Constipation (colostomies).

Jul 12, 2021

Constipation rarely or never occurs with ileostomies because they don’t produce fully formed stool. If anything, ileostomy output can be too watery. But constipation can happen if you have a colostomy. You’re no more or less likely to become constipated now than you were before. The only real difference is that now you can’t strain to push it out.  

Some people with colostomies go a few days with little or no output, and then a day or two with more. This is their normal pattern, and it doesn’t mean they’re constipated. But if it isn’t typical, or if it goes longer than usual or is accompanied by discomfort, then constipation should be considered.  


The main symptom is minimal or no output for an unusual length of time.  

This may be accompanied by cramping and the usual symptoms of constipation. But if the pain is severe, and especially if it’s accompanied by nausea or vomiting, it may be a blockage and require more serious treatment.  

Causes of constipation 

  • A diet low in fiber 
  • Not drinking enough water 
  • Side effects of medication  
  • Other medical causes, which usually existed before the ostomy  
  • A lack of exercise  

How to avoid constipation 

The goal is to bulk up the stool with fiber, drink enough fluids to soften it, keep the intestines lubricated to allow easy passage, and stimulate the GI (gastrointestinal) muscles to contract in waves, moving things along.  

The two most important things to prevent constipation are fiber and water.  

Remember, this doesn’t apply to ileostomates because their food exits their bodies before it’s formed into stool. In fact, eating too much fiber will increase their risk of blockages. And it may not apply to colostomates with underlying medication conditions, like IBD, Celiac disease etc. – who should check with a doctor first.

Fiber comes in two forms – soluble and insoluble. Most fiber-rich foods contain both types and that’s good, because you need both. Soluble fiber softens the stool. Insoluble fiber adds bulk. Together, they make it easier to pass through your system. Think Goldilocks. “This stool is too hard. This stool is too soft. This stool is just right!”  

See the Food Tables (Appendix A) for ideas about what to eat, and what to avoid, to prevent and manage constipation.  

Remember that the more fiber you consume, the more water you need. If you don’t drink enough, your body will find its own water by drawing it out of your stool and this can actually cause constipation.  

Don’t eat massive amounts of fiber-rich foods in one meal. That can cause bloating. Instead, eat smaller portions throughout the day.  Also, don’t suddenly go fiber crazy if your body isn’t used to it. Add more fiber to your diet gradually.  

How much fiber you need varies with individuals, but a general rule is 20 grams a day for women and 30 grams for men. That’s not too hard to achieve. Here’s what about 25 grams of fiber would look like, over a typical day:  

Apple, with skin 

1 medium  

Cooked oatmeal 

1 cup  (or 250 gr) 


½ cup  (or 60 gr) 

Raw carrots 

1 cup  (or 100 gr) 

Baked beans 

¾ cup  (or 175 gr) 

- OR -

100% whole wheat bread 

2-3 slices  

Broccoli, cooked 

½ cup  (or 75 gr) 


1 medium  


1 medium  


1 small handful 

Your body was made to poop in the morning. That’s when colon contractions are most active. A good way to kick start the process is with a high fiber breakfast and a hot beverage. Any warm liquid relaxes the muscles and makes the contractions easier.  

Coffee is particularly effective because it stimulates the colon. 2-3 cups a day is good. But don’t go crazy. Because coffee is a natural diuretic (something that makes the body release more water, through urine), too much of it can cause dehydration and actually make you constipated!  

Some people say that a tablespoon of vegetable oil every day may help to keep stool soft and moist, and the intestinal walls “slippery.”  

Keep moving. Even a daily walk can make a difference.  

What to do if you’re constipated 

The most important thing to do if you’re constipated is to figure out why, so you can avoid it recurring or even becoming chronic. But once you’re dealing with it, here are some tips that can help: 

Increase your intake of fiber and fluids.  

Have a warm bath or shower, or put a heating pad on your abdomen. Heat relaxes the stomach muscles. 

Gently massage your abdomen and the area around your stoma.  

Exercise, like walking, is helpful.  

Take a natural laxative, like prune juice. Many people report that drinking a beer works as a laxative for them too.   

You can try an OTC medication or supplement before resorting to stronger prescription medications. Most come in liquid or tablet form. Examples include: 

Bulking agents, like METAMUCIL® or BENEFIBER®. These are mild laxatives that bulk up the stool with fiber. It’s often the first choice of doctors when recommending an OTC treatment for constipation.  

Magnesium citrate and MIRALAX® are osmotic laxatives (meaning they draw more water into the bowel and keep it there longer). This kind of laxative is often used when the stool is hard or impacted. It’s usually the second choice, after trying bulking agents. 

  • Senna. This is a stimulant laxative (meaning it stimulates the muscles to squeeze harder than usual). It’s often used when the stool is soft but still difficult to pass. Senna is a natural medicine that comes from the leaves of the senna plant. It’s the principal ingredient in some non-prescription laxatives, like SENOKOT®.  

If your constipation becomes chronic, lasts unusually long, or causes pain, nausea, or vomiting, it’s time to stop the home remedies and speak to a doctor

Courtesy Joan Scott, author of The Ostomy Raft