Everything You Always Wanted to Know About Constipation on Dialysis, But Were Afraid to Ask

Lynda N. Newman MSN, RN, ACNS-BC, NP-C, CNN

What is Constipation?

Though it can mean different things to different people, constipation does have a definition. The Rome Foundation, a non-profit group that studies such things ("Rome III," 2012) defines it as:

Two or more of these symptoms in the past 3 months1

  1. Having bowel movements less than 3 times per week
  2. Having the following occur at least one fourth (25%) of the time:
    1. Straining with stool
    2. Lumpy or hard stool
    3. Feeling of incomplete emptying of the bowel
    4. Feeling of ano-rectal blockage (something is blocked "down there")
    5. Need for manual maneuvers (digging stool out with fingers).
  3. Loose stools only happen when laxatives are used

Why am I almost always constipated?


In the general public, people get constipated for many reasons. The most common one is not taking the time to go to the bathroom when they get the urge. Next is not eating right, not drinking enough fluids or not getting enough exercise.

If you have kidney failure, and I assume that you do since you are reading this, you have even more reasons to be constipated. If you have a potassium limit, you may not be able to eat the fruits and vegetables that can help give you an easy bowel movement. If you have a fluid limit, your body will find it harder to make a soft, wet stool that is easy to pass.

But, you might say, I am on peritoneal dialysis (PD)! I eat lots of fruits and veggies, drink 1.5 to 2 quarts of fluid per day, and am still constipated! Well, you still may take phosphate binders and you have 2+ liters of fluid pushing on your bowels. On PD, the problem may be about more than just the discomfort of feeling backed up. Constipation can slow or stop the drainage of your PD fluid by moving the tip of your catheter away from where the fluid is pooled.

With PD or hemodialysis (HD), this all gets worse if the urge to go strikes when you are on a machine. If you ignore an urge, it may go away. But, then the stool will sit in your rectum getting dryer and harder to pass. Add to all of this your binders and iron pills, and it becomes a surprise if you are not constipated!

Alert: You may start having loose or watery stools after a few days of hardly moving your bowels at all. This does not mean that you are having diarrhea. It may mean you are so plugged up that you are pushing loose or watery stools around a blockage. You can try the steps listed under severe constipation. If they do not work for you, or if you start to have belly pain, you may need to call your doctor or head for the emergency room.

How do I stop being constipated?

The goal is to have a heavy, wet stool that is easy to pass and gives you lots of notice that "it is time to go!" Then, you have to take the time to go when you get the urge. After a meal is often the best time, since your gut is already "on the move" to digest what you just ate. Choose the meal after which you can usually take the time. Go into the bathroom and sit for at least 10 minutes after that meal each day. This will help teach your body to have that urge at a time that works for you. In a perfect world your excellent diet will give you all you need to create that heavy, wet easy to pass stool. But since we do not live in a perfect world, sometimes we need a little help.

What can I take for constipation?

There are a lot of products in the digestive health aisle of the drug store. It helps to understand what they do so you can make good choices about what to use when. Of course, always check with your care team before you take any new product, even an over the counter one. Here are some of the types of products you might see: