Constipation may be a side effect of EPI treatment. Staying hydrated, increasing your fiber intake, and adjusting your medication dose may help relieve constipation.

Exocrine pancreatic insufficiency (EPI) occurs when your pancreas doesn’t produce or secrete enough digestive enzymes to break down the food you eat.

Common symptoms of EPI include:

  • stomach pain
  • gas and bloating
  • loose, oily stools
  • diarrhea

Some people living with EPI may experience constipation, which is difficulty passing stool. If you have constipation, you may experience:

  • fewer than three bowel movements a week
  • stools that are dry, hard, or lumpy
  • pain or straining while passing stool
  • a feeling that you’re not able to pass all your stool

The treatment for EPI is pancreatic enzyme replacement therapy (PERT) to help your intestines digest food. These digestive enzymes help reduce symptoms such as diarrhea by making stool firmer.

Constipation may be a potential side effect of PERT, but there are steps you can take to relieve this uncomfortable condition.

According to the Pancreatic Cancer Action Network, constipation is the most common side effect of pancreatic enzymes. This could be a sign that your PERT regimen needs to be adjusted.

Other less common side effects of digestive enzymes include:

  • diarrhea
  • cramps
  • nausea

There are a few strategies you can try to ease symptoms of constipation related to EPI or its treatment.

Adjust your PERT dose

PERT capsules contain a mixture of enzymes, including:

  • lipase, to digest fat
  • protease, to digest proteins
  • amylase, to digest carbohydrates

As these enzymes work to digest macronutrients, you’ll likely notice that your stool is becoming firmer. Although it’s a change from what you’re used to, this isn’t true constipation.

However, if you pass stool less than three times per week and experience pain and difficulty while doing so, you may have constipation.

If the constipation is because of PERT, your doctor may be able to adjust your dose. Another option may be to vary your dose according to what you eat, such as reducing the amount of enzymes you take with a low fat meal.

Drink more water

Constipation can be the result of dehydration. If you’re dehydrated, your body draws the fluid it needs from your intestinal tract, resulting in drier and harder stool.

There are ways you can increase your daily fluid intake, such as:

  • set reminder alarms on your phone
  • keep a reusable water bottle with you
  • add water breaks into your schedule
  • use a tracking app
  • eat more high-water content foods such as fruit and vegetables

It’s possible to drink too much water. Hyponatremia is a condition that results when the water and sodium in your body are out of balance. Hyponatremia has several possible causes, one of which is drinking an excessive amount of water.

If you have any concerns about your water intake, you can talk with your doctor to determine an appropriate daily target.

Increase your fiber intake

If you live with EPI, your doctor may have told you to reduce your fiber intake. This is because dietary fiber can inhibit the action of pancreatic enzymes.

However, if you’re experiencing constipation, you may need a bit more:

  • soluble fiber to improve stool size and consistency
  • insoluble fiber to help stool move through the intestine

Fiber retains water, which softens stool. The difference in water content between stool consistencies is small enough that even a modest increase in water can help. According to a 2021 review:

  • hard stool is 72% water
  • normal stool is 74% water
  • soft stool is 76% water

Softer stool moves more easily, resulting in more frequent bowel movements.

Many food sources of fiber have both soluble and insoluble fiber. You may also consider taking a fiber supplement.

Dietary fiber sources include:

  • nuts and seeds
  • fruits
  • vegetables
  • legumes
  • whole grain foods

Trying to find the right balance of fiber and digestive enzymes to regulate EPI symptoms can be challenging, so you can speak with a doctor or registered dietitian about the amount of fiber that may be right for you.

If you need to increase your fiber intake, do so gradually. It can also help to ensure that you’re properly hydrated.


Aerobic exercise that increases your respiration and heart rate can stimulate intestinal muscle contractions. This can accelerate the movement of food through your colon and ease symptoms of constipation.

Certain yoga poses may also offer relief from constipation. Examples include poses that involve a twisting motion, which can increase the digestive tract muscle contractions that move food along.

Try a laxative

Laxatives help treat or prevent constipation by loosening stools and increasing bowel movements. There are natural and over-the-counter laxative options.

Prunes are a natural laxative that can increase the weight and frequency of bowel movements.

Ground flaxseed may also help relieve constipation. Flaxseed that’s left whole and not ground simply passes through your body without any laxative effect.

A doctor may be able to suggest an over-the-counter laxative or stool softener that can also help.

EPI usually causes loose stool, but some people experience constipation. This can be a side effect of the digestive enzymes you take to reduce bloating and gas.

PERT can cause your stool to be firmer than you’re used to, which may not be true constipation. However, if you experience pain and difficulty passing stool and have fewer than three bowel movements each week, you may be experiencing constipation.

There are ways to ease constipation from EPI enzyme therapy, including changing your PERT dose, drinking more water, and slowly increasing your fiber intake.