Managing Chronic Constipation in Adults: New Evidence-Based Dietary Guidance

Chronic constipation is more common than many people realize. It affects about 1 in 10 adults worldwide and can significantly affect quality of life. Many people struggle with hard stools, infrequent bowel movements, bloating, and abdominal discomfort, often trying different remedies with little success. For years, the most common advice has been simple: eat more fruits and drink more water. But is that enough?

Recently, the British Dietetic Association (BDA) published the first comprehensive dietary guidelines specifically for the management of chronic constipation in adults. The guideline reviewed the best available scientific evidence on foods, nutrients, and supplements that may help improve bowel movements and related symptoms.

Together with my Level 400 BSc Dietetics student, we reviewed the guideline and explored how its recommendations could be adapted to the Ghanaian context. In this article, we summarize some of the key highlights and discuss how they might translate into practical dietary choices using foods that are familiar and accessible locally.

Highlights of the Guidelines

1. Not all fibre works the same – The guidelines reported that psyllium fibre is the most effective fibre supplement for constipation. It works by increasing stool frequency, softens stool and improves overall symptoms. Higher doses (above 10 grams per day) appear to work better. Other fibre types such as polydextrose and some inulin blends (big words) did not show strong benefits for improving bowel movements.
2. Some probiotics help– Probiotics are popular, but not all strains or species help constipation. The guideline emphasized that certain specific strains (Bifidobacterium lactis and Bacillus coagulans Unique IS2) can improve stool frequency and symptoms and that the benefits depend entirely on the exact strain used.
3. Magnesium supplements can improve bowel movements–  Magnesium oxide supplements were shown to increase stool frequency and improve symptoms in adults with chronic constipation. Clinical trials showed that people taking magnesium oxide had more bowel movements compared with placebo, and some studies also reported improvement in overall constipation symptoms.
4. Certain foods have strong evidence – The guidelines did not just look at supplements. They also examined real foods. Here are the foods with the strongest evidence:

• Kiwifruit: it improved stool frequency, stool consistency, overall gut symptoms
• Prunes: Prunes increased bowel movements and improved stool consistency.
• Rye Bread: it improved stool frequency compared to regular wheat bread.

 

5. Mineral-rich water can help– Water that contains high levels of natural minerals, especially magnesium, improved bowel movements in clinical trials.
6. Targeted dietary strategies appear to be more effective for managing constipation– The guideline found that there is currently insufficient high-quality evidence to recommend a specific overall dietary pattern (such as a Mediterranean diet or general high-fibre diet) specifically for the treatment of chronic constipation. This does not mean that healthy dietary patterns are unimportant for overall health. Rather, the available evidence for constipation management supports targeted interventions rather than broad, general diet changes.

What do these mean for our local context?

The guideline highlights several foods and nutrients with evidence for improving bowel movements, many of which can be adapted to the Ghanaian diet. Psyllium fibre remains the most effective fibre supplement for increasing stool frequency and softening stool; for people who need it, psyllium is available in supplement form in many pharmacies and health stores. Naturally fibre-rich foods such as whole grains (including sorghum, millet, oats, whole maize and brown rice), legumes like cowpeas and bambara beans, and fruits can also support bowel movement regularity. While the guideline specifically identifies kiwifruit and prunes as foods with strong clinical evidence, similar locally available options such as pawpaw, mango, dates and other high-fibre fruits may offer practical alternatives. Fermented foods may also contribute beneficial probiotic bacteria, while adequate fluid intake and mineral-rich beverages support bowel function. In some cases, magnesium supplements have been shown to improve symptoms, although these should be used under professional guidance. Overall, the evidence suggests that practical, targeted dietary choices—many of which are already part of traditional Ghanaian eating patterns—can help support regular bowel movements.

Conclusion

Chronic constipation can be frustrating and uncomfortable, but the encouraging message from the guideline is that nutrition can play a meaningful role in its management. The key takeaway is that not all fibre, foods, or supplements work in the same way. Some specific foods and nutrients have stronger evidence than others, and many of these can be incorporated into familiar Ghanaian meals. At the same time, constipation is not always just a dietary issue. Persistent symptoms may sometimes signal underlying medical conditions that require proper evaluation. If constipation is ongoing, severe, painful, or accompanied by symptoms such as unexplained weight loss or blood in the stool, it is important to seek medical advice. Nutrition works best when it is informed, practical, and tailored to the individual. With the right guidance, small but targeted dietary changes can make a real difference—not only for bowel health but for overall wellbeing.

Written by Ms Aisha Mensah (BSc Dietetics Student, class of 2026) and Dr. Laurene Boateng (PhD, RD)
Dr. Laurene Boateng is a Registered Dietitian and Senior Lecturer in the Department of Dietetics, University of Ghana. She is the founder and editor-in-chief of Full Proof Nutrition, a Nutrition Consultancy committed to providing reliable, evidence-based, and practical healthy eating advice through its website www.fullproofnutrition.com.  Click here to join Full Proof Nutrition WhatsApp channel to receive more educative content. Send us a mail on fullproofnutrition@gmail.com

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Reference

1. Dimidi, E., Van Der Schoot, A., Barrett, K., Farmer, A. D., Lomer, M. C., Scott, S. M., & Whelan, K. (2025). British Dietetic Association guidelines for the dietary management of chronic constipation in adults. Neurogastroenterology & Motility, 37(12), e70173.