Constipation is one of the most common gastrointestinal complaints doctors see; experts say that at least 4.5 million people—the majority of them women—suffer from constipation symptoms that are serious enough to warrant medical attention. Because it can be an embarrassing topic, however, many patients self-treat their constipation and avoid discussing it with their doctor. Here are some ideas about why—and how—to treat chronic constipation.
What is chronic constipation and why does it matter?
For some, constipation can simply mean straining, and for others it means infrequent bowel movements (that differ from normal patterns for that individual). Most complementary and alternative medicine providers, myself included, would agree that a daily bowel movement—or even up to three per day—is optimal. But that might not be feasible for women, since their bowel movement frequency is generally less than that of men.[i] Studies have suggested that the majority of women have bowel movements every other day or less.[ii] Because there can be a wide range of what’s considered normal, from three times per week to three times per day, it is important to clarify what’s normal to you with your health care provider.
The current standard definition of constipation means experiencing two or more of the following symptoms for three or more months, without the use of laxatives:
- Straining with defecation more than 25 percent of the time
- Lumpy or hard stools more than 25 percent of the time
- Incomplete evacuation more than 25 percent of the time
- Two or fewer bowel movements per week
Chronic constipation can lead to a decrease in absorption of select nutrients, internal or external hemorrhoids, pelvic floor dysfunction (e.g. urinary incontinence, or bladder, rectal or uterine prolapse).
How can laxatives support normal large intestine function and relieve constipation symptoms?
Laxatives can be helpful temporary solutions to relieve symptoms and to help retrain the bowel. There are a variety of different types of laxatives that work in different ways. Here are the six basic laxative types.
1. Bulk-forming laxatives.
These can be derived from psyllium husks, ground flax seeds or methylcellulose, a synthetic material. Their basic function is to absorb water in the intestine to soften the stool, but they can also result in increased flatulence and bloating. They do act faster than food fiber but slower than other laxatives and typically take about a week to work. Bulk-forming laxatives improve transit time and are very compatible with increases in dietary fiber such as leafy greens, ground flax seeds sprinkled on whole grain, high-fiber cereals, and fresh fruits, especially berries.
2. Emollients and stool softeners
These agents aid the mixing of watery and fatty substances in the bowel both to soften the stool and to lubricate the stool so it can be passed easier. They also prevent dehydration of the stool by stimulating fluid secretion. Stool softeners can be taken orally or rectally and typically work very fast, usually within 24 hours, so they’re ideal for someone who is in pain because of hard stool. Glycerin suppositories or mineral oil are common examples, but mineral oil should be used sparingly because it can decrease absorption of fat-soluble vitamins. Herbs such as buckthorn bark also serve as stool softeners.
3. Saline laxatives
Magnesium salts have been used for decades for constipation, and act fairly quickly. They work by exhibiting a sponge-like action that draws water into the colon to soften the stool and promote transit. When looking for an appropriate product, it’s important to note that magnesium sulfate is more potent than magnesium citrate or magnesium hydroxide and should be used with caution. In addition, individuals with renal impairment or hypertension should avoid saline laxatives.
These are the newer laxatives on the block. Available as an oral prescription, hyperosmotics create a high concentration gradient to draw fluid out of the bloodstream and into the colon. Examples of hyperosmotics include lactulose, lactitol and sorbitol, and produce effects in 2-3 days. Note: Hyperosmotics can also produce some bloating and flatulence.
A polyethylene glycol electrolyte solution is what’s normally given to empty the colon before a colonoscopy. The good news is that it can also be used to treat severe fecal impaction. MiraLax is a newer prescription that uses polyethylene glycol to help relieve constipation.
6. Bowel stimulants
These laxatives stimulate sensory nerve endings in the colonic mucosa to trigger peristalsis. They also promote fluid secretion into the colon and improve the consistency of the stool. Aloe, senna, cascara sagrada and castor oil are all potent stimulants that can produce a rapid response. They should only be used for more severe cases and should not be used long term.
Are there natural solutions to constipation that I should consider?
Alternative medicine practitioners also often recommend these other methods of treating constipation:
- Probiotics to help restore normal colonic microflora, specifically the lactobacillus species
- Digestive enzymes, which enhance the digestive process
- Bitters, which work by increasing the secretion of digestive fluids. Consider yellow gentian and dandelion root for this purpose. Dandelion root also helps stimulate gall bladder function and improve bile secretion.
- Turkey rhubarb has been used as a purgative for at least 2,000 years, and encourages bowel movements by stimulating peristalsis
- Triphala, whose use for chronic constipation is based on principles of Ayurveda. This unique combination of three herbs, or more specifically, three fruits, haritake, amla and bibitake, that gently stimulate the intestines, restore tone to the colon and thus enhance the elimination process while providing a cleansing effect.
When it comes to chronic constipation, most individuals will only need reassurance, education and basic advice. Others will need further evaluation and/or more sophisticated treatment interventions, whether by exclusively natural methods, conventional methods or an integration of both.
Working with your health care provider will help ensure that there is no significant underlying cause of your constipation. Your doctor can also help you get symptom relief, improve general health and provide prevention strategies for the future, all with minimal side effects.
[i] Heaton K, Radvan J, Cripps H, et al. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992; 33:818-824.
[ii] Toglia M. Pathophysiology of anorectal dysfunction. Obstet Gynecol Clin North Am. 1998; 25:771-780.