Most previous guidance on the management of chronic constipation has focussed on the use of medication. However, new guidance funded by the British Dietetic Association, and produced by a team of UK-based clinicians (Dimidi et al, 2025), gives the
first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults. As well as the effect on the bowel, chronic constipation prospectively associated with an increased risk of urgency and hesitancy among parous middle-aged women (Alhababi et al, 2021).
Chronic constipation is characterised by infrequent stools, difficult stool passage, or both, and affects 10.1% of the global population (Barbiero et al, 2021). It significantly impacts quality of life. Nearly all patients try lifestyle management options for symptom relief, including dietary modifications that often focus on increasing dietary fibre intake. However, more than half are not satisfied with their current treatment (Johanson and Kralstein, 2007), highlighting an urgent need to improve management strategies for chronic constipation.
New guidance
The authors summarised the main points of the guidance as:
- These are the first guidelines specifically for the dietary management of chronic constipation and are based on evidence from robust systematic reviews following the GRADE process.
- Psyllium supplements, certain probiotic strains, magnesium oxide supplements, kiwifruits, rye bread and high mineral water are recommended to improve specific constipation outcomes.
- No recommendations were made on whole diet approaches (e.g. high fibre diet) because of a lack of evidence.
A total of 59 recommendations were made, including dietary supplements, foods and drinks that have never been previously included in clinical guidelines, and can now be rapidly implemented into clinical practice.
Speaking about these recommendations, registered dietitian and lead for the guidelines, Dr Eirini Dimidi, from the Department of Nutritional Sciences, King's College London, London, said, “Previous guidelines have incorporated very limited dietary advice, instead focusing on medications to treat symptoms, however we are aware that diet is a preferred approach to managing the condition.
She added: “Chronic constipation can have a huge impact on someone’s day-to-day life. Our research reveals some new dietary strategies that could indeed help patients. At the same time, we urgently need more high-quality trials to strengthen the evidence on what works and what doesn’t.”
Speaking on behalf of the British Dietetic Association, Dr Yvonne Jeanes, Head of Research and Impact, said, “These guidelines are an excellent resource for dietitians and healthcare professionals more broadly, they support a more diet focused and evidenced-based approach to the management of chronic constipation.
“The guidelines state where the gaps in supporting evidence are. Although a high-fibre diet is beneficial for overall health, the guideline development process revealed insufficient evidence to confirm its effectiveness for managing constipation.”
The guidelines represent a milestone for clinicians and patients, offering clear, practical and evidence-based recommendations for the first time, including a clinician friendly tool that quickly helps identify key foods, diets and supplements that can support key symptoms.
