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.
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.
What are the symptoms of constipation?
Symptoms of constipation include infrequent stools, hard stools, and excessive straining to move the bowels. The frequency of bowel movements and the severity of symptoms may vary from person to person.
Dietary changes that may be helpful
Fibre, particularly insoluble fiber, is linked with the prevention of chronic constipation. 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 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. Higher amounts of wheat bran are sometimes more successful than lower amounts.
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. Symptoms disappeared in most infants when cows’ milk was removed from their diet. These results were confirmed in two subsequent, preliminary trials.
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. Nonetheless, the effect of exercise on constipation remains unclear.
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 trial and several double-blind trials 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.
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 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.
Basil (Ocimum basilicum) seed has been found to relieve constipation by acting as a bulk-forming laxative in one preliminary study. A similar study showed the seeds to be useful following major surgery for elderly people with constipation.
Alginic acid, one of the major constituents in bladderwrack(Fucus vesiculosus), is a type of dietary fibre 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.
Holistic approaches that may be helpful
Anecdotal reports have claimed that acupuncture is beneficial in the treatment of constipation. 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.
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.