Introduction
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.
Principal Proposed Natural Treatments
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.
Other Proposed Natural Treatments
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.
Bibliography
Bekkali, N. L., et al. “The Role of a Probiotics Mixture in the Treatment of Childhood Constipation.” Nutrition Journal 6 (2007): 17.
Chiarioni, G., et al. “Bio-feedback Treatment of Fecal Incontinence: Where Are We and Where Are We Going?” World Journal of Gastroenterology 11 (2005): 4771-4775.
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.
Pitkala, K. H., et al. “Fermented Cereal with Specific Bifidobacteria Normalizes Bowel Movements in Elderly Nursing Home Residents.” Journal of Nutrition, Health, and Aging 11 (2007): 305-311.
Rao, S. S., et al. “Long-Term Efficacy of Biofeedback Therapy for Dyssynergic Defecation.” American Journal of Gastroenterology 105 (2010): 890-896.
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