Constipation and Chronic Kidney Disease
There are a few different reasons why constipation can occur with chronic kidney disease (CKD). Common reasons include:
a lack of fiber in diets intended for people with CKD
fluid restrictions for people with later-stage CKD
co-occurring or secondary conditions
medication side effects
Treatments, which include lifestyle changes such as eating more fiber and increasing exercise levels, can often help relieve symptoms.
This article examines the causes and treatment of constipation in people with CKD and reviews the early symptoms of kidney disease and kidney failure. Constipation isn't typically a symptom of kidney failure.
What causes constipation with chronic kidney disease?
CKD can lead to constipation for some people. Common causes of constipation for people with kidney disease include:
Renal diets
It can be difficult enough for people eating a standard American diet to get the fiber they need. People who are on a renal diet are limited in their food choices, and many foods that are high in fiber have traditionally been excluded.
However, newer recommendations for people with chronic kidney disease are less strict about fiber-rich foods such as fruits and vegetables, meaning it's safe to add these foods to a renal diet.
Co-occurring conditions
Many of the conditions that commonly occur alongside kidney disease, such as diabetes, hypothyroidism, and hypercalcemia, can slow down your digestive system. A slow digestive system can lead to constipation.
Bacterial imbalance in the gut
A bacterial imbalance in the gut, called dysbiosis, can occur when your kidney isn't working correctly. It happens because your kidneys aren't filtering bacteria. This leads to an abnormal mix of bacteria in your intestines, which can cause constipation.
Medication reactions
People with kidney disease may develop secondary conditions such as gout, anemia, or bone disease.
Some of the medications prescribed for these secondary conditions, including blood pressure medications, iron supplements, anti-nausea medications, and calcium supplements, can cause constipation in some people.
Fluid restrictions
People with later-stage kidney disease may need to restrict their fluid intake, especially those undergoing dialysis. This can make it challenging to get enough hydration to avoid constipation.
What's the best way to treat constipation with chronic kidney disease?
Treating constipation depends on several factors, but lifestyle and diet changes can often help resolve the condition. Doctors typically recommend starting with lifestyle changes before progressing to medication.
Lifestyle treatments that can help people with chronic kidney disease get relief from constipation include:
Eating more fiber: Getting enough fiber in your diet is one of the best ways to combat constipation. Fiber helps carry waste through your system. It's found in a variety of foods, including whole grains, nuts, lentils, beans, oats, apples, pears, and vegetables.
Increasing your activity: Fitness combats constipation. Exercise helps your blood flow and helps food move through your digestive system. You can start small; even walking a little every day will make a difference.
Increasing fluids: Fluids are one of the best ways to beat constipation. People with chronic kidney disease can talk with their doctors about the best way to get enough fluid to keep their digestive systems moving.
Try probiotics: Probiotics are live microorganisms that are found in fermented food that can help relieve constipation. Fermented foods included options such as yogurt, sauerkraut, miso, kimchi, tempeh, natto, and homemade pickles. Ask your doctor or dietitian about the right amount of these foods to add to your diet.
Relieve symptoms with an over-the-counter (OTC) medication: If your symptoms are severe and haven't been relieved by methods such as hydration or fiber, an OTC medication can help. However, it's important not to take these medications for longer thana few days. OTC options include stool softeners, stimulant laxatives, and fiber supplements.
Prescription-strength medications: Your doctor might prescribe prescription versions of any medication if lifestyle changes aren't enough.
Biofeedback therapy: Biofeedback therapy is a treatment that retrains the muscles that control bowel movements.
How does constipation affect the outlook for people with chronic kidney disease?
Constipation can affect the quality of life and outlook for people with CKD. A 2019 study found that constipation can increase the chances of mortality and was linked to a higher risk of serious complications such as end stage renal disease, heart disease, and Parkinson's disease.
The study also found that constipation in people with CKD led to a higher risk of developing coronary heart disease and stroke.
Is constipation an early warning sign of kidney disease?
Constipation isn't typically an early sign of kidney disease. It's more common for kidney disease to cause early symptoms such as:
fatigue
difficulty concentrating
anemia
loss of appetite
insomnia
unexplained muscle cramping
sleep apnea
red or pink urine
urine that appears foamy
frequent urinary urges
skin that is dry and itchy
puffiness around the eyes
swollen feet and ankles
For people with CKD, what are the symptoms of kidney failure?
As kidney disease progresses, it can cause increased symptoms. Some symptoms are similar to early symptoms but are more severe. Other symptoms are unlikely to show up until chronic kidney disease has progressed to kidney failure.
Symptoms of kidney failure include:
fever
fatigue
confusion
skin rash
itchy skin
very pale skin
weakness
unexplained muscle cramping
bone pain
no urine production or excessive urine production
unusual bleeding
nose bleeding
back pain
stomach pain
a mass in the stomach
diarrhea that is sometimes bloody
loss of appetite
bad breath
a metallic taste in the mouth
vomiting that is sometimes severe
swelling throughout the body
difficulty hearing
Takeaway
Chronic kidney disease doesn't always cause constipation, but there are a number of reasons why it does for many people with CKD. Renal diets, fluid restrictions, medications, co-occurring disorders, and more can all lead to constipation.
Treatment can bring relief and often includes lifestyle changes such as eating more fiber, getting more exercise, and increasing fluids. When these methods aren't enough, medications, biofeedback, and surgery can be options.
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