Low-fiber diet and constipation - what can I do?

A fellow caregiver asked...

I am housebound and I was recently diagnosed with gastroparesis, and so must follow a very low-fiber diet because fiber can form bezoars in the stomach which can lead to obstruction. Since switching to this diet, I have been very constipated since I am used to consuming a lot of fiber. How can I be sure to avoid constipation when I cannot get fiber?

Also, how can I soften the stool that is already hardened?

I know exercise plays a large role, and as I have a disability it is hard for me to do so. Do you have any suggestions for exercises that I can do from my bed that will help my bowels stay regular? Thank you ever so much!

Expert Answer

Beth Reardon, M.S., R.D., L.D.N., is Caring.com senior food and nutrition editor and the director of integrative nutrition at Duke Integrative Medicine. As a practitioner of integrative nutrition, Reardon takes a holistic approach to wellness, recognizing that the foundation for optimal health and healing begins with a health-promoting diet. As a practitioner of integrative nutrition, Reardon takes a holistic approach to wellness, recognizing that the foundation for optimal health and healing begins with a health-promoting diet.

Gastroparesis, or delayed gastric emptying, can be a challenge to manage, but attention to diet and exercise can make symptoms less troublesome. Switching from a high fiber diet to a low fiber diet is important, but as you noted this can also be constipating. It is important to make this change gradually to allow your gut to adjust, at the same time maintaining your fluid intake between meals. Stool that is already hardened is very difficult to soften and may need to be manually broken up so that you can pass it safely. I would seek advice from your physician if your are not able to pass it comfortably to make sure that it is not impacted.

Your question about exercise is also key. Exercise helps to regulate the movement of food through the gut. I appreciate that your options are limited however I can offer a couple of helpful tips. First, begin with a warm castor oil pack and place it on your belly for at least 10 minutes. Repeat this as often as you can throughout the day to stimulate your digestion. Alternatively you can use some warm massage oil: Lie comfortably on your back. Place a small amount of oil in your palm and rub your hands together. Massage the oil over your abdomen beginning along your right hip bone moving your hands upwards to begin a circular motion, gently stimulating the area with your fingertips until you reach the bottom of your ribs. Continue left across the transverse colon then down towards your left hip and back again over your lower abdomen towards your right hip completing the circle. Next, use both hands to to massage the belly in the same counter clockwise direction using that circular motion. A second helpful exercise is simple yet effective as well. Lying on your back, bend your knee and draw one leg at a time up towards your chest. Hold for a count of 8 or as long as is comfortable and then switch legs.Repeat for 8-10 repetitions. If you can you can bring both knees in together, hold for a count of 8 and repeat. Those are two simple, yet very effect practices to stimulate the bowels.

To keep things moving smoothly here are some additional dietary considerations to keep in mind:

  1. Eat smaller more frequent meals throughout the day and limit beverages to between meals.
  2. Chew food really well and cook fruits and vegetables that have been difficult to digest.
  3. Consider the use of digestive enzymes and probiotics to support your body's digestion. Digestive enzymes may include bromelain and papain for tough to digest plant foods (including beans). Probiotics are healthy bacteria that reside in our colon that, among other functions, help to digest our food and maintain immunity.
  4. Include healthy fats, like olive oil, canola oil, nut and seed oils, and avocado in moderate amounts. These fats are essential to our health, but too much fat will slow the movement of food.
  5. Ginger and chamomile teas in between meals are wonderful digestive aids.
  6. Liquid meal replacements are also a good idea to alternate with real food to ease your digestive load.

Good luck and be well.