Constipation is difficulty or infrequency in evacuating the bowels. The retention of feces in the colon and rectum allows too much water to be absorbed from the material, which then dries and hardens, making defecation more difficult. When the bowel is continually overloaded with feces, its muscles lose their tone and constipation becomes chronic. Constipation is primarily caused by a diet lacking in the plant fiber needed to form fecal bulk, whose function it is to provide a “rotor-rooter” type of effect. Constipation may also be caused by ignoring the urge to defecate, a lack of water in the diet, or may a symptom of an underlying disorder, such as an obstruction of the bowel by a tumor or structural deformity. In young children, constipation is occasionally due to allergy, especially to milk and other dairy foods. Although possible, allergy-induced constipation is rare in adults.

Fiber and water are frequently a part of conventional medical treatment for constipation. Other conventional recommendations may include a variety of laxative medications.

ConstipationAs mentioned in the opening paragraph, constipation is primarily caused by a diet lacking in fiber. The most direct solution is to increase the consumption of fiber-containing foods. Of course, this means eating more fruit, vegetables and whole grain foods—which, unfortunately, many people simply aren’t going to do. The next best thing is to use fiber supplements to compensate for the fiber missing from the diet. The question is, what type of fiber supplement is best? Although any type of fiber that you consume will probably do the job, the fiber supplement of choice is psyllium husks. Wheat bran is also a good choice. Psyllium husks & wheat bran In a comparative study of different laxatives, all were effective in inducing a bowel movement within 24 to 36 hours.

Psyllium husks, however, produced a higher percentage of normal, well-formed stools and fewer hard stools than the other laxatives. Incidences of soiling, diarrhea and abdominal pain were also lower in the group receiving psyllium husks. Overall, psyllium husks were found to be an effective treatment for simple constipation, and were associated with better stool consistency and a lower incidence of adverse events. Additional research comparing psyllium husk to other laxatives have also found psyllium to be the superior laxative. Wheat bran is also readily available, and has a long and effective history of use for constipation. Wheat bran tablets or capsules are particularly convenient, and can be easily carried with you to take with a low-fiber meal. Whether your choice is psyllium husks or wheat bran, be sure to drink plenty of water with each serving of fiber—at least 16 oz.

Cascara sagrada and Senna are two of the most effective, natural source laxatives available.
They work by stimulating peristalsis (the muscular movement of the intestines), rather than by having the “rotor-rooter” type of effect that fibers such as psyllium do. The active components of Cascara produce a soft or formed stool in about six to eight hours with little or no griping. They have practically no effect on the small intestine, but cause vigorous peristalsis in the large intestine. As a matter of fact, Cascara is so effective as a natural laxative, that it has been used as part of a method to cleanse the colon prior to roentgen examination and rectoscopy (medical procedures that take place in the bowel), as an effective alternative to cleansing enemas.4 Since Cascara is a stimulant laxative, however, it should only be used on a short-term basis to help reestablish normal bowel patterns. After a few weeks (or sooner), it should be discontinued—while continuing with the psyllium and/or wheat bran. The constituents of Senna have a cathartic (strong laxative) effect through stimulating peristalsis of the large intestine. They bring about their action in six to eight hours. They are absorbed in the small intestine to act on the nerves of the large intestine to stimulate motor propulsion in the colon. When used alone, Senna has a tendency to cause gripping. For this reason it is best used in combination with other herbs. Essential fatty acids Essential fatty acids (such as those found in Borage or Flax oils) are precursors for the production of local “short-term” hormones called prostaglandins. Some of these prostaglandins can be found in the gastrointestinal tract. Essential fatty acids may also play a role in relieving constipation since the prostaglandins they form may help to regulate movement in the bowels. Vitamin E Some folks still use the “old-time” remedy mineral oil to treat constipation. Although it is effective for this purpose, it can also result in reduced absorption of vitamin E. So, make sure to take vitamin E if you’re going to use mineral oil. Diet and/or other considerations.

At the risk of being overly redundant, I’ll say it again. A high fiber diet, rich in fruit, vegetables and whole grains will eliminate constipation (no pun intended) in 99.9% of the cases. Sufficient consumption of fluids is also important—the standard recommendation of eight glasses of water daily is appropriate.

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By Gene Bruno, MS, MHS – Dean of Academics, Huntington College of Health Sciences