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Constipation | | Description |
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
Causes
The most common causes are (1) habit, (2) 'a greedy colon',
which absorbs water too quickly, (3) a spastic colon, in which the muscles
remain in a state of spasm, (4) lack of tone in the muscle, (5) a
low-roughage diet. Of these, poor habit is the most important. The
condition is usually aggravated by using aperients and purgatives.
Uncommon causes, such as a tumor, result in stricture of the bowel,
leading to obstruction.
Symptoms and effects
The
stools are dark, hard, and passed with difficulty, and in small amounts.
In severe, persistent cases there may be swelling of the abdomen, from the
retention of large masses of the remnants from digestion. Colic may occur
in long-standing cases. Piles, which are a cause of increasing
constipation, are often brought on by inattention to the bowels to begin
with.
Treatment
If there is no organic cause, such as
tumor or other source of mechanical obstruction, attention to daily habit
is the most important matter. Daily exercise, regular opening of the
bowels at the same time each day, should be cultivated. A high-roughage
diet is important, with plenty of fruit and vegetables. A cereal rich in
bran is helpful, and wholemeal bread should be
preferred.
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.
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.
Conventional Treatment
Options: 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
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 bladder wrack (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 bladder wrack 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.
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, Vtolo 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. Mller-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, Sol 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.
Source: NOW Foods
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A Selection of Products that may be useful for Constipation.
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