Natural treatments for constipation

DEFINITION: Treatment of difficult or infrequent bowel movements.

• PRINCIPAL PROPOSED NATURAL TREATMENTS: Cascara sagrada, dandelion, He Shou Wu, increased dietary fiber (debittered fenugreek seeds, flaxseed, glucomannan, psyllium husks), increased water intake, methyl sulfonyl methane, probiotics (alone or with prebiotics), Senna, traditional Chinese herbal medicine
• OTHER PROPOSED NATURAL TREATMENTS: Acupuncture, aloe, Ayurvedic herbal combinations, barberry, basil, biofeedback, bladderwrack, buckthorn, cayenne, dandelion, goldenseal, honey, magnesium citrate, red raspberry, kiwi, prunes, slippery elm

Introduction

In the nineteenth century, a naturopathic concept emerged whose influence persists—namely, that regular, frequent, and complete bowel movements are necessary for optimum health. William Harvey Kellogg, of Kellogg’s cereal fame, wrote extensively about the dangers of “auto-intoxication” purportedly caused by inadequate waste elimination. He and others claimed that a concrete-like sludge builds up on the colon’s wall, increasing in thickness over time and destroying the health of the body.

In the twenty-fist century, physicians have performed millions of colonoscopic examinations without finding any evidence of such a coating. Caked colons are a myth. Furthermore, conventional medicine has not found convincing evidence of a 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 general population. Another study found no connection between constipation and colon cancer. While bowel movement frequency varies, having fewer than three bowel movements per week is commonly used as a clinical marker of constipation and may be associated with reduced quality of life.

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. Various complementary and alternative treatments have also been proposed and are often promoted as "natural." Scientific evidence for the effectiveness of such treatments is mixed.

Principal Proposed Natural Treatments

Occasional constipation can be safely self-treated. However, if it becomes a chronic problem, a physician should evaluate it.

Increasing dietary fiber and water intake is the first treatment for chronic constipation. Whole grains, fruits, and vegetables add fiber to the diet. Fiber supplements may also be taken in the form of psyllium husks, debittered fenugreek seeds, glucomannan, and flaxseed. Clinical guidelines recommend a total daily fiber intake of approximately 25 grams for adult women and 38 grams for adult men, depending on age and caloric intake, with a minimum of 16 ounces of liquid. One should start with the lower doses and work up gradually, as too much fiber at once can 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 over-the-counter drug in the United States. All these work by chemical constituents called anthraquinones that irritate the colon wall. When taken to excess, stimulant laxatives can cause dependence. Additionally, if overused, they can cause depletion of potassium. This is especially dangerous for people taking drugs in the digoxin family. Guidelines recommend limiting stimulant laxatives to short-term or occasional use.

Traditional Chinese herbal medicine offers numerous herbal combinations for the treatment of constipation. One such combination has undergone study: a combination of 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 the 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 fructooligosaccharide twice daily for two weeks experienced significant improvement compared to women consuming regular yogurt as the placebo. Additionally, in a six-week, double-blind, placebo-controlled trial of 274 people with constipation-predominant IBS, 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 Lactobacillus rhamnosus was more effective than the 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 benefits with L. casei Shirota. Finally, another study found that B. lactis and B. longum improved bowel regularity in older adults.

The psychological aspect of constipation should also 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 unpleasant, its evils have been greatly exaggerated. Thinking less about it will often go a long way toward solving the problem. Additionally, traveling may trigger constipation in some individuals, likely due to unconscious stress from their new surroundings. Relaxing and eating a healthy diet while on vacation may help prevent constipation.

Other Proposed Natural Treatments

Numerous herbs are used alone or in combination to treat constipation. These include aloe, Ayurvedic herbal combinations, barberry, bladderwrack, basil, buckthorn, cayenne, dandelion, goldenseal, He Shou Wu, red raspberry, kiwi, prunes, and slippery elm. Honey has also shown some potential. However, the effectiveness of these therapies needs additional scientific study. Magnesium citrate is another natural treatment for constipation that has shown effectiveness. Supplementing with magnesium citrate draws water into the intestines, making it easier to have a bowel movement. Magnesium is fast-acting with few side effects but is not recommended for chronic constipation. 

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. Small studies have found acupuncture can improve bowel movements and reduce constipation-related symptoms, such as abdominal pain and bloating. Finally, increasing exercise and hydration and eating a healthy diet are natural lifestyle changes a person can make to relieve constipation.

Bibliography

Bekkali, N. L., et al. "The Role of a Probiotics Mixture in the Treatment of Childhood Constipation." Nutrition Journal, vol. 6, 2007, pp. 17.

Chey, Samuel, W., et al. "Exploratory Comparative Effectiveness Trial of Green Kiwifruit, Psyllium, or Prunes in US Patients With Chronic Constipation." The American Journal of Gastroenterology, vol. 116, no. 6, 2021, pp. 1304-1312, doi:10.14309/ajg.0000000000001149.

"8 Home Remedies for Constipation." Cleveland Clinic, 10 May 2022, health.clevelandclinic.org/home-remedies-for-constipation. Accessed 1 Oct. 2024.

Lacy, Brian E., et al. “ACG Clinical Guideline: Management of Irritable Bowel Syndrome.” The American Journal of Gastroenterology, vol. 116, no. 1, Jan. 2021, pp. 17–44, doi:10.14309/ajg.0000000000001036.

McCallum, Katie. "Home Remedies for Constipation: 5 Ways to Get Relief." Houston Methodist, 1 Sept. 2023, www.houstonmethodist.org/blog/articles/2023/sep/5-home-remedies-for-constipation. Accessed 1 Oct. 2024.

Olopaade, Jennie. "Magnesium Citrate for Constipation: Benefits and Risks." Medical News Today, 19 Dec. 2023, www.medicalnewstoday.com/articles/322588#alternatives. Accessed 1 Oct. 2024.

Pitkala, K. H., et al. "Fermented Cereal with Specific Bifidobacteria Normalizes Bowel Movements in Elderly Nursing Home Residents." Journal of Nutrition, Health, and Aging, vol. 11, 2007, pp. 305-11.

Rao, S. S., et al. "Long-Term Efficacy of Biofeedback Therapy for Dyssynergic Defecation." American Journal of Gastroenterology, vol. 105, 2010, pp. 890-96.

"8 Remedies To Relieve Constipation." Bladder & Bowel Community, www.bladderandbowel.org/bowel/bowel-treatments/8-remedies-to-relieve-constipation-bladder-bowel-community. Accessed 1 Oct. 2024.

Vélez, Christopher D. "Another Natural Remedy for Constipation?" Harvard Health, 22 Feb. 2022, www.health.harvard.edu/blog/another-natural-remedy-for-constipation-202202222690. Accessed 1 Oct. 2024.