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 single bowel movement every day is not always correct. (1)
Indications of constipation
- Transit time slowing down with a reduction in the 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 diet and lifestyle are called Functional Constipation
- Causes due to ill health are called Disease Related
- Causes due to pharmaceuticals are called Drug-Induced
Natural Solutions to Reduce Constipation and Encourage Regularity
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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)
Dietary Fibre Intake
Diet, particularly dietary fiber, has often been regarded as an important determinant of constipation, although personality factors may be important as well. (8) Being vegetarian and especially vegan is strongly associated with a higher frequency of bowel movements as does a high intake of dietary fibre and fluids. Visit our recipe page for a range of vegetarian high fibre recipes here.
It is fairly common to get a good ‘clean-out the night after a hot curry. Capsaicin found in Chili alleviates abnormal intestinal motility through regulating gut motor neuron activity, which is beneficial for the treatment of gastrointestinal motility disorders, such as constipation. (13) Visit our recipe page for a range of spicy recipes here.
Going 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)
It also makes sense to avoid too many binding agents in any type of food. These include all types of refined grains, flour, eggs, and other sticky, glutinous processed food products.
Visit our recipe page for a range of gluten free recipes here.
Herbs for constipation
Colonaid contains a blend of herbs specifically designed to reduce constipation and encourage regularity. These herbs inlcude:
- Psyllium (Plantago ovata) seed husk
- Cascara (Rhamnus purshiana) bark
- Wormwood (Artemisia absinthium) bark
- Black Walnut (Juglans nigra) green hulls
- Fennel (Foeniculum vulgare) seed
- Turkish rhubarb (Rheum palmatum) root
- Slippery Elm (Ulmus rubra) bark
- Cloves (Syzigium aromaticum) bud
You can find out more about the individual herbs and how they work by clicking on the herb names below.
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Psyllium (Plantago ovata) seed husk: Psyllium is classified as a mucilaginous fiber due to its powerful ability to form a gel in water. This bulking fiber acts as a sponge, absorbing water and waste material in the bowels. Psyllium husks significantly increase the level of stool moisture and both wet/ dry stool weight, this is why it has such great effect at relieving constipation and improving bowel health. 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)
Cascara (Rhamnus purshiana) bark: The mechanism of action is twofold. Firstly, there is stimulation of colonic motility, resulting in increased propulsion and accelerated transit of faeces through the colon. Secondly, there is an increase in water content in the colon. The laxative effect of Cortex Rhamni Purshianae is not generally observed until 6–8 hours after oral administration.
Wormwood (Artemisia absinthium) bark: Infection of human beings with Toxocara cati or Toxocara canis, (the common roundworm of cats and dogs, respectively) commonly occurs in people with a history of pica or close contact with domestic animals. A study showed fecal egg numbers per gram were decreased gradually in cats in trial groups using Wormwood.
Black Walnut (Juglans nigra) green hulls: Black walnut is used to treat parasitic worm infections and certain other infections including diphtheria and syphilis. It is used to expel tapeworms and other internal and external parasites. In vitro studies have suggested that plumbagin, an active constituent, may inhibit the motility and hatching of specific worm larvae.
Fennel (Foeniculum vulgare) seed: Studies have shown Fennel to reduce intestinal spasm and colic in infants.
Turkish rhubarb (Rheum palmatum) root: Rhubarb contains the anthraquinones rhein and emodin. Emodin is traditionally used as a laxative and is found to increase or decrease the contractility of intestinal smooth muscle in low doses and high doses, respectively. Modern pharmacological studies indicated that rhein can exert a significant therapeutic effect, and more than 1000 articles about rhein can be found in PubMed and more than 100 of which have paid attention to its pharmacological mechanism of action. 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 dried powder, tinctures, infusions, and fluid extract.
Slippery Elm (Ulmus rubra) bark: The demulcent mucilage of Slippery elm provides a protective, anti-inflammatory and healing coating to mucous membrane surfaces. It reduces inflammation and irritation.
Cloves (Syzigium aromaticum) bud: Clove has widely been used as an antimicrobial agent, killing parasites and bacteria in the digestive tract.
Warning Notice: This product contains Cascara Bark that can have stimulant laxative effects. Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain. Consult your physician if you have frequent diarrhea, or if you are pregnant, nursing, taking medication, or have a medical condition.
- 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 afterward to achieve long-term results.
Other Lifestyle advice for constipation
An individualized supervised physical activity program (20 min to 30 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. I suggest simple bodyweight exercises such as sit-ups, push-ups, and squats are adequate. 20 of each 2-3 times a week can have amazing results.
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) One of the most effective ways of reducing stress is 20 minutes of meditation per day.
Understanding the Various 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)
- the sensation of anorectal 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 the 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, monoamine oxidase 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’s, multiple sclerosis, hypothyroidism, diabetes, etc.)
- Local disorders (luminal and extraluminal obstruction, irritable colon syndrome, hemorrhoid, etc.) (1)
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
(13) Capsaicin alleviates abnormal intestinal motility through regulation of enteric motor neurons and MLCK activity: Relevance to intestinal motility disorders. PUBMED https://pubmed.ncbi.nlm.nih.gov/26011134/