Lifestyle Medicine and Chronic Constipation in Viet Nam: Dietary Fiber, Bowel Habits, and Stepwise Care

Lifestyle Medicine and Chronic Constipation in Viet Nam: Dietary Fiber, Bowel Habits, and Stepwise Care

Last reviewed: October 30, 2026

A patient experiencing constipation may be advised to eat more vegetables, drink more water and exercise regularly. These are familiar recommendations, and they can be helpful. Yet some people continue to struggle despite making these changes. They may have bowel movements several times a week but still experience hard stools, prolonged straining or the uncomfortable feeling that their bowel has not emptied completely.

Another person may already consume substantial amounts of dietary fiber but find that increasing it further makes bloating worse. Someone else may have used laxatives for months without understanding why treatment provides only temporary relief.

These experiences illustrate why chronic constipation requires more than general lifestyle advice. It is a common clinical problem with several possible underlying mechanisms, and the most appropriate management depends on the patient's symptoms, medical conditions and response to previous treatment.

Lifestyle Medicine can contribute through individualized nutrition, appropriate hydration, physical activity, supportive bowel habits and sustainable self-management. However, these interventions should be connected to clinical assessment and evidence-based treatment rather than presented as a universal solution.

Recent international developments, including the Rome V diagnostic framework and a new Asia–Pacific clinical consensus published in 2026, provide an opportunity to make constipation care more precise.

For healthcare professionals in Viet Nam, the challenge is to translate this evidence into practical care while recognizing when a patient needs medication, specialized investigation or treatment beyond lifestyle modification.

Understanding Chronic Constipation Beyond Bowel Movement Frequency

Constipation is often associated with having fewer than three bowel movements per week. However, frequency alone does not adequately describe the condition.

Some people pass stool regularly but experience considerable difficulty during defecation. Others report hard or lumpy stools, excessive straining, a sensation of incomplete evacuation or the need to use manual maneuvers to assist bowel movements.

These symptoms can interfere with work, travel and social activities, even when bowel movements occur relatively frequently.

The Rome V framework, published in 2026, introduced an important terminology change within the adult classification of disorders of gut–brain interaction. The term functional constipation was replaced by chronic constipation, reflecting a broader shift away from the term "functional" in the Rome classification.

The updated framework describes chronic constipation through difficult, infrequent or incomplete defecation. Its symptom-based criteria retain familiar features, including straining, hard or lumpy stools, incomplete evacuation, a sensation of anorectal blockage, manual assistance during defecation and fewer than three spontaneous bowel movements per week.

At least two qualifying features are required. The individual defecation-related symptoms must occur during more than one-quarter of bowel movements, with the criteria fulfilled during the preceding three months and symptom onset at least six months before diagnosis. Loose stools should rarely occur without laxatives, and the criteria for irritable bowel syndrome should not be met.

These criteria provide a structured way to identify chronic constipation within the Rome V classification. However, they do not mean that every person reporting longstanding constipation automatically has a disorder of gut–brain interaction.

Medication effects, metabolic disorders, neurological conditions, structural abnormalities and other identifiable causes must still be considered.

Chronic constipation may involve normal colonic transit, slow colonic transit, impaired rectal evacuation or overlapping mechanisms. Symptoms alone cannot reliably distinguish all these patterns.

This matters because patients may respond differently to the same treatment. Increasing dietary fiber may help someone whose main difficulty involves hard stools and inadequate stool bulk, but it may provide little benefit to a person whose principal problem is impaired coordination of the muscles involved in defecation.

An appropriate assessment should therefore begin by understanding what the patient means by constipation rather than assuming that infrequent bowel movements are the only problem.

The 2026 Asia–Pacific Consensus Supports a Stepwise Approach

In August 2026, the Asian Neurogastroenterology and Motility Association and the Asia-Pacific Association of Gastroenterology published a regional consensus on chronic constipation in the Journal of Neurogastroenterology and Motility.

The consensus was developed by a multidisciplinary expert group from across Asia using structured literature reviews, a Delphi consensus process and the Grading of Recommendations Assessment, Development and Evaluation framework.

It contains 39 consensus statements addressing clinical assessment, nonpharmacological management, medication treatment and specialized investigations.

The expert group included Dr. Duc Trong Quach, a Vietnamese gastroenterologist affiliated with the University of Medicine and Pharmacy at Ho Chi Minh City and Nhan Dan Gia Dinh Hospital.

His participation provides a relevant connection to Vietnamese clinical practice, although the consensus remains a regional professional document rather than an official guideline issued by the Vietnamese Ministry of Health.

The guidance recognizes that chronic constipation is heterogeneous and frequently overlaps with other gastrointestinal symptoms. It also acknowledges differences in access to specialized diagnostic investigations across Asian healthcare settings.

Its approach begins with appropriate clinical assessment, followed by lifestyle-related measures and conventional medical treatment selected according to the patient's circumstances.

An important recommendation is to assess the response to initial treatment within approximately four weeks.

When symptoms remain inadequately controlled, clinicians should review whether treatment was used appropriately, whether the original diagnosis remains plausible and whether further treatment or investigation is necessary.

A patient who continues to experience difficult evacuation despite reasonable treatment may need assessment for a defecatory disorder rather than another recommendation to consume more fiber. Someone with persistent hard stools may benefit from an appropriate laxative or medication adjustment after clinical review.

The value of the Asia–Pacific consensus lies in its practical approach. Rather than repeating the same recommendations indefinitely, clinicians are encouraged to determine whether treatment is working and reconsider the problem when the expected improvement has not occurred.

Clinical Assessment Must Identify Contributing Causes and Warning Signs

An appropriate assessment begins with the patient's usual bowel pattern, symptom duration, stool consistency, associated discomfort and previous treatment response.

The Bristol Stool Form Scale can help patients describe stool appearance more consistently. Hard, separate lumps or lumpy, sausage-shaped stools may support the assessment of constipation, although stool form alone is not sufficient for diagnosis.

Medication history is particularly important.

Opioid analgesics, anticholinergic medicines, iron preparations, some calcium-containing products and several other medications can contribute to constipation. Symptoms may begin or worsen after a medicine is introduced or its dose is changed.

Medication-associated constipation should not automatically be attributed to inadequate dietary fiber. At the same time, medicines should not be stopped or adjusted without reviewing their clinical indications and possible alternatives.

Relevant medical conditions may include hypothyroidism, diabetes-related autonomic dysfunction, neurological disorders and other conditions affecting intestinal transit or evacuation.

Clinical assessment should also identify warning signs that may require further investigation.

Rectal bleeding, unexplained iron-deficiency anemia, unintentional weight loss, a concerning change in bowel habits or a significant family history of colorectal cancer may indicate a need for additional assessment.

Severe abdominal pain accompanied by marked distension, persistent vomiting or inability to pass stool and gas may indicate bowel obstruction or another acute abdominal condition requiring emergency evaluation.

In these circumstances, increasing dietary fiber or taking additional laxatives without medical assessment may be unsafe.

Colonoscopy should not automatically be performed for everyone with chronic constipation. Its use should reflect alarm features, relevant clinical findings and age-appropriate colorectal cancer screening requirements.

The objective is to identify people who can reasonably begin with conservative treatment while ensuring that significant underlying disease is not overlooked.

Dietary Fiber: Different Types Have Different Effects

Dietary fiber has long been central to constipation advice, but newer evidence challenges the assumption that simply eating more fiber will improve symptoms in every patient.

In October 2025, the British Dietetic Association published comprehensive evidence-based guidelines on dietary management of chronic constipation in adults.

The guideline development involved four systematic reviews covering 75 randomized controlled trials and resulted in 59 accepted recommendation statements.

These addressed fiber supplements, selected probiotic strains, other supplements, specific foods and mineral-rich waters.

The certainty of evidence varied considerably. Most statements were supported by low- or very-low-certainty evidence, while a smaller number were supported by moderate-certainty findings.

One important conclusion was that the available randomized trials did not provide sufficient evidence to formulate recommendations for whole dietary patterns, including broadly defined high-fiber diets.

This does not mean that vegetables, fruit, legumes and whole grains are ineffective or undesirable.

These foods remain important components of a nutritionally adequate diet and contribute to overall health. The limitation concerns the strength of trial evidence for specific constipation outcomes when an entire dietary pattern is evaluated as a treatment.

Among individual fiber supplements, psyllium has some of the most consistent evidence supporting clinical benefit.

Psyllium is a soluble, gel-forming fiber that absorbs and retains water, helping to influence stool consistency and passage. The British Dietetic Association guidelines support its use in appropriate adults with chronic constipation, generally beginning with a small amount and increasing gradually according to tolerance.

Adequate fluid intake is important when using bulk-forming fiber supplements.

However, not all fiber preparations have the same properties. Different fibers vary in water-holding capacity, fermentability and effects on gastrointestinal symptoms. Some may produce more gas or bloating than others.

A supplement labeled as containing dietary fiber should therefore not automatically be assumed to provide the same effects as psyllium.

Some patients may experience improvement in stool frequency but continue to have abdominal bloating or difficulty with evacuation. Others may find that additional fiber makes their symptoms more troublesome.

Patients with suspected bowel obstruction, certain severe evacuation disorders or other relevant conditions may not be suitable for routine increases in bulk-forming fiber without further assessment.

The useful clinical question is not simply how much fiber someone consumes. It is whether the type and amount of fiber are appropriate for the patient's symptoms, tolerance and underlying condition.

Kiwifruit, Prunes and Other Foods: What Does the Evidence Support?

The 2025 British Dietetic Association guidelines also evaluated specific foods and beverages, including kiwifruit, prunes, rye bread and selected mineral-rich waters.

Several randomized trials found that kiwifruit consumption improved bowel movement frequency in adults with chronic constipation.

Compared with psyllium, kiwifruit produced a modest additional improvement in stool frequency in some analyses, but it did not consistently demonstrate superior effects on stool consistency or other symptoms.

Prunes have also been studied, although the evidence does not establish that they are consistently more effective than psyllium.

These findings provide more specific information than the broad suggestion that any fruit will relieve constipation.

However, they should not be interpreted as a recommendation that every patient needs imported fruit or a particular specialty product.

Food availability, cost, preferences, gastrointestinal tolerance and other medical conditions should influence dietary choices.

In Viet Nam, familiar fruits, vegetables, legumes and whole grains can contribute to adequate dietary fiber intake. Their general nutritional value should be distinguished from clinical trial evidence supporting a specific food as a treatment for chronic constipation.

For example, papaya, dragon fruit, guava and other locally available fruits may form part of a balanced diet according to individual tolerance, but they should not automatically be presented as proven treatments equivalent to interventions evaluated in randomized trials.

A patient with diabetes may need to consider the carbohydrate content and portion size of dried fruits. Someone experiencing substantial bloating may tolerate one source of fiber better than another.

The same caution applies to mineral-rich water and dietary supplements.

Certain preparations have demonstrated benefits for specific constipation outcomes, but their composition varies. They may also be unsuitable for some patients, particularly when kidney function or other medical conditions require consideration.

The objective is to identify dietary options that are accessible, nutritionally appropriate and reasonably supported by evidence rather than searching for a single natural remedy.

Probiotics Require Strain-Specific Interpretation

Probiotics are frequently promoted for constipation and general digestive health, but the evidence is more complicated than commercial claims often suggest.

Different microorganisms, strains, formulations and doses may produce different effects. Evidence supporting one preparation cannot automatically be extended to another product simply because both contain probiotic bacteria.

The 2025 British Dietetic Association guidelines evaluated probiotic interventions and found that some specific organisms or strains may improve particular constipation outcomes. However, the evidence was inconsistent across preparations.

For example, the guideline's pooled assessment did not demonstrate consistent improvements in stool frequency or stool consistency for preparations containing the Shirota strain, previously classified as Lactobacillus casei Shirota and now commonly classified as Lacticaseibacillus paracasei strain Shirota.

The certainty of the supporting evidence was very low, making it important not to interpret the absence of demonstrated benefit as definitive proof that the strain can never be effective.

More recent studies have reported some favorable findings.

A randomized trial published in The Journal of Nutrition in April 2025 evaluated a fermented milk product containing this strain among 50 adults in the United States who experienced hard or lumpy stools.

The investigators reported improvements in selected stool-related outcomes and quality of life.

However, the trial was open-label and used a no-intervention control rather than a matched placebo. The study also involved researchers affiliated with organizations receiving support from, or connected to, the product manufacturer.

These characteristics are important when interpreting the findings.

A separate randomized pilot study published in Beneficial Microbes on April 13, 2026, investigated a fermented milk product containing the same strain among Vietnamese adults experiencing hard or lumpy stools.

The Vietnamese study included 51 participants at a single center. They were randomly assigned to receive the fermented milk product daily for four weeks or no intervention, followed by a two-week observation period.

The investigators reported improvements in several measures of stool consistency, bowel movement frequency and constipation-related symptoms in the intervention group.

These findings may be useful for further research, but the study also had important limitations.

It was small and open-label. Participants knew whether they were receiving the product, and the control group did not receive a matched placebo.

Expectations, differences in behavior and other uncontrolled factors may therefore have influenced the observed results.

The participants were selected for hard or lumpy stools and should not automatically be considered representative of everyone meeting Rome V criteria for chronic constipation.

The Vietnamese study also included researchers affiliated with the manufacturer's research institute, making transparent consideration of potential commercial interests important.

Taken together, the earlier pooled evidence and the more recent American and Vietnamese trials do not establish a consistent treatment effect across different populations or clinical circumstances.

The favorable results reported in these small studies warrant further investigation, but they do not justify recommending the strain or a particular commercial formulation as an established treatment for all patients with chronic constipation.

Further independent, adequately powered, placebo-controlled studies would help determine whether the observed benefits are reproducible and clinically meaningful.

For VLMA, the appropriate educational message is to distinguish promising research from evidence sufficient to support routine clinical use, while avoiding endorsement of any commercial probiotic product.

Hydration, Physical Activity and Bowel Habits

Adequate hydration is important for normal physiological function and may be helpful when constipation is associated with insufficient fluid intake.

However, advising someone who is already adequately hydrated to drink progressively larger amounts of water is not an established treatment for every form of chronic constipation.

Fluid requirements vary according to environmental conditions, activity levels, diet and individual medical circumstances.

In Viet Nam, hot weather and occupations involving prolonged outdoor work may increase fluid losses through sweating. A person working in agriculture or construction may have different hydration requirements from someone working indoors.

At the same time, people with heart failure, advanced kidney disease or prescribed fluid restrictions require individualized advice.

Appropriate hydration should not be confused with excessive water consumption.

Physical activity can support overall health and may contribute to bowel function, particularly among people who are largely inactive.

Walking and other suitable movement may be reasonable components of a broader management plan. However, evidence supporting specific exercise programs as stand-alone treatments for chronic constipation is less consistent than the evidence supporting several established medications.

Exercise should not be presented as sufficient treatment for constipation caused by medication effects, neurological disease or impaired defecatory coordination.

Bowel habits also deserve attention.

Some people frequently postpone defecation because they are working, traveling or unable to access a suitable toilet. Others spend prolonged periods straining even when they have little urge to pass stool.

Establishing regular and comfortable opportunities for bowel movements may be helpful.

Colonic activity often increases after meals, particularly after breakfast, making this a practical time for attempting defecation when it fits the person's routine.

Appropriate toilet posture may improve comfort for some people, although evidence supporting specific positioning techniques remains more limited than that supporting established treatments.

These suggestions should not become rigid requirements. A patient should not be made to feel that treatment has failed simply because they cannot pass stool at the same time every day.

Access to suitable toilet facilities can be an important practical consideration.

For some workers, students and people who travel frequently in Viet Nam, the ability to respond to the urge to defecate may be limited by workplace conditions, privacy or the availability of clean facilities.

A useful Lifestyle Medicine intervention should consider these circumstances rather than assume that every patient has complete control over their daily routine.

When the Main Problem Is Difficulty Evacuating Stool

One of the most important distinctions in chronic constipation is between difficulty moving stool through the colon and difficulty evacuating stool from the rectum.

Some patients experience impaired coordination of the abdominal muscles, pelvic floor and anal sphincter during attempted defecation.

This may be described as dyssynergic defecation, a type of defecatory disorder.

Patients may report excessive straining, persistent sensations of anorectal blockage, incomplete evacuation or the need for manual assistance, even when their stools are relatively soft.

In these circumstances, increasing dietary fiber or repeatedly changing laxatives may not adequately address the underlying problem.

Clinical assessment may include an appropriate digital rectal examination and specialized investigations when indicated.

Anorectal manometry can assess pressure patterns and muscle coordination during attempted defecation. Balloon expulsion testing evaluates the ability to expel a simulated stool, while defecography may be useful in selected cases.

Rome V introduced important changes to the diagnostic framework for dyssynergic defecation in 2026.

The updated criteria require symptoms suggesting difficult evacuation during at least one-quarter of bowel movements, together with physiological evidence of impaired evacuation.

Under Rome V, one appropriately abnormal test among anorectal manometry, balloon expulsion testing or defecography may satisfy the physiological testing requirement when the relevant symptom criteria are also met.

This differs from earlier Rome approaches that generally required more than one abnormal investigation.

However, the change should not be interpreted as an instruction to diagnose dyssynergic defecation automatically whenever one test produces an abnormal result.

Test performance, reference values, clinical findings and the possibility of structural abnormalities remain important.

The 2026 American Gastroenterological Association Clinical Practice Update on refractory constipation continues to recommend anorectal manometry together with balloon expulsion testing for appropriate patients before constipation is classified as refractory.

These recommendations can be understood together. Rome V defines diagnostic criteria, while clinical guidance addresses how investigations should be selected and interpreted in practice.

When dyssynergic defecation is identified, pelvic floor biofeedback therapy can be an effective treatment.

Biofeedback helps patients learn to coordinate abdominal pressure with appropriate relaxation of the anal sphincter and pelvic floor during defecation.

Importantly, this is not the same as routine pelvic floor strengthening exercises.

In some patients, the difficulty involves inappropriate muscle contraction or an inability to relax the relevant muscles rather than insufficient muscle strength. Repeated strengthening exercises without appropriate assessment may therefore fail to address the condition.

The Asia–Pacific consensus and American professional guidance recognize the importance of identifying defecatory disorders and providing appropriately delivered biofeedback therapy when indicated.

This provides a clear example of why chronic constipation cannot be managed through one standard lifestyle recommendation.

Medication Is Part of Evidence-Based Stepwise Care

Lifestyle interventions can be useful components of initial management, but many patients also require medication.

The 2026 Asia–Pacific consensus recommends a stepwise approach that combines appropriate lifestyle measures with conventional laxatives, followed by reassessment and treatment adjustment when necessary.

The joint 2023 American Gastroenterological Association and American College of Gastroenterology guideline provides evidence-based recommendations for pharmacological management of chronic idiopathic constipation in adults.

Polyethylene glycol is among the treatments supported by strong evidence.

Other options may include selected osmotic and stimulant laxatives, depending on the patient's condition and previous treatment response.

For people whose constipation remains inadequately controlled with appropriate initial therapies, clinicians may consider other medication classes, including intestinal secretagogues or medicines that influence gastrointestinal motility.

The 2023 guideline provides strong recommendations for several prescription treatments in eligible patients, including linaclotide, plecanatide and prucalopride, based on the evidence available at the time.

However, these international recommendations do not establish that every medicine is registered, available, reimbursed or appropriate for use in Viet Nam.

Medication selection should consider age, kidney function, pregnancy when relevant, other medical conditions, current treatment, contraindications, expected benefits and potential adverse effects.

For example, magnesium-containing laxatives require particular caution in patients with impaired kidney function because magnesium can accumulate when renal excretion is reduced.

Patients should also receive balanced information about the safety of laxatives.

The belief that all laxatives inevitably damage the bowel or cause permanent dependence is not supported as a universal conclusion.

At the same time, evidence for long-term treatment and potential adverse effects varies between medication classes.

Some stimulant laxatives have strong evidence for short-term or rescue treatment, while data about certain aspects of prolonged use remain more limited.

Repeated or escalating medication use without reassessing the clinical problem is not appropriate.

Patients who require continuing treatment should receive suitable follow-up rather than being told either to stop all laxatives or to continue indefinitely without monitoring.

A stepwise approach does not mean that every patient must follow an identical sequence of medicines. Treatment should be selected according to clinical findings, reviewed for effectiveness and tolerability, and adjusted when the expected benefit has not been achieved.

Lifestyle Medicine complements this process by helping people maintain appropriate dietary and behavioral changes alongside medical treatment.

Persistent Symptoms Require a Better Understanding of the Problem

Some people continue to experience constipation despite repeated dietary changes, supplements and laxatives.

Before describing the condition as refractory constipation, clinicians should determine whether adequate treatments have been tried and whether important contributing factors have been overlooked.

In January 2026, the American Gastroenterological Association published a Clinical Practice Update on evaluation and management of refractory constipation, containing 14 best-practice advice statements.

The update emphasizes reassessment of secondary causes, including medications, disordered eating and relevant neurological conditions.

It also recommends evaluating for defecatory disorders and providing pelvic floor biofeedback therapy when indicated before concluding that appropriate conventional treatment has failed.

This is particularly important because patients with unrecognized dyssynergic defecation may experience little benefit from repeated changes in laxatives.

When symptoms remain difficult to control, colonic transit testing may help distinguish slow-transit constipation from other patterns.

The results can guide decisions about further medication, specialist intervention or additional investigation.

Invasive treatments require particular caution.

The 2026 American Gastroenterological Association update recommends that surgery be considered only in highly selected patients after confirming slow colonic transit, excluding or appropriately addressing defecatory disorders, and evaluating other relevant gastrointestinal, psychological and clinical factors.

Surgery is not a routine solution for persistent constipation. It can involve significant complications, and some patients continue to experience unsatisfactory bowel function afterward.

These recommendations reinforce the importance of reconsidering the diagnosis rather than simply escalating treatment.

More medication, additional supplements, repeated colonoscopy without an appropriate indication or unnecessary invasive procedures do not automatically produce better outcomes.

A more useful approach is to determine which mechanism is likely responsible for persistent symptoms and select treatment accordingly.

What Research From Viet Nam Can and Cannot Tell Us

Research from Vietnamese healthcare and educational settings can help identify symptom patterns and priorities for further investigation.

A cross-sectional study published in the Vietnam Journal of Community Medicine on April 25, 2026, examined constipation and associated factors among 776 students at Thai Nguyen University of Medicine and Pharmacy.

Data were collected between January and November 2025.

The researchers used Rome IV criteria to identify functional constipation and the Bristol Stool Form Scale to describe stool characteristics.

Constipation was identified in 7.0% of participants.

The investigators reported statistically significant associations involving factors such as low dietary fiber intake, limited physical activity, shorter sleep duration, stress and family history of constipation.

These findings suggest that constipation may coexist with several lifestyle-related behaviors and circumstances.

However, the results must be interpreted carefully.

The study involved students at one university and cannot establish the prevalence of chronic constipation in the general Vietnamese population.

Its cross-sectional design also cannot determine whether the associated factors caused constipation.

Poor sleep and psychological stress may contribute to gastrointestinal symptoms, but constipation itself may also interfere with sleep, daily functioning and emotional well-being.

The study used Rome IV criteria, which were appropriate for its methodology. Its findings should not be retrospectively described as having been obtained using Rome V.

A related study involving the same university population was published in the Journal of Health and Development Studies on April 26, 2026.

It examined the relationship between constipation, quality of life and treatment needs.

The researchers reported associations with academic activities, physical health and mental well-being.

Only 29.6% of students identified with constipation reported a need for treatment.

This finding suggests that the presence of symptoms does not necessarily correspond with perceived need or willingness to seek care.

However, the two studies used the same underlying population of 776 students and should not be counted as independent evidence from different cohorts.

Together, they provide useful information about constipation-related experiences among students at one Vietnamese medical university, not nationally representative evidence about all Vietnamese adults.

Further research could benefit from broader population sampling, longitudinal follow-up and intervention studies evaluating specific treatment pathways.

Such studies may help clarify how dietary habits, working conditions, medication use, healthcare access and other factors influence constipation symptoms across different Vietnamese populations.

Measuring Improvement Beyond Bowel Movement Frequency

The effectiveness of constipation treatment should be evaluated using outcomes that reflect the patient's symptoms and daily functioning.

Bowel movement frequency is useful, but it is not sufficient on its own.

Someone may begin passing stool more frequently while continuing to experience painful straining or incomplete evacuation. Another person may have fewer bowel movements than average but feel comfortable and have no clinically significant symptoms.

Treatment assessment should therefore consider stool consistency, ease of passage, straining, incomplete evacuation, abdominal discomfort, bloating and the need for additional medication.

Clinical trials frequently measure spontaneous bowel movements and complete spontaneous bowel movements.

The latter incorporates the patient's sense that evacuation was complete, providing information beyond frequency alone.

Validated instruments such as the Patient Assessment of Constipation Symptoms and the Patient Assessment of Constipation Quality of Life can support more comprehensive evaluation.

However, their use in Viet Nam should consider appropriate translation, cultural relevance and validation for the population being assessed.

Simple patient-reported goals are also valuable.

Someone may want to reduce painful straining, avoid repeated interruptions at work, feel comfortable traveling or stop worrying about unpredictable bowel symptoms.

These goals help connect treatment decisions with outcomes that matter to patients.

Healthcare organizations can also assess whether initial evaluation identifies warning signs, whether treatment response is reviewed and whether patients with persistent symptoms receive appropriate investigation or referral.

The number of dietary counseling sessions delivered does not establish that bowel function or quality of life has improved.

A responsible evaluation should distinguish what was provided, what changed and whether the change can reasonably be attributed to the intervention.

This approach helps make Lifestyle Medicine part of evidence-based healthcare rather than a collection of general wellness recommendations.

Making Constipation Care Practical in Viet Nam

International clinical guidance needs to be adapted to the resources and circumstances in which patients receive care.

The World Gastroenterology Organisation's 2025 global guideline uses a resource-sensitive cascade approach, recognizing that diagnostic investigations and treatment options are not equally available in all healthcare settings.

This is relevant to Viet Nam, where access to specialized gastrointestinal investigations and pelvic floor biofeedback therapy may vary between facilities.

Primary care services may be able to provide initial assessment, review medication history, recognize warning signs and initiate appropriate conservative or medical treatment within their professional capacity.

Patients who do not respond may require referral to gastroenterologists or specialized centers capable of evaluating anorectal function and colonic transit.

The objective is not to require advanced testing for everyone with constipation. It is to ensure that patients with persistent symptoms have a pathway toward further assessment rather than receiving repeated generic advice without meaningful review.

Practical barriers should also be considered.

Some people work in environments where access to clean, private toilet facilities is limited. Others may have difficulty attending repeated appointments or purchasing particular food products and supplements.

Dietary recommendations should reflect familiar, affordable and locally available foods, together with individual nutritional requirements.

An intervention may have supporting clinical evidence but still be impractical if the patient cannot obtain it consistently.

Access to specialized biofeedback therapy presents another challenge.

When treatment is clinically indicated, healthcare professionals should consider realistic referral options rather than substituting routine pelvic floor strengthening exercises for a treatment requiring specific expertise.

Interprofessional collaboration can strengthen care.

Gastroenterologists, primary care physicians, clinical nutrition professionals, nurses and appropriately trained pelvic floor rehabilitation practitioners may contribute according to their qualifications and authorized responsibilities.

At the organizational level, a stepwise pathway could involve appropriate initial assessment, documentation of bowel symptoms, review of treatment response, identification of patients requiring further investigation and follow-up of meaningful outcomes.

The value lies in improving the care patients receive, not simply establishing additional lifestyle counseling activities.

Professional Responsibilities and Legal Boundaries in Viet Nam

Lifestyle Medicine can contribute to constipation care through evidence-based nutrition education, appropriate physical activity, behavior-change support and attention to the social circumstances affecting bowel health.

However, diagnosing gastrointestinal disorders, interpreting specialized investigations, prescribing medication and delivering clinical pelvic floor rehabilitation are healthcare activities requiring appropriate professional competence and authorization.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15, together with its applicable amendments and implementing regulations, provides the relevant legal framework.

Consolidated Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026, reflects the consolidated provisions of the Law.

Healthcare professionals must act within their qualifications, competence, legally authorized scope of practice and applicable institutional responsibilities.

Education or certification in Lifestyle Medicine does not independently authorize someone to diagnose chronic constipation, prescribe medication, interpret anorectal physiological investigations or provide individualized clinical rehabilitation beyond their permitted professional responsibilities.

Clinical nutrition delivered as part of medical examination and treatment must also comply with applicable professional and institutional requirements.

International recommendations from the Rome Foundation, Asian Neurogastroenterology and Motility Association, Asia-Pacific Association of Gastroenterology, American Gastroenterological Association and other professional bodies may inform education, evidence appraisal and clinical quality improvement.

However, they do not automatically become Vietnamese regulatory requirements or establish the approval, availability, reimbursement or suitability of particular medicines, diagnostic procedures or rehabilitation services in Viet Nam.

Patient confidentiality and personal data protection are also important.

Gastrointestinal symptom histories, medication records, laboratory findings, questionnaires and other identifiable health information must be handled according to applicable Vietnamese legal requirements.

The Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, are relevant to organizations processing identifiable personal health information.

Organizations collecting, storing or sharing such information should establish appropriate lawful processing arrangements, security safeguards and clearly defined responsibilities.

For the Vietnam Lifestyle Medicine Alliance, the appropriate contribution is professional education, scientific knowledge sharing, critical appraisal of evidence and responsible communication about the application of research in healthcare.

Educational materials should not be presented as official Vietnamese clinical practice guidelines, individualized medical advice or authorization to provide regulated medical treatment.

From General Advice to More Individualized Constipation Care

Chronic constipation illustrates why evidence-based Lifestyle Medicine requires more than recommending healthier habits.

Dietary fiber, appropriate hydration, suitable physical activity and supportive bowel routines may help many patients. However, their effectiveness depends on the underlying clinical problem, the intervention selected and the person's circumstances.

The 2025 British Dietetic Association guidelines demonstrate that evidence differs substantially across dietary strategies, including individual fiber supplements, foods and probiotics.

The 2026 Asia–Pacific consensus reinforces the value of stepwise management and timely reassessment. Rome V provides an updated diagnostic framework, while recent American guidance emphasizes recognizing defecatory disorders and optimizing treatment before labeling constipation refractory.

Together, these developments support a more precise approach to care.

For healthcare professionals in Viet Nam, the task is to distinguish patients who may improve through relatively simple interventions from those who require medication, specialized assessment, pelvic floor biofeedback or further investigation.

The success of treatment should not be measured only by how frequently someone passes stool or how many lifestyle recommendations they receive.

It should be reflected in more comfortable bowel movements, less straining, reduced symptom burden, appropriate treatment and improved quality of life.

Lifestyle Medicine can make a meaningful contribution when it helps people adopt sustainable changes while ensuring that underlying conditions are recognized and medically indicated care is not delayed.

The goal is not simply more frequent bowel movements. It is satisfactory bowel function and care that responds to the person, the clinical problem and the available evidence.

Selected References

1. Corsetti M, Shin A, Lacy BE, et al. Bowel Disorders. Gastroenterology. 2026;170(6):1261–1282. doi:10.1053/j.gastro.2026.02.003.

2. Rome Foundation. Rome V Diagnostic Criteria for Disorders of Gut–Brain Interaction. 2026.

3. Patcharatrakul T, Siah KTH, Syam AF, et al. Asian Neurogastroenterology and Motility Association and Asia-Pacific Association of Gastroenterology Chronic Constipation Consensus 2026. Journal of Neurogastroenterology and Motility. Published online August 28, 2026. doi:10.5056/jnm26076.

4. Dimidi E, van der Schoot A, Barrett K, et al. British Dietetic Association Guidelines for the Dietary Management of Chronic Constipation in Adults. Journal of Human Nutrition and Dietetics. 2025;38(5). doi:10.1111/jhn.70133.

5. Chang L, Chey WD, Imdad A, et al. American Gastroenterological Association–American College of Gastroenterology Clinical Practice Guideline: Pharmacological Management of Chronic Idiopathic Constipation. The American Journal of Gastroenterology. 2023;118(6):936–954. doi:10.14309/ajg.0000000000002227.

6. Staller K, Neshatian L, Lembo A, Bharucha AE. AGA Clinical Practice Update on Evaluation and Management of Refractory Constipation: Expert Review. Clinical Gastroenterology and Hepatology. 2026;24(2):296–305. doi:10.1016/j.cgh.2025.09.031.

7. World Gastroenterology Organisation. A Global Cascade Approach to Diagnosis and Management of Chronic Constipation. WGO Global Guidelines. 2025.

8. Phạm Văn Học, Đồng Đức Hoàng. Thực trạng táo bón và một số yếu tố liên quan ở sinh viên Trường Đại học Y Dược Thái Nguyên. Tạp chí Y học Cộng đồng. 2026;67(4). Published April 25, 2026. doi:10.52163/yhc.v67i4.4941.

9. Đồng Đức Hoàng, Phạm Văn Học. Mối liên quan của táo bón đến một số lĩnh vực đời sống và nhu cầu điều trị của sinh viên Trường Đại học Y Dược Thái Nguyên năm 2025. Tạp chí Khoa học Nghiên cứu Sức khỏe và Phát triển. 2026;10(2):79–85. Published April 26, 2026. doi:10.38148/JHDS.0905SKPT26-002_V.

10. Cook CM, Akiyama T, Blonquist T, et al. Effect of Daily Consumption of a Fermented Milk Containing Lacticaseibacillus paracasei Strain Shirota on Stool Consistency in United States Adults With Hard or Lumpy Stools: A Randomized Controlled Trial. The Journal of Nutrition. 2025;155(4):1183–1192. doi:10.1016/j.tjnut.2025.02.021.

11. Hoang Van V, Dong Van T, Nguyen Bao N, et al. Effects of Fermented Milk Containing Lacticaseibacillus paracasei Strain Shirota on Constipation and Gut Microbiota: A Randomised Pilot Study in Vietnam. Beneficial Microbes. Published online April 13, 2026. doi:10.1163/18762891-bja00116.

12. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. doi:10.1177/15598276251379821.

13. National Assembly of Viet Nam. Law No. 15/2023/QH15, dated January 9, 2023. Law on Medical Examination and Treatment.

14. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026. Law on Medical Examination and Treatment.

15. National Assembly of Viet Nam. Law No. 91/2025/QH15, dated June 26, 2025. Law on Personal Data Protection. Effective January 1, 2026.

16. Government of Viet Nam. Decree No. 356/2025/NĐ-CP, dated December 31, 2025. Detailing Certain Articles and Measures for the Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

Editorial, Clinical and Legal Disclaimer

This article is published by Vietnam Lifestyle Medicine Alliance (VLMA) for general information and professional education. VLMA is a physician-led professional education and knowledge-sharing initiative operated by Vietnam Lifestyle Medicine Alliance Company Limited. The article presents an evidence-informed discussion of Lifestyle Medicine in chronic constipation care and does not constitute an official clinical practice guideline, individualized medical advice, a diagnosis, a dietary prescription, a medication recommendation, a rehabilitation prescription or a treatment protocol.

The diagnostic frameworks and treatment recommendations discussed primarily relate to adults and should not automatically be applied to children, pregnant patients or individuals with particular medical conditions without appropriate clinical assessment.

Dietary fiber, hydration, physical activity and bowel habit interventions may contribute to constipation management but must not replace necessary clinical evaluation or medical treatment.

The information must not be used to independently diagnose chronic constipation or an underlying gastrointestinal disorder, interpret specialized investigations, initiate or discontinue prescribed medication, undertake clinical pelvic floor rehabilitation or determine an individualized treatment plan without appropriate professional assessment.

People experiencing severe abdominal pain, marked abdominal distension, persistent vomiting, inability to pass stool or gas, significant gastrointestinal bleeding or other concerning symptoms require prompt medical evaluation. Suspected bowel obstruction or another acute abdominal emergency may require urgent treatment.

Fiber supplements, laxatives, probiotics and other interventions are not universally appropriate. Their suitability depends on the patient's clinical condition, underlying cause, treatment history, contraindications and potential adverse effects.

The discussion of specific probiotic research, dietary supplements, foods or treatment products is intended solely for scientific evaluation and does not constitute an endorsement of any commercial product or manufacturer.

International recommendations discussed in this article do not automatically constitute Vietnamese clinical standards or establish the regulatory approval, availability, reimbursement or suitability of particular medicines, diagnostic tests, supplements or rehabilitation services in Viet Nam.

All regulated clinical activities must be undertaken by appropriately qualified healthcare professionals acting within their legally authorized scope of practice and applicable requirements governing healthcare facilities in Viet Nam.

This article does not endorse any commercial probiotic product, fiber supplement, laxative brand, mineral water, dietary product, diagnostic service or healthcare provider. Identifiable personal health information must be handled according to applicable confidentiality and personal data protection requirements.

The content reflects the scientific evidence, professional recommendations and legal sources reviewed as of October 30, 2026, and may require updating as further research, clinical guidance and Vietnamese regulatory requirements evolve.