli*                    ½ cup
Peach                          1 medium
Prunes*                      3
Prunes*                      3
Spaghetti (cooked)   ½ cup
Turnips*                    ¾ cup

(Each serving contains about 150mg potassium, 20-90mg phosphorus and 1 – 5.4 grams of fiber.) (*Items contains 2 or more grams of fiber per serving.)

There are several other choices of kidney friendly high fiber foods. However, many high fiber foods contain high levels of potassium and or phosphorus. A sudden increase in your fiber intake may also cause gas, bloating and cramps. Talk to a registered dietitian if you are dealing with constipation and want to make changes to your renal diet plan.

An increase of fiber in your diet may not solve your constipation problem, but there are other paths to relief from constipation:

•Increase your daily activity level – Daily walk, stretching, light housework.
•If you have to go to the restroom – go. Do not hold on to it.
•Do not use laxatives or stool softeners for long periods of time.
•Avoid milk of magnesium, Correctol®, epsom salts and mineral oil.

Dialysis patients have been prescribed stool softeners due to constipation for long periods of time. Patients should consult with their physician for stool softener recommendations, dosage and frequency. Many people also take laxative. Patients with kidney disease should not take a laxative without their doctor’s approval.

Constipation can easily be treated in most cases. And an increase in fiber will not work for all patients. The best thing patients can do is to work closely with a renal dietitian who can help develop a kidney friendly diet plan.

Roberta Wager, RN, MSN, is a dialysis nurse for Fresenius Medical Care North America in San Antonio, TX. She is also a Past-President of AAKP and a two-time kidney transplant recipient.

This article originally appeared in the March 2013 issue of aakpRENALIFE magazine.