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digestive system
Constipation
Integrative Therapies

Home Care

Constipation can be defined as difficult or infrequent stools. It is healthy to have a bowel movement at least once a day and up to 3 times a day. The main causes for common constipation are:

• A diet that lacks water and other fluids.

• A diet lacking fruits and vegetables or other sources of fiber.

• Lack of exercise, since exercise promotes bowel movements.

• Emotional states, such as nervous tension, worry, and anxiety.

• Ignoring the urge to go to the bathroom.

If the constipation occurs with sudden abdominal pain, it is important to see a doctor who can determine if there is an obstruction of the bowel. Strong laxatives should be absolutely avoided in this case.

Always consult a doctor for constipation that starts suddenly and persists for weeks or alternates with diarrhea. This may indicate a growth in the large intestine.


THE PROPER DIET FOR CONSTIPATION WILL INCLUDE THE FOLLOWING:

1. Drink at least 8 cups of fluid per day in the form of water, diluted juices, or broths. This is especially important when the stools are hard. Drinking milk may not be beneficial as it can cause constipation in many individuals.

2. Consume an adequate amount of fiber daily. Eat 1 tablespoon of wheat bran per day, and drink 1 cup of fluids immediately afterwards. Do not use bran if your stool is in the form of dry, hard pebbles. Also, eat 2 apples and at least 2 servings of raw vegetables a day.

Also recommended are steamed, green leafy vegetables such as spinach, chard, kale, or beet greens. These vegetables are readily available in most supermarket produce departments.

3. Eat at least 1 serving per day of whole grains such as oatmeal and brown rice.

4. Avoid, as much as possible, white flour and white sugar containing foods such as candy, white bread, cakes, or pastries.

5. Early in the morning, eat 6 prunes that have been soaked overnight (with their liquid), or drink prune juice, starting with 1/2 cup per day and increasing your intake until you get results.

Eat slowly and chew your food well. When possible, try to relax for a few minutes before eating a meal.


HERBS USED FOR CONSTIPATION:

1. Psyllium seeds – Use 1 teaspoon per day. Pour 1 cup of warm water or juice on top of the seeds. Let it stand for 2 to 3 minutes, then drink. Follow with 1 more cup of fluids. (These seeds can also be turned into powder in a coffee grinder, but this is not absolutely necessary.) Use Psyllium before using any other herbs.

2. Aloe Vera – Many different Aloe Vera products are for sale on the market. Follow the manufacturers’ instructions by taking a full dose for the first week. Then slightly increase or decrease the dosage until you have 1 full bowel movement a day.

3. Cascara sagrada – 2 teaspoons of liquid tincture, which is a liquid herbal extract, or 2 capsules of the dried herb can be used as a laxative. Do not use it for more than 2 weeks since it will not help your bowels to develop normal movements. DO NOT USE DURING PREGNANCY!

4. Senna leaves – The same cautions apply as with Cascara. Make a tea using 1 teaspoon of leaves per cup of boiling water. Simmer 3 minutes. Steep 20 minutes. Drink 1 cup a day.

Please note that long-term use of laxatives, herbal or otherwise, can prevent proper absorption of nutrients from the food you eat.


HOMEOPATHY:

From the following homeopathic medicines, choose the one that best matches your symptoms. Dissolve 3 pellets under your tongue.

• Nux vomica 12C: In cases when the person is "hooked" on laxatives. Take in the early evening. A daily dose may be needed for up to a week. It can also be used for constipation after overindulgence of food or liquor, or for constipation that alternates with diarrhea.

• Sulphur 12C: Take this if it's painful to pass stool because of a rectal fissure, which is a crack in the lining of the rectum. Other symptoms that require sulphur are burning or itching at the anus or hard, dark, and dry stools. Take 1 time per day for 3 to 4 days.

• Alumina 12C: If the stool is so soft that it requires lots of toilet paper, take 1 time per day.

• Graphites 12C: Take this if you have no urge to have a bowel movement, days go by without a bowel movement, and when it comes, it is in the form of round balls stuck together with mucus and is painful to pass. Graphites also can help with fissures or cracks and hemorrhoids that burn and itch. Take once a day for a few days.

Note: A wide range of homeopathic medicines can be helpful for individuals with constipation. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.


AN ADDITIONAL MEASURE FOR CONSTIPATION INCLUDES:

Castor Oil packs on the abdomen. Rub your entire abdomen with castor oil (available from a pharmacy), cover with plastic to retain the oil, and put a dry towel on top. Then place a heating pad or a hot towel over this for 20 minutes.

DO NOT USE A HEATING PAD if you have abdominal pain of an unknown origin.


Clinic

Footnotes

BarShalom R, Soileau J. (eds.) Natural Health Hotline. Beaverton, OR: Integrative Medical Arts, 1991-1999.

Bingham SA, Cummings JH. Effect of exercise and physical fitness on large intestinal function. Gastroenterology. 1989 Dec;97(6):1389-1399.
Abstract: The effect of exercise on large intestinal function has been determined in 14 healthy but normally sedentary men and women, aged 22-34 yr while on a constant diet. For an initial 3-5-wk period (control) no activity was allowed. Six subjects then undertook a 9-wk training schedule by the end of which they were capable of jogging for 1 h per day, 5 days a week. A further 6 subjects undertook a similar training schedule that lasted for only 7 wk, at the end of which they were jogging for 45 min per day. Finally, 2 subjects were studied continuously while taking light exercise for 6 wk and then jogging for a further 3 wk. Physical fitness was monitored and showed significant changes with maximum aerobic capacity increasing from 2.4 +/- 0.5 to 3.1 +/- 0.4 L/min, maximum heart rate after a step test falling from 152 +/- 8 to 129 +/- 5 beats per minute, and resting pulse rate also falling from 56 +/- 4 to 50 +/- 5 beats per minute. High-density lipoprotein cholesterol also increased significantly. Colonic function was assessed by measurement of stool weight and transit time, using the continuous radiopaque marker technique, fecal pH, nitrogen excretion, and ammonia concentration. No change was observed overall in mean daily fecal weight [124 +/- 39 (control) and 129 +/- 49 g/day (exercise)], transit time [55 +/- 20 (control), 54 +/- 23 h (exercise)], nor in fecal frequency, dry stool weight, pH, ammonia, or total nitrogen excretion. Significant changes did occur in 5 individuals with significant slowing of transit time in 2 and speeding up in 3. Overall transit time increased in 9 subjects and decreased in 5; hence, when diet is constant, exercise has marked effects on physical fitness but no consistent effect on large bowel function.

Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, Notarbartolo A, Carroccio A. Intolerance of cow's milk and chronic constipation in children. N Engl J Med. 1998 Oct 15;339(16):1100-1104.
Abstract: BACKGROUND: Chronic diarrhea is the most common gastrointestinal symptom of intolerance of cow's milk among children. On the basis of a prior open study, we hypothesized that intolerance of cow's milk can also cause severe perianal lesions with pain on defecation and consequent constipation in young children. METHODS: We performed a double-blind, crossover study comparing cow's milk with soy milk in 65 children (age range, 11 to 72 months) with chronic constipation (defined as having one bowel movement every 3 to 15 days). All had been referred to a pediatric gastroenterology clinic and had previously been treated with laxatives without success; 49 had anal fissures and perianal erythema or edema. After 15 days of observation, the patients received cow's milk or soy milk for two weeks. After a one-week washout period, the feedings were reversed. A response was defined as eight or more bowel movements during a treatment period. RESULTS: Forty-four of the 65 children (68 percent) had a response while receiving soy milk. Anal fissures and pain with defecation resolved. None of the children who received cow's milk had a response. In all 44 children with a response, the response was confirmed with a double-blind challenge with cow's milk. Children with a response had a higher frequency of coexistent rhinitis, dermatitis, or bronchospasm than those with no response (11 of 44 children vs. 1 of 21, P=0.05); they were also more likely to have anal fissures and erythema or edema at base line (40 of 44 vs. 9 of 21, P<0.001), evidence of inflammation of the rectal mucosa on biopsy (26 of 44 vs. 5 of 21, P=0.008), and signs of hypersensitivity, such as specific IgE antibodies to cow's-milk antigens (31 of 44 vs. 4 of 21, P<0.001). CONCLUSIONS: In young children, chronic constipation can be a manifestation of intolerance of cow's milk.

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 Aug;27(8):893-900.
Abstract: When the cholesterol saturation index of bile is reduced by wheat bran there is generally a fall in the deoxycholic acid content of bile. As the same effects occur with senna, bran might act on bile simply via its accelerating effect on colonic transit. We have studied the effects of a new, concentrated, wheat fibre preparation (Testa Triticum Tricum, Trifyba, which is 80% dietary fibre) upon bile composition, deoxycholic acid metabolism and intestinal transit time, and have assessed whether these effects are related. Twenty constipated volunteers were prescribed Testa Triticum Tricum in doses (10-32 g/day) sufficient to relieve their symptoms for at least six weeks. Before and at the end of this period, duodenal bile was sampled to enable measurement of deoxycholic acid pool (by isotope dilution), total bile acid pool, bile acid composition and cholesterol saturation index. Whole gut transit time fell from 120 +/- SD35 to 68 +/- 35 hours. At the same time, biliary % deoxycholic acid fell from 26.6 +/- 12.0 to 23.0 +/- 11.8 (p = 0.002), the total bile acid pool expanded from 2.36 +/- 0.88 to 2.75 +/- 0.90 g (p = 0.008) and cholesterol saturation index fell from 1.13 +/- 0.32 to 1.07 +/- 0.29 (p = 0.04). In subjects with initial cholesterol saturation index over 1.0 (n = 12), it fell from 1.33 +/- 0.25 to 1.22 +/- 0.21 (p = 0.008). There was no significant correlation between change in saturation index and change in % deoxycholic acid or deoxycholic acid pool, nor between any of these parameters and change in transit time.

Meshkinpour H, Selod S, Movahedi H, Nami N, James N, Wilson A. Effects of regular exercise in management of chronic idiopathic constipation. Dig Dis Sci. 1998 Nov;43(11):2379-2383.

Muller-Lissner SA. Effect of wheat bran on weight of stool and gastrointestinal transit time: a meta analysis. Br Med J (Clin Res Ed). 1988 Feb 27;296(6622):615-617.
Abstract: Twenty original papers that reported on the effect of wheat bran on large bowel function were analysed. Bran increased the stool weight and decreased the transit time in each study in healthy controls and in patients with the irritable bowel syndrome, with diverticula, and with chronic constipation. Statistical evaluation of the data showed, however, that constipated patients had lower stool output and slower transit whether or not they had taken bran, and they responded less well to bran treatment than controls. From these data it is concluded that bran can be expected to be only partially effective in restoring normal stool weight and transit time in patients who are constipated.

Myers AM, Malott OW, Gray E, Tudor-Locke C, Ecclestone NA, Cousins SO, Petrella R. Measuring accumulated health-related benefits of exercise participation for older adults: the Vitality Plus Scale. J Gerontol A Biol Sci Med Sci. 1999 Sep;54(9):M456-466.

Oettl GJ. Effect of moderate exercise on bowel habit. Gut. 1991 Aug;32(8):941-944.
Abstract: Ten healthy volunteers (six men and four women, aged 22-41 years) were studied in a crossover trial. The study was divided into three one week periods. During each period the subjects either ran on a treadmill, cycled on a bicycle ergometer, or rested in a chair for 1 hour every day. The exercise was performed at two thirds predicted maximum heart rate (equivalent to 50% VO2 max). The sequences were rotated; no studies were performed in the perimenstrual period. Transit was measured by the method of measuring the excretion of a single dose of radio-opaque markers; all stools were collected, weighed, and x rayed after the ingestion of radio-opaque markers. Dietary fibre and fluid intake were measured on the fourth day of each test period by 24 hour record. Lifestyle was otherwise unchanged. Transit time was dramatically accelerated by moderate exercise (both jogging and cycling); however, stool weight, defecation frequency, dietary fibre intake, and fluid intake did not change significantly. Whole gut transit changed from 51.2 hours (95% confidence intervals 41.9 to 60.5) at rest to 36.6 hours (31.6 to 39.2) when riding and 34.0 hours (28.8 to 39.2) when jogging. Riding and running both differed significantly from resting (p less than 0.01); the difference between riding and running was not significant.

Passmore AP, Wilson-Davies K, Stoker C, Scott ME. Chronic constipation in long stay elderly patients: A comparison of lactulose and senna-fiber combination. Br Med J. 1993 Sep 25;307(6907):769-771.
Abstract: OBJECTIVES--To compare the efficacy and cost effectiveness of a senna-fibre combination and lactulose in treating constipation in long stay elderly patients. DESIGN--Randomised, double blind, cross over study. SETTING--Four hospitals in Northern Ireland, one hospital in England, and two nursing homes in England. SUBJECTS--77 elderly patients with a history of chronic constipation in long term hospital or nursing home care. INTERVENTION--A senna-fibre combination (10 ml daily) or lactulose (15 ml twice daily) with matching placebo for two 14 day periods, with 3-5 days before and between treatments. MAIN OUTCOME MEASURES--Stool frequency, stool consistency, and ease of evacuation; deviation from recommended dose; daily dose and cost per stool; adverse effects. RESULTS--Mean daily bowel frequency was greater with the senna-fibre combination (0.8, 95% confidence interval 0.7 to 0.9) than lactulose (0.6, 0.5 to 0.7; t = 3.51 p < or = 0.001). Scores for stool consistency and ease of evacuation were significantly higher for the senna-fibre combination than for lactulose. The recommended dose was exceeded more frequently with lactulose than the senna-fibre combination (chi 2 = 8.38, p or = 0.01). As an index of the standard daily dose, the dose per stool was 1.52 for lactulose and 0.97 for the senna-fibre combination, at a cost per stool of 39.7p for lactulose and 10.3p for senna-fibre. Adverse effects were no different for the two treatments. CONCLUSIONS--Both treatments were effective and well tolerated for chronic constipation in long stay elderly patients. The senna-fibre combination was significantly more effective than lactulose at a lower cost.

Rao SS, Beaty J, Chamberlain M, Lambert PG, Gisolfi C Effects of acute graded exercise on human colonic motility. Am J Physiol. 1999 May;276(5 Pt 1):G1221-1226.
Abstract: Whether physical exercise stimulates colonic motility is unclear. Our aim was to determine the immediate effects of graded exercise on colonic motility. Colonic motility was recorded at six sites in 11 untrained subjects, by colonoscopically placing a solid-state probe. Subjects were free to ambulate. The next day, subjects exercised on a bicycle at 25, 50, and 75% of peak oxygen uptake for 15 min, with each followed by a 15-min rest. Motor patterns, motility indexes, and regional variations before, during exercise, during rest, and during postexercise periods were compared. During exercise, there was an intensity-dependent decrease (P < 0.001) in the number and area under the curve of pressure waves. The incidence of propagated or simultaneous pressure waves and cyclical events also decreased (P < 0.05). After exercise, the pressure activity reverted to baseline, but the number and amplitude of propagated waves increased (P < 0.01), whereas the simultaneous waves and cyclical events remained lower. Acute graded exercise decreases colonic phasic activity. This may offer less resistance to colonic flow, whereas the postexercise increase in propagated activity may enhance colonic propulsion.

Schindlbeck NE, Muller-Lissner SA. [Dietary fiber. Indigestible dietary plant constituents and colon function]. Med Monatsschr Pharm. 1988 Oct;11(10):331-6. Review) [Article in German]

Voderholzer WA, Schatke W, Muhldorfer BE, Klauser AG, Birkner B, Muller-Lissner SA. Clinical response to dietary fiber treatment of chronic constipation. Am J Gastroenterol. 1997 Jan;92(1):95-98.
Abstract: OBJECTIVES: To determine the clinical outcome of dietary fiber therapy in patients with chronic constipation. METHODS: One hundred, forty-nine patients with chronic constipation (age 53 yr, range 18-81 yr, 84% women) at two gastroenterology departments in Munich, Germany, were treated with Plantago ovata seeds, 15-30 g/day, for a period of at least 6 wk. Repeated symptom evaluation, oroanal transit time measurement (radiopaque markers), and functional rectoanal evaluation (proctoscopy, manometry, defecography) were performed. Patients were classified on the basis of the result of dietary fiber treatment: no effect, n = 84; improved, n = 33; and symptom free, n = 32. RESULTS: Eighty percent of patients with slow transit and 63% of patients with a disorder of defecation did not respond to dietary fiber treatment, whereas 85% of patients without a pathological finding improved or became symptom free. CONCLUSION: Slow GI transit and/or a disorder of defecation may explain a poor outcome of dietary fiber therapy in patients with chronic constipation. A dietary fiber trial should be conducted before technical investigations, which are indicated only if the dietary fiber trial fails.

Wilson JA. Constipation in the elderly. Clin Geriatr Med. 1999 Aug;15(3):499-510. (Review)