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 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
Although dietary and other natural approaches discussed below are often effective,
individuals with constipation should be evaluated by a doctor to rule out potentially serious
causes.
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.
Medical treatments
Over the counter products are best divided into fast- and slow-acting agents. Rapid relief
of constipation is achieved with suppositories containing glycerin (Fleet®) or bisacodyl (Dulcolax®) enemas, and magnesium-containing products magnesium-containing
products (Phillips’ Milk of Magnesia® Magnesium Citrate Solution®). Overnight
relief is obtained with senna (Senokot®, Fletcher’s
Castoria®) and bisacodyl (Dulcolax®) tablets. Bulk-forming laxatives containing psyllium (Metamucil®, Konsyl-D®), polycarbophil
(Fibercon®), and methylcellulose
(Citrucel®), as well as the stool softener docusate
(Colace®, Surfak®), may require up to 72 hours for relief of symptoms.
Laxatives available with a prescription include
lactulose (Chronulac®), which acts within one to two days, and polyethylene glycol
(Miralax®), which may require two to four days of treatment before constipation is
relieved. Large quantities of polyethylene glycol-electrolyte solution (CoLyte®,
GoLYTELY®, NuLytely®) might be prescribed for bowel cleansing the evening prior to
intestinal examinations.
Healthcare practitioners often recommend increased dietary
fiber and fluid intake to shorten bowel transit time and increase stool weight. Use of
laxatives beyond one week is discouraged, due to weakening of the colon and 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
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
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.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic 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.
Copyright © 2004 Healthnotes, Inc. All rights reserved.
www.healthnotes.com
Learn more about Healthnotes, the company.
Learn more about the authors of Healthnotes.
The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in vitro),
clinical experience, or traditional usage as cited in each article. The results reported may
not necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over-the-counter medication is also available. Consult your doctor,
practitioner, and/or pharmacist for any health problem and before using any supplements or
before making any changes in prescribed medications. Information expires March 2005.
| 
