Conditions

Constipation

The term constipation refers to a change in daily bowel habits ­ in particular, a decrease in the number of bowel movements or pain/difficulty passing stools.

If a person is constipated but still has a good appetite and is not uncomfortable, there is no need to worry. However, if there is a loss of appetite, vomiting, or discomfort, the person should seek immediate medical attention.

The most common cause of constipation is insufficient fluids and too little fiber in the diet. Too much fat in the diet may contribute to constipation, as can a lack of proper exercise.

Normal bowel movements occur from two or three times a week to two or three times a day. Those that are considered "regular" have at least one bowel movement a day ­ however this is not an absolute necessity for good health. Constipation usually results from a delay in transit within the colon from a wide variety of causes. Constipation can occur at any age, and most people have constipation sometime in life, but it is more frequent in infancy and old age.

Any of the following may cause constipation (in addition to insufficient fluids or too little fiber):

• Drugs:
  Aluminum and calcium antacids, anticholinergics, antidepressants, calcium supplements, calcium-channel blockers, cholestyramine narcotics, sympathomimetics, pseudoephedrine, tranquilizers and sedatives.
  
• Endocrine or metabolic disorders or changes:
  Hypothyroidism, hypercalcemia, hypokalemia, and pregnancy
  
• Neurological disorders:
  Smooth muscle or connective tissue disorders, and congenital impairments can induce constipation ­ talk to your physician for more information.

Signs and Symptoms:

If a person is usually regular, the following signs can indicate constipation:

• Two or more days without a bowel movement (this can be variable depending on the normal timing of bowel movements)
• Pain or difficulty passing a bowel movement
• Large or hard stools

If a person develops the following symptoms along with the previous ones, they should see a medical professional immediately.

• Loss of appetite
• Vomiting
• Severe discomfort

Diagnosis:

Most cases of constipation respond to simple at-home treatments. However, if you experience severe pain when passing a stool; if there is blood in the stools; if you notice a cut or tear near your rectum; or if you develop chronic or persistent constipation, you should be examined by a doctor.

Your doctor will likely ask you for a medical history, including your usual bowel movement habits. He or she will likely feel your stomach and may listen to it for bowel sounds. Your doctor may also check for rectal fissures or hemorrhoids.

Treatment Options:

Treatment focuses on the underlying disease or removing factors causing the constipation. Chronic constipation can usually be prevented with a combination of diet, fluid intake, exercise, and, when necessary, short-term use of a laxative. Excessive or prolonged use of laxatives is not recommended.

Traditional Treatments:

• Increasing the amount of fiber and fluid in your diet is the best place to start.
• A stool softener, such as docusate sodium (Colace and others), may be prescribed to soften the stool and help it pass through the intestines more easily.
• Magnesium hydroxide (found in milk of magnesia), citrate of magnesia, and phosphosoda (Phosph-soda, Sal-Hepatica) are bulk-forming laxatives that work by drawing fluids from the body into the intestine, increasing the contents of the intestines, and thereby initiating a bowel movement.
• Stimulant laxatives, such as bisacodyl (found in Dulcolax), castor oil, phenolphthalein (Modane) and senna leaf extract, work by irritating the intestinal wall and, thus stimulating peristalsis (the wave-like contractions of the intestines that push waste along).
• Stimulant laxatives are harsh and can cause cramping. Bulk-forming laxatives are preferable to stimulant types. No laxative should be used on a regular basis, as dependency can develop.
• Lubricants, such as glycerin and mineral oil, coat the stool and help it slip more easily through the rectum. Prolonged use of mineral oil can cause inflammation of the liver, spleen, and abdominal lymph nodes, and can interfere with the body's absorption of vitamins A and D. Lubricants can also be dangerous if they accidentally go down the windpipe and enter the lungs.

Complementary and Alternative Therapies:

Lifestyle and dietary changes, along with nutritional support, can contribute to the long-term resolution of constipation. Herbs can be used to help tone and strengthen bowel function. Laxative herbs should be used with caution, as they may become less effective with habitual use. Mind-body techniques, such as meditation and yoga, may help reduce nervous tension that may contribute to constipation.

Nutritional Supplementation:

• Acidophilus and bifidobacteria help to establish good intestinal flora, which is very helpful in relieving constipation. If you have chronic or recurrent constipation, probiotic bacteria are strongly recommended. Follow the label directions.
• Organic flaxseed oil or olive oil will help ease discomfort of passing hard stool. Take 1 tablespoon of either two to three times daily until the problem is resolved.
• Fuctooligosaccharides (FOS) nourish the beneficial intestinal bacteria, and can be very effective in correcting constipation. Take one or two capsules, three times daily.
• The B vitamins are important for digestion and also contribute to the health of the colon. Take a good vitamin B complex supplying at least 50 mg of each of the major B vitamins, twice daily. Also take 500 mcg of vitamin B12 twice daily for three days, then once daily for one week, then once a week for ten weeks.
• Garlic destroys harmful bacteria in the colon. Take 2 capsules twice daily, with meals.
• Apple pectin is a good source of fiber to aid in correcting constipation. Take 500 mg daily. Take separately from other supplements and medications.

Alternative Therapies:

• Food grade aloe vera has a healing and cleansing effect on the digestive tract and aids in forming soft stools. Drink _ cup of aloe vera juice in the morning and at night. It can be mixed with a cup of herbal tea.
• Ginger stimulates the digestive system and eases passage of foods through the intestines.
• Use milk thistle to aid in liver functions and to enhance bile output to soften stools.
• Cascara sagrada is an herbal formula that offers over night relief. Follow label directions.
• Licorice is soothing to irritated intestinal walls and helps relieve chronic constipation. Take a cup of licorice tea or 500 mg in capsule form once or twice daily for three or four days.
  Warning: Do not take licorice on a daily basis for more than five days in a row, as it can elevate blood pressure. If you have high blood pressure do not take licorice at all.
• If you experience constipation alternating with diarrhea, oatmeal cooked in flaxseed tea can be very helpful. It soothes irritated intestines and relieves constipation.
• Psyllium is an excellent stool softener with mild laxative properties. Follow label directions.
• Slippery elm is invaluable for irritated intestines. It soothes and helps resolve inflammation. Take a cup of slippery elm tea or 500mg in capsule form three times a day, as needed.
• Calcarea carbonica is a homeopathic therapy that treats hard, distended stomachs.
• If you have hard, dry stools and experience pain right before a bowel movement, take one dose of Lycopodium two or three times daily for two or three days.
• Stubborn constipation might benefit from the homeopathic therapy, Plumbum metallicum, three times a day for two or three days.
• See your local homeopathic practitioner for more homeopathic therapies that fit your constitutional needs.
• The following acupressure points can be beneficial for constipation when stimulated: Bladder 20 ­ 25, Large Intestine 11, and Stomach 36.
• Essential oils of basil, lavender, myrrh, and rose strengthen the digestive system and help to counteract constipation. You can use any or all of them in an aromatherapy bath or add a few drops to massage oil and use it in conjunction with acupressure massage.

General Recommendations:

• An Epsom salts bath is relaxing and increases circulation. An hour or two after an Epsom salts bath, a bowel movement will often occur.
• Massaging the lower abdomen is comforting and helps get things moving. Gently massage the abdomen, following the natural movement of the intestines. Start in the lower right "corner" move up toward the ribs, over to the left side, and then down toward the pelvis.
• Avoid using aluminum cookware. Some believe that taking in minute traces of aluminum can exacerbate constipation.
• Avoid tight clothing.
• Eat high fiber foods such as fresh fruits, raw green leafy vegetables, whole-grain oatmeal, and brown rice.
• Drink more water. Drink at least eight to ten 8-ounce glasses of water every day, whether you are thirsty or not.
• Avoid fried foods.
• Prunes and figs are natural laxatives.
• Eat smaller portions.
• Get some exercise. A twenty-minute walk can often relieve constipation. Yoga can also help relieve constipation.
• If constipation is persistent, consider taking a cleansing enema.
• If you use laxatives, take acidophilus to replace the "friendly" bacteria.

Warnings:

• Do not take licorice on a daily basis for more than five days in a row, as it can elevate blood pressure.
• If you have high blood pressure do not take licorice. Do not take laxatives on a regular basis as this can lead to dependency.
• If you experience a loss of appetite, vomiting, bloody stools or extreme discomfort ­ contact your health provider immediately.