Dietary and lifestyle recommendations for constipation

This narrative review presents the available evidence on dietary and lifestyle interventions for the management of chronic constipation in adults, a disorder with an estimated prevalence of 10-15% and a substantial impact on quality of life. The evidence supports a daily fiber intake of 25-35 g, preferably from food sources, through mechanisms that increase stool bulk, water retention, and colonic fermentation. Among supplements, psyllium demonstrated the greatest efficacy in global symptom response (RR: 1.82; 95% CI: 1.51-2.20), bowel movement frequency, and straining, whereas other fibers showed limited effects. Specific foods such as kiwifruit and prunes increase complete spontaneous bowel movements (RR: 1.13; IC 95%: 0.39-1.88) and improve stool consistency, with effects attributed to fiber, sorbitol, and bioactive compounds; mango suggests additional microbiota-mediated benefits, although evidence remains limited. Dietary patterns such as the Mediterranean diet are associated with a lower risk (16%; 95% CI: 9-22), independent of fiber intake. Fluid intake shows an inverse association (OR: 0.80), but increasing fluids alone does not improve symptoms in adequately hydrated individuals. Physical activity reduces risk, whereas sleep disorders increase it (OR: 1.47-1.94), with a U-shaped relationship according to sleep duration. Overall, the evidence supports a multifactorial, individualized, and pathophysiology-based approach, prioritizing fiber type, dietary patterns, and behavioral modifications, with limitations related to methodological heterogeneity and the predominance of observational studies. Gradual fiber titration with adequate hydration is recommended to minimize bloating and flatulence, and clinical phenotypes should be considered when selecting targeted and safe therapeutic interventions in routine practice.