As we age, bowel health assumes a greater importance for a number of reasons, including: increased prevalence of constipation, incontinence, bowel obstruction and other bowel disorders.
Bowel regularity varies for everyone. For some individuals, bowel motions occur daily, while for others, every second or third day is “normal” for them.
Constipation should be diagnosed based on symptoms such as pain, motion consistency, straining or difficulty in passing a motion, rather than diagnosed on motion frequency alone.
Bowel Health and Constipation
Constipation can be caused by any of the following:
- reduced oral intake (food, fluid and/or fibre),
- reduced physical activity,
- reduced independence in toileting
- clinical conditions like Parkinson’s Disease.
Constipation in turn, can reduce appetite, causing unintentional weight loss, or in the worst-case scenario can lead to bowel obstruction and hospitalisation.
High Fibre Diet for Bowel Health
To maintain bowel health and regular bowel motions, a high fibre diet with regular fluid intake is recommended. Aim for 25-30g fibre per day.
Fibre comes in different forms and a combination of these is helpful to ensure good bowel motions and health. It is important to include a variety of soluble fibre, insoluble fibre and resistant starch in the daily diet to achieve a good balance.
- Insoluble fibre- adds bulk, absorbs water, and keeps stools soft and regular. This helps move the stool through the bowel. Good sources of insoluble fibre include: wholegrain foods, wheat/corn/rice bran, skins and seeds of fruit and vegetables, nuts, seeds, dried beans.
- Soluble fibre- dissolves in water to form a thick gel in the intestine, slowing digestion and then movement of food through the large bowel. This can assist with stabilising blood glucose levels and help lower cholesterol. By slowing digestion, it also helps people feel full for longer after eating. Good sources of soluble fibre include some fruits and vegetables, oats and oat bran, psyllium, dried beans, lentils, peas and soy products.
- Resistant starch- while not traditionally considered a type of fibre, it acts in a similar way. Resistant starch travels undigested to the large bowel where it feeds the good bacteria and the by-products helps keep the bowel lining healthy. Resistant starch is found in under-ripe bananas, cooked and cooled potatoes, rice, quinoa and pasta, legumes and wholegrain products.
A high fibre diet can be achieved by the including the following:
- porridge is a great source of soluble fibre which absorbs fluid and helps produce a soft bowel motion which is easy to pass
- pear juice & prunes contain high amounts of sorbitol which also help keep the bowel motion hydrated and easy to pass.
- Weet-Bix and other wholegrain cereals, wholemeal/grain bread, nuts, baked beans, fruit & vegetables contain insoluble fibre which provide the ‘roughage’ which helps keep the gut clean and healthy.
- Wheatgerm, oat bran or wholemeal flour can be added to cake and dessert recipes
- Psyllium husks (Metamucil) are a good source of natural fibre. Ensure adequate fluid intake is taken with this to allow it to have maximum effect.
- It is important to increase fibre intake gradually, to avoid causing stomach upset
- Ensure that if you increase your fibre intake, you also increase your fluid intake. Aim for 1.5 to 2L fluid daily
What About Texture Modified Diets for Nutrition and Bowel Health?
Texture modified diets tend to be lower in fibre, due to a reduced intake of fruit and vegetable skins, piths, seeds and nuts. Fibre in the texture modified diet can be maintained by choosing porridge, Weet-Bix, fruit juices, and texture modified fruit, legumes, vegetables or nut pastes (please check IDDSI standards).
Low Fibre Diet for Bowel Health
Occasionally a low fibre diet is required when bowel surgery is necessary, or if an individual suffers from diverticulitis, irritable bowels, inflammatory bowel disease, cancer or chronic loose bowel motions.
Examples of low fibre foods include rice bubbles, corn flakes, white bread, mashed white potato, white rice and pasta, certain low fibre fruit and vegetables, including those that are stewed, pureed, strained.
It is important to get dietary advice from the Dietitian to assist with these situations.
Low fibre diets are not intended for long term use and when appropriate, fibre should be reintroduced gradually.
Loose Bowel Motions
To manage loose bowel motions, it is important to continue including dietary fibre, particularly soluble fibre (oats, oat bran, psyllium husks, Metamucil) as this will help bind stools so that they form a gel.
Fluids for Bowel Health
Fluid intake is important in the case of both constipation (to keep bowel motions soft and easy to pass) and loose motions, due to risk of dehydration from water lost through the bowel motions. Fluids include water, juice, cordial, soft drink and high fluid food items such as yoghurt, custard, ice-cream and ice-blocks.
Note that strong tea and coffee consumed in large amounts may have a diuretic affect, and are not the best fluid for hydration.
Referral to your facility dietitian and GP for further review of constipation or loose bowels is recommended as multiple clinical conditions, medications or possible food intolerance may affect bowel motions.