When I worked in the hospital, the nurses used to see me coming. I had a reputation – the charge nurse actually gave me the nickname, and it stuck: the Poop Queen. Because no matter what else was going on with a patient, one of the first things I’d ask was whether they were pooping.
I’m not embarrassed by that title. I wear it proudly. Poop is one of the most overlooked topics in healthcare, and it deserves way more airtime than it gets, especially in chronic kidney disease (CKD) management.
Chantelle Greentree, RD
The link between constipation and kidney disease
A large number of Canadians are constipated, and yet when it comes to chronic kidney disease, people don’t usually talk about bowel movements. All the attention goes to potassium, phosphorus, protein, sodium, fluid : the usual suspects.
Meanwhile, whether someone is actually pooping regularly gets left out of the conversation entirely.
Here’s why that’s a problem: bowel movements and potassium management are directly connected.
Some of your potassium is normally excreted through your stool, not just through urine. If you’re constipated, that pathway slows way down. Your body holds onto potassium instead of clearing it, which may impact your blood potassium levels a lot when you already have reduced kidney functions.
So if you’re constipated and your potassium is creeping up, the conversation shouldn’t stop at “eat less potassium or stop eating bananas.” It needs to include “are you actually pooping regularly?”
This connection isn’t complicated, but it’s easy to miss because bowel movements and kidney labs get treated like two separate conversations : one is a GI issue, one is a kidney issue. In reality, we need to be accessing the whole body to optimize health.
A few things also make CKD patients more prone to constipation in the first place: fluid restrictions, phosphate binders (a known and common side effect of these medications), and years of being told to cut back on fruits, vegetables, and whole grains over potassium and phosphorus fears – the very high fiber foods that support regular bowel movements.
“I’m Pooping Fine” Usually Isn’t the Full Story
Here’s another reason this gets missed: patients report that they are pooping regularly and that’s usually where the conversation ends.
If I had a penny for every time someone told me they were pooping fine, but a little more digging told a different story… well, with inflation, let’s make it a quarter. Because “yes, I’m pooping” and “my bowels are actually moving well” are not the same thing.
Pooping regularly doesn’t mean you are having a bowel movement every day. Pooping every single day means nothing on its own if you’re straining the entire time.
Pooping every day but producing what I affectionately call bunny pellet poops? News flash — you’re constipated. Frequency alone doesn’t tell you what you need to know. Poop consistency matters. Straining to pass those smelly nuggets matters.
The goal is for CKD patients to have regular, easy to pass bowel movements, e.g. every 1 – 2 days to minimize the risk of high potassium.
This is exactly why “are you pooping?” isn’t actually a useful question on its own — it’s the follow-up questions that matter: How often? What does it look like? Are you straining? Without that detail, constipation hides in plain sight behind a technically-true “yes.”
Not as simple as add more fiber and drink more water
Making lifestyle and nutrition changes can help relieve constipation and slow down kidney disease progression but navigating this without the support of a registered dietitian can feel very overwhelming.
The typical diet advice for constipation of increasing fluids and fiber may not be suitable for CKD patients.
CKD patients may have fluid restrictions and high fiber foods such as bran, beans, lentils, prunes, fruitlax, nuts and seeds may also be high in phosphorus and/or potassium which some kidney patients may have to limit.
Work with an experienced renal dietitian
This is why “are you pooping?” is one of the first questions I ask — right up there with reviewing labs and medications.
Not because it’s a fun icebreaker (though I won’t pretend it isn’t a little bit fun), but because the real answer, once I dig into frequency, consistency, and straining, is genuinely helpful in managing your potassium status.
If you have CKD and you’re dealing with constipation, this isn’t a separate issue to mention only if you remember. It’s part of your kidney management, and it’s worth bringing up at appointments. But if you work with me, you can count on me asking about your poop right after I ask you how your weekend was, especially if I see your potassium labs not behaving.
Wishing you a Bristol Stool type 3 or 4. Wondering exactly what that is or how to get there? Let the Poop Queen show you the way – feel free to book a free discovery call to chat about how I can support your kidney and bowel health needs.
I offer virtual nutrition counselling across BC, Alberta and Ontario.
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