CKD and Constipation
By Mrinal Pandit, Chief Dietitian, NephroPlus
Constipation- one of the most encountered problem in the people with CKD. Constipation refers to difficult or irregular bowel movements. Constipation is a condition in which you have fewer than three bowel movements a week, or hard, dry and small bowel movements that are painful or difficult to pass. The frequency of bowel movement is variable, and there is an insufficient basis for defining a pathological state. Dietary fiber confers comparable benefits in renal failure patients as in other patients. In addition, insoluble fiber may lower serum nitrogen by enhancing faecal nitrogen excretion. Constipation is associated with haemorrhoids, diverticulosis and appendicitis. Constipation should be managed by diet whenever possible, as laxative may cause worsening of bowel function over time.
To find out why you are constipated your Nutritionist/Consultant will assess your
- Prescribed Medicine chart
- Daily Physical Activity
- Routine Eating Pattern
- Daily Intake of Fiber in diet
- Frequency of bowel movement.
Your diet can affect the chances of you being constipated. Low fiber in the diet can lead to constipation .Other issues that can contribute are over the counter medicine, phosphorus binders, iron supplementation and more of refined food intake. The recommended intake for fiber in daily diet should be between 22- 34 gram, depending on the age group and gender. Watch out for the content of fiber before using it, as most of the fibers are low in protein and high in potassium and phosphorus. Talk to your Nutritionist before you go on high fiber diet.
There are two types of fiber–
Soluble Fiber
It is a gel like substance, which dissolves in the water. It can help control blood glucose levels and lower cholesterol in the blood stream and reduce the risk of heart disease. Soluble fibers slow down the digestion of food, reduce hunger and prevent over eating. It can be a boon for people who are struggling with weight loss.
Food sources of soluble fiber are oats, apples, fruits with skin, barley, psyllium etc.
Insoluble Fiber
Gives bulk to the stools and promote easy passage through the digestive track. It can benefit people with constipation and irregular bowel movements.
Food sources of insoluble fiber- skin of vegetables, wheat bran, cereals and pulses.
List of fiber-containing foods suitable for people with CKD
| Sr. No | Food Item | Householdmeasurement | Potassium Content mg | Total dietary Fiber Content in g |
| 1 | Bajra | 30 g/ 6 “ diameter disc | 92.1 | 3.45 |
| 2 | Jowar | 30 g/ 6 “ diameter disc | 98.4 | 3.07 |
| 3 | Maize dry | 30 g/ 6 “ diameter disc | 88.8 | 3.67 |
| 4 | Wheat flour (whole) | 30 g/ 6 “ diameter disc | 109.8 | 3.41 |
| 5 | Bottle gourd | 100g raw/ 1 Bowl cooked | 124 | 2.92 |
| 6 | Corn baby | 50 g raw/ ½ cup | 130 | 3.05 |
| 7 | Kovai small | 100g raw/ 1 Bowl cooked | 167 | 3.25 |
| 8 | Ladies finger | 5 pods (3″ long) 52 g | 131 | 2.04 |
| 9 | Parwar | 100g raw/ 1 Bowl cooked | 117 | 2.61 |
| 10 | Peas, green | 50 g / ½ cup | 124.5 | 3.16 |
| 11 | Capsicum green | 100g raw/ 1 Bowl cooked | 154 | 2.06 |
| 12 | Apple | 1 cup slice / 2.5” dial | 116 | 2.07 |
| 13 | Guava country | 40 g (¼ piece) | 113.2 | 3.4 |
| 14 | Jambu fruit | 95 g (1 fruit) | 99.75 | 2.9 |
| 15 | Pears | 56 g (½ cup chopped) | 104.16 | 2.50 |
| 16 | Pineapple | 75 g ( ½ cup chunks) | 107.25 | 2.59 |
| 17 | Plum | 100g (2 small fruits (2.1/8”) dial) | 162 | 2.07 |
| 18 | Almonds (20 g) | 15-16 pieces (1.2 g each) | 139.8 | 2.6 |
| 19 | Ground nuts (20 g ) | 2 tbsp | 135.8 | 2.08 |
| 20 | Fenugreek seeds | 7.4 g/ 2 tsp | 66 | 3.5 |
Exercise and lifestyle modification
Physical activity may stimulate gastrointestinal peristalsis and contribute to prevention of constipation. Regular exercise up to 45 mins five times a week can help relieve constipation and increase the cardio protective cholesterol also known as HDL .
Other than regular physical activity, fixing a regular time may help you have regular bowel movements. Make sure you give enough time to move bowel. Do not hold the bowel if you have urge to use the restroom, this can lead to bloating and distention.