What are natural treatments for constipation?
In the nineteenth century, a naturopathic concept came into being whose influence persists today: namely, that regular, frequent, and complete bowel movements are necessary for optimum health. William Harvey Kellogg, of Kellogg’s cereal fame, wrote extensively of the dangers of “auto-intoxication” purportedly caused by inadequate elimination. He and others claimed that a concrete-like sludge builds up on the wall of the colon, increasing in thickness over time and destroying the health of the body.
However, in modern times, physicians have performed millions of direct examinations of the colon, using the procedure known as colonoscopy, without finding any evidence of such a coating. Caked colons are a myth.
Furthermore, conventional medicine has never observed any connection between elimination and overall health. Many people eliminate only once a week or so, and their health appears to be no worse than that of the population at large. In addition, one study found that there is no connection between constipation and colon cancer.
Nonetheless, most people find occasional constipation unpleasant. For some, it becomes a severe chronic problem. It can be associated with irritable bowel syndrome (IBS), in which case it is called constipation-predominant IBS. Conventional treatment for constipation involves mainly increasing exercise and intake of dietary fiber and water, while reserving laxatives, suppositories, and enemas for emergencies.
Occasional constipation can be safely self-treated. However, if constipation becomes a chronic problem, it should be evaluated by a physician.
Increasing dietary fiber and water intake is the first treatment to try for chronic constipation. Whole grains and fruits and vegetables add fiber in the diet. In addition, fiber supplements may be taken in the form of psyllium husks, debittered fenugreek seeds, glucomannan, and flaxseed. A typical dosage of fiber is 5 to 10 grams, one to three times daily, with a minimum of sixteen ounces of liquid. One should start with the lower doses and work up gradually, as too much fiber at once can actually worsen constipation.
The herbs Cascara sagrada and Senna are stimulant laxatives approved as over-the-counter (OTC) treatments for constipation. Another herb, common buckthorn, also contains these substances, but it is not an approved OTC drug in the United States. All of these work by virtue of chemical constituents called anthraquinones that irritate the colon wall. When taken to excess, stimulant laxatives can cause dependence. In addition, if overused, they can cause depletion of potassium. This is especially dangerous for people taking drugs in the digoxin family.
Traditional Chinese herbal medicine offers numerous herbal combinations for the treatment of constipation. One such combination has undergone study: a combination of the herbs rhubarb and licorice called Daio-kanzo-to. In this two-week, double-blind, placebo-controlled trial, 132 people complaining of constipation were randomly assigned to one of three groups: placebo, low-dose Daio-kanzo-to, or high-dose Daio-kanzo-to. The results indicate that the higher-dose group, but not the lower-dose group, experienced statistically significant improvements in constipation compared with placebo.
Some evidence indicates that probiotics (friendly bacteria) alone or taken with prebiotics (nutrients that encourage the growth of probiotics) may improve constipation. For example, 266 women with constipation who consumed yogurt containing the probiotic Bifidobacterium animalis and the prebiotic fructoligosaccharide twice daily for two weeks experienced significant improvement compared to women consuming regular yogurt as placebo. In addition, in a six-week, double-blind, placebo-controlled trial of 274 people with constipation-predominant IBS, the use of a probiotic formula containing B. animalis significantly reduced discomfort and increased stool frequency. In another double-blind, placebo-controlled study of forty-five children with chronic constipation, researchers found that the use of Lactobacillus rhamnosus was more effective than placebo and just as effective as magnesium oxide. Furthermore, a small trial found benefits in children, this time with a mixture of bifidobacteria and lactobacilli, and a study not limited to children found benefit with L. casei Shirota. Finally, another study found that a combination of B. lactis and B. longus improved bowel regularity in the elderly.
The psychological aspect of constipation also should be considered. Like sleep, elimination is inhibited by thinking too much about it. Part of the key to solving chronic constipation problems is to decrease the sense of worry and anxiety about it. Although constipation is certainly unpleasant, its evils have been greatly exaggerated. Thinking less about it will often go a long way toward solving the problem.
Numerous herbs are used alone or in combination formulas for the treatment of constipation. These include aloe, Ayurvedic herbal combinations, barberry, bladderwrack, basil, buckthorn, cayenne, dandelion, goldenseal, He shou wu, red raspberry, and slippery elm. Honey has also shown some potential. The effectiveness of these therapies has not been scientifically evaluated to any meaningful extent.
Besides herbs, other alternative medicine therapies have been proposed for use in the treatment of constipation. Biofeedback may be effective for some forms of constipation (particularly those associated with uncoordinated functioning of pelvic muscles), but the evidence is mixed for short-term benefits and is lacking for long-term benefits. One small study failed to find acupuncture helpful.
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De Paula, J. A., E. Carmuega, and R. Weill. “Effect of the Ingestion of a Symbiotic Yogurt on the Bowel Habits of Women with Functional Constipation.” Acta Gastroenterologica Latinoamericana 38 (2008): 16-25.
Guyonnet, D., et al. “Effect of a Fermented Milk Containing Bifidobacterium animalis DN-173 010 on the Health-Related Quality of Life and Symptoms in Irritable Bowel Syndrome in Adults in Primary Care.” Alimentary Pharmacology and Therapeutics 26 (2007): 475-486.
Koh, C. E., et al. “Systematic Review of Randomized Controlled Trials of the Effectiveness of Biofeedback for Pelvic Floor Dysfunction.” British Journal of Surgery 95 (2008): 1079-1087.
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Rao, S. S., et al. “Long-Term Efficacy of Biofeedback Therapy for Dyssynergic Defecation.” American Journal of Gastroenterology 105 (2010): 890-896.