Find comfort from constipation, a change in normal bowel habits
characterized by a decrease in frequency and passage of hard, dry stools. According to
research or other evidence, the following self-care steps may be helpful:
- Try a bulk laxative
- For results within 12 to 24 hours, take 5 to 10 grams per day of
psyllium husk or 3 to 4 grams per day of glucomannan mixed in water, followed by a second
glass of water
- Get more fiber and water in your diet
- To increase stool bulk, include more vegetables, beans, bran,
flaxseed, and whole grains in your diet; don’t forget to drink more water when you
increase fiber intake
- Get a checkup
- Constipation that starts suddenly should be evaluated by a
healthcare professional to make sure no serious diseases are the cause
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full constipation article for
more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About constipation
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.
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constipation
What are the symptoms?
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 options
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
Vitamins 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.