Supporting constipation in restrictive eaters
Constipation is common among people with restricted or limited diets, and support is not as simple as “just eat more fibre.” For neurodivergent people, sensory differences, low appetite, food aversions, interoception differences, medication, hydration, gut motility, co-occuring conditions and a limited range of tolerated foods can all play a role.
When food choices are already limited, advice that focuses on adding unfamiliar foods or dramatically changing the diet can feel overwhelming and may not be realistic or supportive. Instead, constipation care should start with what feels safe and achievable, building from there to support comfortable and regular bowel movements without compromising food security.
At Whole Body Nutrition, we take a whole-body approach to nutrition, which means we often ask about bowel movements alongside other bodily functions. Many of our clients are restrictive eaters, and as a result, constipation and other gut issues can be common.
We want to understand what’s happening in the gut because of its close connection with the brain (via the gut brain connection) and its role in things like mood, appetite, digestion and overall wellbeing. Understanding what’s happening in the gut can also help us better understand restrictive eating. Constipation, bloating, nausea or abdominal discomfort can make eating feel harder and can sometimes contribute to further food avoidance. By supporting gut health and addressing these symptoms, we can help make eating feel more comfortable and support a greater sense of safety around food.
Recently Margo, Sam and Casey attended the Microba Clinical Conversations conference “Solving stubborn constipation” which was excellent! See below a couple of clinical insights.
1. Constipation isn’t always a “fibre problem”
One of my biggest takeaways was that constipation is a symptom, not a mechanism. Two people can present with exactly the same symptoms, infrequent bowel motions, hard stools and straining etc, but have completely different underlying drivers.
For example, constipation may be related to slow colonic transit, inadequate fibre intake, methane-associated slowing, or an issue with the pelvic floor/outlet. This is why simply telling someone to “eat more fibre” doesn't always help, and in some people, it can actually worsen bloating and discomfort.
2. The “exit” can be the problem, not the colon
A particularly interesting reminder was to think about defecatory dysfunction in people who strain, feel blocked, have incomplete evacuation, or need to use their fingers/press around the perineum to pass stool.
If someone is trying to push out a soft stool but the pelvic floor isn't relaxing appropriately, it's essentially like “straining against a closed door.” In these cases, adding more fibre or laxatives may not address the underlying problem. Pelvic floor assessment and physiotherapy/biofeedback may be much more appropriate.
3. Don’t ignore the urge to go
For neurodivergent people, interoception can make internal body signals harder to notice, interpret or respond to. This means the urge to poo may be subtle, delayed, or easy to miss and repeatedly holding can further reduce that signal over time.
So, building awareness of and responding to early body cues is particularly important with constipation.
4.Breakfast & the morning “poo window”
Eating breakfast within the first hour of waking can help get your gut moving.
Your colon has powerful high-amplitude propagating contractions (HAPCs) the contractions responsible for moving stool through the bowel. These occur several times throughout the day, with many occurring in the morning, particularly after waking and eating, due to the gastrocolic reflex.
So, eating in the morning gives your digestive system a signal: “It’s time to get things moving!”
If you regularly skip breakfast or delay eating for hours after waking, you may be missing an opportunity to take advantage of this natural morning window particularly if constipation is an issue.
Breakfast ideas:
🥣 Porridge with milk, fruit, peanut butter + yoghurt
🍳 2 eggs on toast + avocado + fruit
🥛 Smoothie with milk, banana, oats, yoghurt + peanut butter
🥯 Bagel with cream cheese + eggs + a piece of fruit
🥣 Leftover dinner
For some neurodivergent people, eating soon after waking can be really difficult due to nausea, sensory sensitivities, medication effects, low appetite or simply not feeling ready for food.
If a full breakfast feels impossible, start where your body feels comfortable. A few bites, a drink, or a familiar “safe” food may be enough to begin building a morning eating routine. You can gradually work towards a more substantial breakfast if and when that feels manageable.
There is no one “right” breakfast. The aim is to find a morning eating option that feels safe, tolerable and realistic for you, while giving your gut a little encouragement to get moving.
Written by Margo White, your Melbourne-based neurodiversity affirming clinical nutritionist and Neurodivergent advocate.
This article is intended as general advice only and does not replace medical advice. It is recommended that you seek personalised advice specific to your individual needs.
