Fasting Can Lead to Constipation During Ramadan—These Tips Can Help

Muslims around the world start 30 days of fasting as part of Ramadan. The ninth month of the Muslim lunar calendar, Ramadan is a holy time for Muslims that includes introspection, communal prayer, and abstaining from food and drink from sun up until sun down—that means fasting for as many as 11 to 17 hours at a time.

For many who observe Ramadan, those lifestyle changes—along with decreased sleep due to night prayers and other activities—can result in digestive issues, like constipation. Research reported in the Iranian Red Crescent Medical Journal shows that during Ramadan, those who fast may see significant increases in constipation, as well as bloating, heaviness or fullness.

While those who struggle with this challenge may feel like they just have to tough it out or ignore the discomfort, there are ways to help alleviate constipation. Here, nutritionists offer tips to help relieve constipation during Ramadan.

Managing Constipation During Ramadan

According to the National Institute of Diabetes and Digestive and Kidney Diseases, constipation occurs when a person has fewer than three bowel movements a week. Stool may also be hard and difficult to pass—and even after a bowel movement, you may not feel completely empty.

Various factors can lead to constipation, including many lifestyle factors or nutrition issues, like food intake, hydration, amount of movement, and even stress levels.

Ramadan specifically is a time when many people experience constipation. According to a 2017 study in the Journal of Religion and Health, constipation frequency and severity increased significantly among people who fasted.

Samina Qureshi, RDN, a dietitian who works primarily with individuals that suffer from irritable bowel syndrome and a large Muslim population, has seen this first-hand. "Throughout the year, my clients that observe Ramadan are interested in how to fuel their bodies appropriately and even more so, how to avoid constipation that occurs while fasting," Qureshi told Health.com. "We spend time during our sessions chatting about how to set ourselves up for success prior to, during, and after Ramadan."

Below, Qureshi offers tips she shares with her clients who observe Ramadan, to help reduce the frequency and severity of constipation, while still observing the holy month through fasting.

Eat More Fiber

During Ramadan, reduced food intake can be a large driver for constipation. When fasting, people decrease their meals to just two a day—Sahar, the morning meal; and Iftar, the evening meal. According to a 2016 report mentioned earlier, about 30% of the day's total calorie intake occurs at suhur—the pre-sunrise meal—and approximately 60% is seen at Iftar—the meal after sunset.

Because you're limited to two meals a day when fasting, it's important to make sure they're fiber-rich. In the report, researchers found that eating fewer than 15 grams of fiber each day was associated with an increased risk of constipation.

Eating a fiber-heavy morning meal may help reduce your chances of constipation. "Oatmeal can be a quick and easy option and is filled with fiber to help bulk up your stool," Qureshi said. "Another easy option for Suhoor [Sahar, the morning meal] is a smoothie with hydrating fruit, nut or seed butter, yogurt, chia seeds, and ground flaxseed for an extra boost of fiber."

Getting your fiber from natural sources and whole foods is key here. Fiber is a carbohydrate our bodies can't digest, which is why it plays a big role in digestion—it specifically adds bulk to stool, which allows for softer bowel movements. When you opt for a fiber supplement, you don't get the added benefit of the extra bulk to help move and soften stool.

Drink More Water

Water and fiber go hand-in-hand. Increasing fiber without adding adequate fluids can lead to more constipation, Qureshi said.

According to the 2016 report, drinking less than 750 milliliters (about 25 ounces) of fluids each day can contribute to constipation. While water needs vary from person to person, the Institute of Medicine of the National Academies recommends 95 to 125 ounces of total liquid intake daily, about 80% of which comes from water and other fluids.

It may be hard to fully meet your needs while fasting. To help address this issue, it's important to regularly sip on water during the night hours rather than trying to chug water during the morning or evening meals.

To keep track of your fluid intake, you may want to take a look in the toilet: Urine color is a simple way to assess hydration levels and has been found to be a reasonably accurate indication of whether more hydration is necessary. Normal urine color is light to pale yellow; anything darker suggests you may need more fluids in your diet.

Additional Tips

Paying attention to fiber and hydration are an important starting place, but there are additional actions that can also help you address constipation and move your bowels a little more smoothly.

• Adjust your position: Passing stools in the squatting or semi squatting position is the most natural for our bodies and prevents excessive straining. There are specific devices—one specifically known as a Squatty Potty—designed to accommodate squatting during bowel movements. You can also simply use a foot stool or books under your feet to create the squatting position while having a bowel movement.
  
• Breathing exercises: According to a study review in Medicines, "diaphragmatic breathing is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions." There are many potential benefits to breathing exercises and helping improve constipation is one of them. Try to take regular deep breaths daily, and especially while trying to pass stools to help promote bowel movements.
  
• Get moving: It can be difficult to find the motivation to exercise during Ramadan but even just walking can help improve constipation. Try to incorporate a 15-minute walk twice a day to keep things moving whenever your schedule allows, afternoon and 20-30 minutes after Iftar tend to work for many schedules.

If you've tried all of the tips outlined, or you're unsure about any of them, consider reaching out to your health care provider for further guidance. Additional actions a provider may recommend could include stool softeners or laxatives.