While IC patients are frequently in the bathroom to urinate, sometimes the very medicines recommended to help the condition cause another bathroom-related problem: constipation. And constipation causes increased discomfort in the pelvis, which is the last thing ICers need. According to the Harvard Medical School, some of the medicines that can cause constipation, especially in high doses or in combination with other medicines include antidepressants, opioids, anticholinergics (like Ditropan) and allergy medicines.(1) The best plan is to try and avoid constipation before it starts since once it starts, it rarely gets better on its own without taking a laxative.(2) While laxatives usually work, they are a short-term solution. Constipation caused by medications taken regularly requires taking some initiative.
#1 – Drink enough water
This tends to be the first line of advice for almost anything IC-related. Diluted urine is happy urine for IC patients. And in this case, the more water you drink, the more it keeps your digestive track working. Just be careful of what kind of water you drink so you don’t flare. Most tap and bottled waters are fine for IC bladders. Flavored waters and carbonated waters aren’t always fine.(3) Along with drinking water, drinking a warm or hot beverage about 30 minutes before your normal time for a bowel movement can be helpful.(2) Though hot chocolate and coffee are not usually bladder friendly, some teas, such as chamomile and peppermint, usually are.(3)
(The color of your urine will tell you just how hydrated you are. If your urine is dark yellow, cloudy then you are not drinking enough water. If your urine is clear, then you are drinking too much. Your urine should be a pale clear yellow.)
#2 – Get moving
The findings are mixed on whether exercise can get your bowels moving, but they are clear in that they can help with symptoms of constipation. For example, a 2011 study of IBS patients found that exercise significantly reduced their symptoms.(4) It is definitely worth a try to find a way to get moving that works for you and your symptoms. Even a session of yoga in your living room can be a good starting point. Read more about IC and pelvic pain friendly exercises here!
#3 – Increase your fiber intake
Eating fiber is essential for bowel health but when you have IC and are confused about what to eat, you might have accidentally cut back on the core foods that help our bowel function normally. Your goal is to eat 20 to 24 grams of fiber a day. The good news is that many foods high in fiber are also generally IC friendly. Green peas has one of the highest fiber levels at 13 to 16 grams of fiber per serving.
A variety of beans are also more bladder friendly such as pinto and lima beans. Try a small amount of lentils or black beans before eating a full serving. They fall into the “worth trying” category. Artichokes are also high in fiber and usually bladder friendly. Raspberries are another higher fiber food and on the “worth trying” list though they can be high in oxalates for some patients.
Whole-wheat pasta and breads are high fiber as is oatmeal. All of them are usually bladder friendly as long as you’re careful with what goes on or in them. Finally, skin-on pears and apples are good sources of fiber. Pears are usually bladder friendly as are sweet and mild applies like Gala, Fuji and Pink Lady.(3) Potatoes do well for fiber as well. Fruits or veggies with skin or peeling, generally have a decent amount of fiber in the skin or peeling. For example, a small apple with the peeling on it has 4 grams of fiber. The same apple without the peeling has half the amount of fiber.(5)
When it comes to fiber supplements, focus on those that are made of soluble fiber rather than insoluble fibers. Why? Soluble fibers are more gentle on the bowel. Insoluble fibers, such as a heavy granola, can be very rough on our tender bowel tissues. Psyllium fiber is composed of half soluble and insoluble fiber thus may not be as well tolerated as acacia fiber. And, of course, avoid all products that are sugar free or citrus flavored.(3) One of the most popular supplements is Heather’s Tummy Fiber (aka acacia fiber). It is very easy on the gut and rarely causes problems for patients. (5)
#4 – Consider probiotics
Sometimes having bacteria out of whack in your digestive tract can increase constipation, so probiotics may be helpful. The most friendly IC food source for probiotics is yogurt in plain, vanilla, blueberry, raspberry, peach or prune flavors, which are all on the foods to try list of the IC diet.(3) If you are lactose intolerant, look instead for coconut milk yogurt products. Probiotic supplements are also available. As with any supplement, it’s a good idea to check with your doctor before trying it and also be careful of its added ingredients and how those may affect your bladder.
#5 – Give prunes a chance
Along with increasing fiber intake, prunes are also known to help with constipation. More than just something your grandma told you, prunes really do help with constipation. In fact, a study in 2011 found that they are more effective than psyllium (Metamucil) for mild to moderate constipation and should be tried first.(6) The good news is that fresh plums are usually bladder friendly while organic dried prunes and prune juice diluted with water are worth a try for IC patients.(3)
#6 – Take a laxative or stool softener
When constipation goes on for too long, sometimes a laxative is needed to get things moving again. Stool softeners can also work. Natural remedies can seem best, but beware of senna (also known as Senokot), which is an herb that works as a laxative.(7) Teas and pills containing senna are not usually IC bladder friendly.(3)
There are four different types of laxatives. The first is a bulking agent, which is fiber-based and increases the water content of your stool. The second is a stool softener, which contains oils that soften the stool so it can pass through more easily. Third are stimulant laxatives, which stimulate the nerves in your digestive system to cause more bowel movements. The final kind are osmotic laxatives, which pull water from the surrounding tissues into your digestive system to soften your stool.(7)
Some over-the-counter laxatives to consider are milk of magnesia, polyethylene glycol (Miralax) and bisacodyl rectal suppository. A stool softener are another good, and a bit more gentle, option. Docusate sodium (Colace) can be helpful for medicine-induced constipation.(2) If you are struggling with “packing”, hard little bowel movements just inside the rectum, a Fleet Enema or Fleet glycerine suppositories can provide relief in just minutes.
Remember, though, that most laxatives shouldn’t be taken on a regular basis unless your doctor gives the OK.(7)
#7 – Physical Therapy
Some patients might be struggling with constipation because they have tight, weakened muscles. If you haven’t had a pelvic floor assessment, this is a good opportunity to determine if your muscles are contributing to the problem. Tight muscles make it difficult to start your urine stream, urinate and/or have a bowel movement. If yes, then pelvic floor physical therapy can be remarkably helpful for both the bowel and the bladder.
#8 – Medication
Symproic is a new medication approved by the US FDA in 2017 to treat opioid induced constipation. Learn more here!
#9 – Reduce Hemmorhoid Discomfort
If you struggle with pain during bowel movements, you could might be suffering from hemorrhoids. Hemmorhoids (aka hemmies) are small distended pouches of skin and blood vessels that can occur both inside and outside of the rectum, usually because of straining. Hemmie pain tends to be quite sharp, with a burning quality to it around the rectum. You might find using a hemorrhoid wipe or ointment helpful, such as Tucks Medicated Wipes. For internal hemmies, your physician may prescribe a steroid suppository.
#10 – Know when to call your doctor
No matter how proactive you are, it’s also good to be aware of when to call your healthcare provider. If you need to take a laxative and are on other medications, it’s always a good idea to check on any possible interactions. You should also call your healthcare provider if you have blood in your stool, vomiting or cramps lasting more than two hours. If you go four days or longer without a bowel movement or have diarrhea for 24 hours after taking medicine for constipation, you also need to call.(2)
- Harvard Health Publishing Harvard Medical School. What to do when medication makes you constipated. Aug. 2017.
- Kaiser Permanente. How to prevent constipation caused by your medicines.
- IC Network. 2012 ICN food list.
- ohannesson E, et. al. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011 May Volume 106, No. 5.
- Jennings KA. 16 easy ways to eat more fiber. Healthline. July 7, 2016.
- Attaluri A, et. al. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011 April Volume 33, No. 7
- West H. Thirteen home remedies for constipation. Medical News Today. Aug. 1, 2017.