Chronic constipation is far more common—and far more misunderstood—than most people realize. Despite being one of the most frequent gastrointestinal complaints worldwide, it’s still underdiagnosed, undertreated, and often minimized. New dietary guidelines are helping bring clarity to what actually works, but they also highlight how much education is still needed.
As a colorectal surgeon and gut-health educator, I see this gap every day. Let’s break down what the science tells us, what’s changed, and what patients actually need to know.
Chronic constipation affects up to 50% of adults over the age of 60, but it is not just a condition of aging. Studies estimate that up to 15% of the general population meets diagnostic criteria for chronic constipation—and that number is likely an undercount.
Why?
Many people don’t know what “normal” bowel habits look like
There’s still stigma around talking about bowel movements
Access to colorectal or pelvic floor specialists is limited
Symptoms are often dismissed as “diet,” “stress,” or “just how my body is”
On top of that, modern lifestyles don’t help. Diets heavy in processed foods, inadequate hydration, and sedentary routines all contribute to slower gut motility. Many patients know something isn’t right—but don’t have a clear reference point for comparison.
Education is the missing link, and that’s where things are finally starting to shift.
The updated British Dietetic Association dietary guidelines represent a meaningful step forward—not because everything is new, but because the recommendations are finally specific.
For years, many patients (and even clinicians) were told simply to “eat more fiber.” But what does that actually mean?
Which fiber?
How much?
From food or supplements?
What if fiber makes symptoms worse?
These guidelines help answer those questions clearly. Some of the recommendations—like two kiwifruits or about ten prunes per day—have long been favored by dietitians. But many healthcare providers receive only minimal nutrition training and aren’t taught how nuanced constipation management really is.
Now, we have clearer, evidence-based answers.
In many ways, this research confirms what already works—but it also helps refine it.
My approach to chronic constipation has consistently focused on four core pillars:
Targeted fiber
Fruits and psyllium husk specifically
Adequate hydration, ideally with electrolytes
Multi-strain probiotics, including
Bacillus coagulans
Lactobacillus
Bifidobacterium
Magnesium supplementation, when appropriate
Much of this framework was developed while researching Constipation Nation, and the new guidelines reinforce it.
What was new and interesting?
Stronger support for psyllium as the preferred fiber source
Less emphasis on alternatives like wheat dextrin
Emerging data on foods like rye bread, which may benefit gut motility
If you read ingredient labels on fiber supplements, you’ll quickly see that not all fibers are equal—and many can safely be ignored.
Kiwifruit stands out for several reasons:
It contains both soluble and insoluble fiber
Its fiber has excellent water-retention properties, helping stool stay soft
It may stimulate mucin production, allowing stool to pass more easily
Clinical studies consistently show improved stool frequency and comfort
Rye bread appears to help by increasing stool bulk and speeding colonic transit, though it may not be suitable for everyone.
The key takeaway? These foods don’t just add fiber—they improve stool quality and movement.
Here’s something that doesn’t always show up in guidelines.
Many patients tell me:
They’ve never eaten kiwifruit
They don’t know where to buy it
Or they find it too expensive
Even in a globalized economy, access to fresh, specific foods is not universal. That matters.
While kiwifruit is an excellent natural laxative, we need continued research into more affordable and accessible options. Whole prunes, for example, remain a reasonable alternative—even if they don’t outperform positive controls in every study.
Ultimately, dietary strategies should empower patients—not force them toward medications simply because healthier options aren’t available.
Chronic constipation is common, complex, and often overlooked—but it’s also highly manageable with the right approach.
Clearer dietary guidelines help both patients and clinicians move beyond vague advice and toward strategies that actually work. Education, accessibility, and individualized care are just as important as fiber grams and food lists.
My hope is that as awareness grows, fewer people will suffer in silence—and more will understand that better gut health is achievable without jumping straight to pharmaceuticals.
If we keep educating, researching, and improving access, we can change the conversation around constipation for good.
