Nearly everyone suffers from intermittent constipation at some point in their life, but chronic constipation is a serious health condition.
Not only can it cause ongoing pain and be very upsetting but has dire consequences for the rest of the body.
Here we will outline the possible causes and suggest some natural solutions, potentially giving long-term relief.
What is constipation?
The many definitions of constipation reflect the differences in what is perceived as normal; for instance, the frequency of bowel movements and the weight and consistency of feces are greatly diverse among individuals so that constipation perceived by one person may be the normal (physiological) condition for another one. (1)
Healthy people have a bowel evacuation frequency anything from three times daily to three times a week. The old belief that we should have a bowel movement everyday is not always correct. (1)
Indications of constipation
- Transit time slowing down with a reduction in number of small volume stools
- Infrequent, difficult, or incomplete bowel evacuation
- stools that range from small, hard ‘rocks’, to a large bulky mass (2)
Constipation can cause a range of complex issues, including abdominal pain and bloating, anorexia, and nausea.
Other problems outside the colon can begin, like headaches, hair loss, restlessness, and confusion.
Causes of constipation
Three major causative groups of constipation are recognized
- Causes related to lifestyle are called Functional Constipation
- Causes due to ill health are call Disease Related
- Causes due to pharmaceuticals are called Drug Induced
Types of Constipation
Chronic Constipation refers to those patients that experience symptoms of constipation for more than 6 months whereas acute constipation may be as short as a couple of days.
Chronic constipation has been reported in 15% to 25% of the general population. It affects patients of all ages and both sexes, and different cultures and ethnicities. It is more commonly reported in women, elderly patients, residents of chronic care facilities and patients with concurrent psychiatric illnesses. (3)
Functional constipation acute or chronic is common in 95% of subjects so this is what we will talk about in this text.
It is present in children, businessmen, or travelers who voluntarily, or not, delay defecation. It can be diagnosed when a combination 2 or more of the following symptoms are present within the previous 3 months. (1)
- sensation of ano-rectal blockage
- straining during defecation
- infrequent bowel movements
- lumpy or hard stools in at least 25% of defecations
- going less than 3 times per week
- sensation of incomplete evacuation at least 25% of the time
- manual maneuvers to facilitate at least 25% of defecations
- loose stools are rarely present (1)
The pathophysiology of functional constipation is still unclear, but it has been traditionally thought to involve slow colonic transit and/or pelvic floor dysfunction, although there is a huge variation in the identification of the exact dysfunction, mainly due to the diagnostic methods used.
The majority of patients with functional constipation mainly use self-managed interventions, like changes of lifestyle and use of over-the-counter laxatives. (1)
Contributing factors to functional constipation
- decreased intestinal muscle tone
- lack of exercise
- dietary changes
- anal fissure
- diverticular disease
- intestinal and/or ovarian cancer
- bowel obstruction (e.g. carcinoma)
- anal retention (e.g. proctitis)
- other physical or inflammatory conditions of the lower rectum or anus (1)
Drugs that cause constipation
- antacids containing aluminum
- antianorexics (amphetamines)
- antiarrhythmics (verapamil)
- anticholinergics (atropine)
- antidepressant (tricyclics, monoamineoxidase inhibitors)
- diuretic (benzothiadiazide,K-sparing diuretics),
- laxatives (when chronically administered)
- antineoplastics (decarbazine)
- anemia medications (iron and bismuth supplements) (1)
Causes of Disease related constipation
- Systemic disorders (Parkinson, multiple sclerosis, hypothyroidism,diabetes, etc.)
- Local disorders (luminal and extraluminal obstruction, irritable colon syndrome, hemorrhoid,etc.) (1)
Dietary advice for constipation
One recent study showed that probiotics statistically improved stool consistency and frequency. A more recent double-blinded, placebo-controlled Random Crossover Trial divided 300 chronically constipated patients (151 males and 149 females) into three groups (placebo, Lactobacillus plantarum and Bifidobacterium breve, or Bifidobacterium lactis) for a treatment duration of 30 days. The treatment groups significantly improved in all aspects of constipation symptoms. (7)
Diet, particularly dietary fiber, has often been regarded as an important determinant of constipation, although personality factors may be important as well. (8)
One study found that those who ate more fruits and vegetables had fewer complaints of constipation. In addition, however, it was found that those who ate more of a number of dietary constituents including cheese, dry beans and peas, milk, and meat and poultry also had less self-reported constipation. As one might expect, these individuals also had a higher caloric intake. When controlled for caloric intake, however, these dietary components were still significant. (8)
Go Gluten Free
Going gluten free can be a good idea in the beginning stages of resolving chronic functional constipation.
Studies have shown the ‘classical’ presentation of ‘Non Celiac Gluten Sensitivity’ is a combination of irritable bowel syndrome-like symptoms, including abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation), and systemic manifestations such as ‘foggy mind’, headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, and anemia. (11)
Lifestyle advice for constipation
An individualized, supervised physical activity program (20 min to 60 min of moderate-to-vigorous activity, three to five days per week) over a 12-week period significantly improved the symptom severity scores of patients.
One study showed related factors such as age, engaged professionals, sleep quality, poor emotional (depression and anxiety tendencies), mental stress, interpersonal relations, work fatigue, stimulating beverage use, exercise conditions, drug induced constipation were all associated with the distribution of chronic functional constipation. (10)
Herbs for constipation
- Psyllium is the most commonly used bulking agent in Canada. In placebo-control trials, psyllium has been shown to decrease stool transit time, and improve stool frequency, consistency and weight. (4)
- The laxative effect of Cortex Rhamni Purshianae is not generally observed until 6–8 hours after oral administration. Firstly, there is stimulation of colonic motility, resulting in increased propulsion and accelerated transit of faeces through the colon (which reduces fluid absorption from the faecal mass). Secondly, there is an increased water content in the colon (5, 6).
- Rhubarb consists of the dried rhizome of Rheum palmatum Rhubarb contains sennosides A–F with laxative properties, a considerable quantity of tannin. A laxative action without abdominal pain is caused by a dose of 0.5–2 g. The most used preparations are dreid powder, tinctures, infusions, and fluid extract. (9)
- The Ultimate Herbal DETOX program contains all of the herbs mentioned above, plus dietary guideline and recipes which can resolve chronic constipation. Follow this plan for 14 days and continue with the dietary advice afterwards to achieve long-term results.
I hope this article has been helpful
Brett Elliott ©
(1) Constipation and Botanical Medicines: An Overview. PUBMED https://www.ncbi.nlm.nih.gov/pubmed/26171992
(2) (McMillanand Williams, 1989; Norton, 1996; Ross, 1998)
(3) Chronic constipation: Current treatment options. PUBMED https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206558/
(4) Mechanisms of constipation in older persons and effects of fiber compared with placebo. PUBMED https://www.ncbi.nlm.nih.gov/pubmed/7775727/
(5) 26. De Witte P. Metabolism and pharmacokinetics of the anthranoids. Pharmacology 1993, 47 (Suppl. 1):86–97.
(6) WHO monographs on selected medicinal plants. Vol. 1. Geneva, World Health Organization, 1999:241–258. http://apps.who.int/iris/bitstream/10665/42052/2/9241545372.pdf
(7) Del Piano M, Carmagnola S, Anderloni A, et al. The use of probiotics in healthy volunteers with evacuation disorders and hard stools: A double-blind, randomized, placebo-controlled study. J Clin Gastroenterol. 2010;44(Suppl 1):S30–4. PubMed https://www.ncbi.nlm.nih.gov/pubmed/20697291
(8) Demographic and Dietary Determinants of Constipation in the US Population. PUBMED https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1404600/pdf/amjph00215-0049.pdf
(9) Constipation and Botanical Medicines: An Overview. PUBMED https://www.ncbi.nlm.nih.gov/pubmed/26171992
(10) [Distribution characteristics of basic syndromes of chronic functional constipation and its related factors analysis]. PUBMED https://www.ncbi.nlm.nih.gov/pubmed/25509257
(11) Gluten Sensitivity. PUBMED https://www.ncbi.nlm.nih.gov/pubmed/26605537