Constipation

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Constipation

Constipation is a condition that causes you to have difficulty passing stools. Normally, people have anywhere from two or three bowel movements a week to two or three a day. Constipation can occur at any age, but it is more frequent in infancy and old age.

Signs and Symptoms

	Infrequent, difficult passage of stools (fewer than three bowel movements a week)
	Sudden decrease in frequency of bowel movements
	Stools harder than normal
	Bowel still feels full after bowel movement
	Bloated sensation

What Causes It?

Most cases of constipation are caused by changes in diet or physical activity, including not drinking enough fluids. Psychological factors, particularly depression, may cause constipation. Chronic abuse of laxatives can also lead to chronic constipation. Certain drugs can cause it, as can physical abnormalities in the bowel or intestinal tract.

What to Expect at Your Provider's Office

Your health care provider will perform a physical exam and may feel your abdomen or give you a rectal examination. You may have tests on your blood and stool, or a barium enema.

Treatment Options

Treatment Plan

First, your health care provider will treat any underlying disease or food allergy. Dietary changes, extra fluid intake, and exercise all help to prevent constipation. Short-term use of a laxative or stool softener may be helpful. Your provider also may talk with you about proper bowel habits. It is important to have a regular daily routine. Leave plenty of time for a bowel movement shortly after a mealtime.

Drug Therapies

Prescription

N/A

Over the Counter

	Bulk-forming agents, such as psyllium, bran, or methylcellulose (for example, Citrucel)—help start contractions of the large intestine
	Laxatives—use for short-term only because of possible serious side effects; do not use if you have bowel obstruction, or kidney or heart failure
	Lukewarm water or bisocodyl suppositories—loosen stools, help begin retraining
	Stool softeners—increase the amount of water in the stool, which helps to stimulate contractions of the large intestine

Complementary and Alternative Therapies

Lifestyle and dietary changes along with nutritional support can contribute to the long-term resolution of constipation. You can use herbs to help tone and strengthen bowel function. Use laxative herbs with caution because they may become less effective with habitual use.

Nutrition

	Take time to eat, breathe slowly and chew food thoroughly.
	Eat smaller, more frequent meals and avoid overeating at one sitting.
	Eliminate refined foods, sugars, caffeine, alcohol, and dairy products from your diet.
	Decrease intake of saturated fats (animal products) and increase essential fatty acids (cold-water fish, nuts, and seeds).
	Eat more fresh vegetables and whole grains.
	Drink more water.
	Stewed or soaked prunes, 1 to 3 a day, have a slightly laxative effect.
	Flax meal, 1 heaping tsp. in 8 oz. of apple juice, provides fiber and soothes the digestive tract. Follow with an additional 8 oz. of water.
	Warm lemon water taken before meals stimulates digestion.
	Consider digestive enzymes for chronic constipation.
	Vitamin C, 1,000 mg, two to three times per day
	Magnesium, 250 mg, two to three times per day

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups a day. Tinctures may be used singly or in combination as noted.

A combination of herbs to tone digestion and relieve constipation includes the following in equal parts as a tea or tincture: licorice root (Glycyrrhiza glabra), cascara sagrada (Rhamnus purshiana), dandelion root (Taraxacum officinalis), yellow dock (Rumex crispus), fennel seed (Foeniculum vulgare), and ginger (Zingiber officinalis). Steep tea for 20 minutes. Drink 1 cup, three times a day, before meals. You may take 15 to 20 drops of a tincture, three times a day, before meals. For long-term use (more than two weeks), eliminate cascara and substitute burdock (Arctium lappa). Do not take licorice if you have high blood pressure.

Homeopathy

Some of the most common remedies used for constipation are listed below. Usually, the dose is 12X to 30C every one to four hours until your symptoms get better.

	Calcarea carbonica for constipation without urge to pass stool
	Nux vomica for constipation with constant, yet ineffectual, urge to pass stool
	Silica for constipation with the sensation that stool remains in the rectum after bowel movements

Physical Medicine

Castor oil packs to the abdomen may be useful in resolving constipation. Apply oil directly to skin, cover with a clean, soft cloth (for example, flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results, use for three consecutive days in one week.

Contrast hydrotherapy may help to tone and strengthen bowel function. Apply hot and cold towels to the abdomen. Alternate three minutes hot with one minute cold and repeat three times. This is one set. Do two to three sets a day.

Acupuncture

Acupuncture can stimulate and tone digestive function.

Massage

Therapeutic massage can help reduce stress and relieve constipation due to spasm and nervous tension.

Following Up

If you have chronic constipation, you may need to work regularly with your provider. Left untreated, it can cause serious health problems.

Special Considerations

Constipation is common in pregnancy and is usually relieved by changing your diet and drinking more water. If you are pregnant, do not take herbs that are stimulating to the digestive tract since they can induce contractions. Do not use laxative herbs in pregnancy without a provider's supervision.

Supporting Research

Andreoli TE, Bennett JC, Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 1993.

Ashraf W, Park F, Lof J, Quigley EM. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. AlimentPharmacol Ther. 1995;9:639–647.

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:476–491.

Dambro MR. Griffith's 5 Minute Clinical Consult 1999. Baltimore, Md: Lippincott Williams & Wilkins; 1999.

Hobbs C. Foundations of Health: The Liver and Digestive Herbal. Capitola, Calif: Botanica Press; 1992:129–135.

McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. 1998;12:491–497.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:85, 274, 281, 350.

Stein JH, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.