Heart Failure and Constipation, What is the Link?

While it’s not always a direct cause, people with CHF or heart failure are more likely to experience constipation.  Fluid restrictions, a lower activity level due to fatigue, diuretics that remove fluids from the body, and decreased blood flow to your digestive tract are contributing factors.

Constipation is Uncomfortable and Potentially Dangerous

That’s why I decided to write this blog post! 

You can take steps to avoid this problem and keep things regular.

As a dietitian working in hospitals and long term care, I am consulted when patients struggle with constipation. Unfortunately, constipation has become so common I see it nearly every day in all age groups, especially in heart failure patients.  It’s not unusual to see patients on three different medications for constipation! I want to help you avoid this problem. 

  • Constipation is uncomfortable and can make you feel bad.  
  • Constipation can cause increased blood pressure and pain in heart failure patients.  
  • Untreated constipation can lead to dangerous blockages of the intestine.  Some people need surgery to remove the blockage. Unfortunately, part of their colon is removed in the process. 

I don’t want this to happen to you.

You must let your doctor know if you are experiencing constipation that doesn’t resolve.  Don’t wait for more than a few days without a bowel movement to check in and get treated.

While medications are often necessary to resolve constipation, my goal is to help you understand the causes and take the steps needed to avoid future issues.  

Let’s dive in and solve this all too common problem!

Factors Contributing to Constipation

Fluid Restriction

If your doctor orders a fluid restriction, you must follow it.  

However, reduced fluid intake can contribute to constipation, especially if you are not eating many fruits and vegetables. Therefore, understanding that you are at higher risk is essential.  

The fluid in your colon is absorbed and used to hydrate the body.  When you are on a fluid restriction, there is less fluid overall.  When your body absorbs water from the colon, the result can be hard stools that are difficult to pass.

For more information, follow this link to my article on managing fluids in heart failure.

Decreased Blood Flow

Congestive heart failure affects all of the organs in your body, including your digestive tract.

Each time you eat, your heart sends blood to your digestive tract to start the process of digesting food. If you have heart failure, this process does not work as efficiently, and less blood makes its way to your gut affecting your digestion. 

In addition, the digestive tract’s smooth muscles may not work as well. As a result, things can slow down and back up.

As a side note, people with severe heart failure may have nausea, fullness, and vomiting.  There are medications that can help, so be sure to discuss this with your doctor.



Diuretics relieve heart failure symptoms by removing fluid and sodium from the body.  They are sometimes called water pills.  I can remember my grandmother taking her water pill every day.  Examples of common diuretics are

  • Hydrochlorothiazide (HCTZ)
  • Furosemide (Lasix)
  • Bumetanide (Bumex)
  • Torsemide 
  • Spironolactone (Aldactone)

There are several others on the market.  If you don’t know if you are on a diuretic, check with your pharmacist or doctor.

One of the main side effects listed for diuretics is dehydration. And we know that dehydration leads to constipation.  You have an even greater risk if you are on both a fluid restriction and a diuretic.

Other Medications

It’s not just heart failure medications that cause constipation.  Constipation is a common side effect of many drugs.  Pain medications, NSAIDs,  allergy medications, and iron supplements are some of the most common culprits.

Here are some medications to watch out for

  • Opioids: hydrocodone,  oxycodone, morphine, Percocet, tramadol
  • NSAIDs:  Ibuprofen, Advil  Naproxen, Motrin, Celebrex
  • Antihistamines: Benadryl, Claritin, Zyrtec, Unisom
  • Iron Supplements

In addition, certain antidepressants and medications for urinary incontinence cause constipation.  So do anti-nausea medications and non-diuretic blood pressure medications. 

There are so many I can’t list them all. Don’t stop taking your medications. Just be aware and check labels carefully. 

How Can You Avoid Constipation?

First of all, continue taking medications as prescribed.  I know I say that alot, but it’s very important to take the medications that you need. In most cases you can resolve the constipation!

The best thing you can do for constipation is to make the necessary dietary changes. 

Eat Plants!

Eat fruits, vegetables, beans, legumes, and whole grains.  

Fiber helps prevent constipation. And all plant foods, from lettuce to berries to corn, contain fiber.  Animal foods do not. They have zero fiber and will not help.

Plant foods contain two types of fiber: 

  • Soluble 
  • Insoluble

Soluble fiber forms a gel and bulks up the stool, making it easier to pass through.  

Our small intestine does not digest insoluble fiber. Instead, this undigested fiber enters the large intestine and speeds up the time it takes for stool to move through the digestive tract.  

Insoluble fiber plays another role in a healthy gut.  Our large intestine is home to trillions of microbes that feed on insoluble fiber from the plant foods we eat. These microbes play a role in digestion. So keeping your gut microbes fed and happy is another way to manage constipation.

How perfect! 

Here are some specific goals:

  • Increase your intake of fruits and vegetables.  Try for three fruit servings and five vegetable servings a day. 
  • Eat a variety of fruits and vegetables.  Don’t get stuck in a rut eating the same thing over and over.
  • Eat whole grains instead of refined or processed foods. That means wheat bread instead of white bread, brown rice instead of white rice, and higher fiber cereals with at least 5 grams per serving.
  • Add beans, peas, or legumes once daily.
  • Every day, have at least one of the following: prunes, grapes, pears, greens, or artichokes.

Check out my article on The Best Diet for Heart Failure.

Drink Enough Water!

Stay Hydrated While Keeping Within Your Fluid Restriction

Not everyone has a fluid restriction. If you do not have a fluid restriction, be sure to stay well hydrated, without overdoing it. Eight cups per day is a good rule of thumb, but this can change based on weather, weight, activity level, and your body. The best way to determine hydration is to check your urine. It should be straw-colored–not too dark and not too light.

If you have a fluid restriction, then follow it. It’s important to stay within that restriction without becoming dehydrated. For example, if your fluid restriction is 1500mls (6 ¼ cups), that doesn’t mean 1000mls is better.  Every week I see patients who need IV fluids because they become dehydrated.  Dehydration is not only a cause of constipation; it also can be bad for your kidneys.

Track your fluids daily.  You should be consuming close to the number recommended by your physician.  Getting enough is just as crucial as not overdoing it.

Move Your Body

Exercise is proven to alleviate constipation. 

Any way that you move your body is helpful.  You don’t need to take a strenuous class or go to the gym. Moving your body keeps the blood flowing and helps your GI tract work more efficiently.

Going for a walk or bike ride is a great way to enjoy physical activity.   So can working in the garden or going for a swim. If you have limited mobility, simply moving your arms and legs, or changing positions can make a difference.  

 Check with your doctor for appropriate physical activity. 

Colonic Massage

Colonic massage can help food move through your digestive system.  Start on the lower right side of your abdomen and gently massage your abdomen in a circular motion, working your way up, across the middle, and down the left side. This mimics the way food moves through your colon and helps signal the body to get things going.  

Do this once or twice a day.

What About Fiber Supplements?

Fiber supplements can be helpful. Most fiber supplements are made from psyllium husk or methylcellulose.

There is no evidence that fiber supplements cause any harm.  That being said, they are not a substitute for fruits and vegetables and are best used as an additional tool to keep you regular.


Now That You Know

It is my hope that you find this information helpful and you avoid this all too common problem.  For more ways to add fiber to your diet, jump on over to my article “What is the Best Diet for Heart Failure?” or check out the excellent “fiberfull” recipes on the blog.  

And if you have any constipation remedies that work for you, drop me a line and let me know.

And don’t forget to sign up for my email list, so you don’t miss out on future blog posts!


Please enter your comment!
Please enter your name here

Stay in Touch

The CHF Dietitian is your one-stop solution to managing a diagnosis of heart failure and living your best life.


Related Articles