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CONSTIPATIONView Our Related Product Sections:
Constipation is a condition in which a person experiences a change in normal bowel habits, characterized by a decrease in frequency and/or passage of hard, dry stools. Constipation can also refer to difficult defecation or to sluggish action of the bowels. The most common cause of constipation is probably dietary, which is discussed below. However, constipation may be a component of irritable bowel syndrome or other conditions ranging from drug side effects to physical immobility. Serious diseases, including colon cancer, may sometimes first appear as bowel blockage leading to acute constipation. However, constipation itself does not appear to increase the risk of colon cancer, contrary to popular opinion.1 Dietary and other natural approaches discussed below should be used by people with constipation only when there is reason to believe no serious underlying condition exists. Checklist for Constipation
What are the symptoms of constipation? Symptoms of constipation include infrequent stools, hard stools, and excessive straining to move the bowels. Frequency of bowel movements and severity of symptoms may vary from person to person.  How is it treated? Doctors often recommend increasing both dietary fiber and fluid intake to shorten bowel transit time and increase stool weight. Several types of laxatives are also used: bulk-forming laxatives (e.g., natural fibers, cellulose, synthetic polysaccharides); stool softeners (e.g., mineral oil, ducosate salts); stimulant laxatives (e.g., phenolphthalein, bisacodyl, senna, castor oil); and other drugs that increase water content of the stool. Long-term use of laxatives is discouraged, due to the possibility of weakening the colon or causing fluid retention. Laxative abuse is common in the elderly and among people with eating disorders. Dietary changes that may be helpful: Fiber, particularly insoluble fiber, is linked with prevention of chronic constipation.2 Insoluble fiber from food acts like a sponge, pulling water into the stool and making it easier to pass. Insoluble fiber comes mostly from vegetables, beans, brown rice, whole wheat, rye, and other whole grains. Switching from white bread and white rice to whole wheat bread and brown rice often helps relieve constipation. It is important to drink lots of fluid along with the fiber—at least 16 ounces of water per serving of fiber. Otherwise, the fiber may actually worsen the constipation. In addition, wheat bran may be added to the diet. Doctors frequently suggest a quarter cup or more per day of wheat bran along with fluid. An easy way to add wheat bran to the diet is to put it in breakfast cereal or switch to high-bran cereals. Wheat bran often reduces constipation, although not all research shows it to be successful.3 Higher amounts of wheat bran are sometimes more successful than lower amounts.4 A double-blind trial found that chronic constipation among infants and problems associated with it were triggered by intolerance to cows’ milk in two-thirds of the infants studied.5 Symptoms disappeared in most infants when cows’ milk was removed from their diet. These results were confirmed in two subsequent, preliminary trials.6 7 Constipation triggered by other food allergies might be responsible for chronic constipation in some adults. If other approaches do not help, these possibilities may be discussed with a physician. Lifestyle changes that may be helpful: Exercise may increase the muscular contractions of the intestine, promoting elimination.8 Nonetheless, the effect of exercise on constipation remains unclear.9 Nutritional supplements that may be helpful: Glucomannan is a water-soluble dietary fiber that is derived from konjac root. Like other sources of fiber, such as psyllium and fenugreek, glucomannan is considered a bulk-forming laxative. A preliminary trial10 and several double-blind trials11 12 13 14 have found glucomannan to be an effective treatment for constipation. The amount of glucomannan shown to be effective as a laxative is 3 to 4 grams per day. In constipated people, glucomannan and other bulk-forming laxatives generally help produce a bowel movement within 12 to 24 hours. Chlorophyll, the substance responsible for the green color in plants, may be useful for a number of gastrointestinal problems. In a preliminary trial, chlorophyll supplementation eased chronic constipation in elderly people.15 Herbs that may be helpful: The laxatives most frequently used world-wide come from plants. Herbal laxatives are either bulk-forming or stimulating. Bulk-forming laxatives come from plants with a high fiber and mucilage content that expand when they come in contact with water; examples include psyllium, flaxseed, and fenugreek. As the volume in the bowel increases, a reflex muscular contraction occurs, stimulating a bowel movement. These mild laxatives are best suited for long-term use in people with constipation. Many doctors recommend taking 7.5 grams of psyllium seeds or 5 grams of psyllium husks, mixed with water or juice, one to two times per day. Some doctors use a combination of senna (18%) and psyllium (82%) for the treatment of chronic constipation. This has been shown to work effectively for people in nursing homes with chronic constipation.16 Basil (Ocimum basilicum) seed has been found to relieve constipation by acting as a bulk-forming laxative in one preliminary study.17 A similar study showed the seeds to be useful following major surgery for elderly people with constipation.18 Alginic acid, one of the major constituents in bladderwrack (Fucus vesiculosus), is a type of dietary fiber that may be used to relieve constipation. However, human studies have not been conducted on the effectiveness of bladderwrack for this condition. Stimulant laxatives are high in anthraquinone glycosides, which stimulate bowel muscle contraction. The most frequently used stimulant laxatives are senna leaves, cascara bark, and aloe latex. While senna is the most popular, cascara has a somewhat milder action. Aloe is very potent and should be used with caution. Other stimulant laxatives include buckthorn, alder buckthorn (Rhamnus frangula), and rhubarb (Rheum officinale, R. palmatum). The unprocessed roots of fo-ti possess a mild laxative effect. The bitter compounds in dandelion leaves and root are also mild laxatives. Other integrative approaches that may be helpful: Anecdotal reports have claimed that acupuncture is beneficial in the treatment of constipation.19 20 21 22 However, a small, controlled study of eight people with constipation concluded that six acupuncture treatments over two weeks did not improve bowel function during the course of the study.23 Placebo-controlled trials of longer duration are needed to determine whether acupuncture is a useful treatment for constipation. Biofeedback techniques have been shown to significantly increase the frequency of bowel movements among women with chronic constipation.24 References:  1. Dukas L, Platz EA, Colditz GA, et al. Bowel movement, use of laxatives and risk of colorectal adenomatous polyps among women (United States). Cancer Causes Control 2000;11:907–14. 2. Morais MB, Vítolo MR, Aguirre ANC, Fagundes-Nteo U. Measurement of low dietary fiber intake as a risk factor for chronic constipation in children. J Pediatr Gastroenterol Nutr 1999;29:132–5. 3. Müller-Lissner SA. Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis. BMJ 1988;296:615–7. 4. Marcus SN, Heaton KW. Effects of a new, concentrated wheat fibre preparation on intestinal transit, deoxycholic acid metabolism and the composition of bile. Gut 1986;27:893–900. 5. Iacono G, Cavataio F, Montalto G, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med 1998;339:1100–4. 6. Daher S, Solé D, de Morias MB. Cow’s milk and chronic constipation in children. N Engl J Med 1999;340:891. 7. Shah N, Lindley K, Milla P. N Engl J Med 199918;340:891–2. 8. Oettl GJ. Effect of moderate exercise on bowel habit. Gut 1991;32:941–4. 9. Bingham SA, Cummings JH. Effect of exercise and physical fitness on large intestinal function. Gastroenterology 1989;97:1389–99. 10. Passaretti S, Franzoni M, Comin U, et al. Action of glucomannans on complaints in patients affected with chronic constipation: a multicentric clinical evaluation. Ital J Gastroenterol 1991;23:421–5. 11. Marzio L, Del Bianco R, Donne M, et al. Mouth-to-cecum transit time in patients affected by chronic constipation: effect of glucomannan. Am J Gastroenterol 1989;84:888–91. 12. Marsicano LJ, Berrizbeitia ML, Mondelo A. Use of glucomannan dietary fiber in changes in intestinal habit. G E N 1995;49:7–14 [in Spanish]. 13. Signorelli P, Croce P, Dede A. A clinical study of the use of a combination of glucomannan with lactulose in the constipation of pregnancy. Minerva Ginecol 1996;48:577–82 [in Italian]. 14. Staianno A, Simeone D, Giudice ED, et al. Effect of the dietary fiber glucomannan on chronic constipation in neurologically impaired children. J Pediatr 2000;136:41–5. 15. Young RW, Beregi JS Jr. Use of chlorophyllin in the care of geriatric patients. J Am Geriatr Soc 1980;28:46–7. 16. Passmore AP, Wilson-Davies K, Flanagan PG, et al. Chronic constipation in long stay elderly patients: a comparison of lactulose and senna-fiber combination. BMJ 1993; 307:769–71. 17. Kocharatana P, et al. Clinical trial of maeng-lak seeds used as a bulk laxative. Maharaj Nakornratchasima Hosp Med Bull 1985;9:120–36. 18. Muangman V, Siripraiwan S, Ratanaolarn K, et al. A clinical trial of Ocimum canum Sims seeds as a bulk laxative in elderly post-operative patients. Ramathibodi Med J 1985;8:154–8. 19. Kangmei C, Shulian Z, Ying Z. Auriculoacupuncture therapy—a traditional Chinese method of treatment. J Tradit Chin Med 1992;12:308–10. 20. Xuemin S. Clinical observations on 50 cases of obstipation treated with acupuncture. J Tradit Chin Med 1982;2:162. 21. Fischer MV, Behr A, Reumont J. Acupuncture—a therapeutic concept in the treatment of painful conditions and functional disorders. Report on 971 cases. Acupunct Electrother Res 1984;9:11–29. 22. Shuli C. Clinical application of acupoint tianshu. J Tradit Chin Med 1992;12:52–4. 23. Klauser AG, Rubach A, Bertsche O, Muller-Lissner SA. Body acupuncture: effect on colonic function in chronic constipation. Z Gastroenterol 1993;31:605–8 [in German]. 24. Heymen S, Wexner SD, Vickers D, et al. Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Dis Colon Rectum 1999;42:1388–93. | ||||||||||||||||||
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Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.
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