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Constipation, either acute or chronic, can be described as difficult, infrequent, or incomplete bowel movements. The stool tends to be small and/or hard. Bowel movements should, under normal circumstances, occur at least daily.
Do not ignore the urge to defecate. Doing so can reduce the reflex and cause constipation to worsen. The delayed bowel movement becomes more difficult to pass and the unpleasant experience starts a negative feedback cycle.
Incidence; Causes & Development
Chronic constipation is more common in women.
Acute constipation generally results from a change in diet and/or lifestyle, significant stress, drug side-effects, or some organic cause.
Chronic constipation is usually due to diet, colon health problems, insufficient dietary fiber and roughage, a sedentary lifestyle, ignoring defecation urges, or frequent traveling. Chronic constipation is also associated with some disease conditions such as hypothyroidism, dehydration and nerve injury. Psychogenic constipation is described as an obsessive-compulsive fixation on frequency and quality of bowel movements.
Diagnosis & Tests
Check your transit time by consuming charcoal or beets. It should take from 18 to 24 hours to see evidence in the toilet (black or red). Longer times may result in bowel toxicity symptoms and increase the burden on your liver. If constipation does not improve using the above methods then professional help may be needed.
Treatment & Prevention
Saline oral preparations and enemas, Epsom salts, or magnesium citrate preparations can be safely used if necessary for acute constipation.
The use of laxatives should be avoided unless the problem cannot be dealt with otherwise.
General rules for treating constipation
Before using laxatives, try first to remove any underlying cause. Make sure you are:- Getting regular aerobic exercise
- Having or trying to have your movement at the same time each day
- Drinking enough water. Increase water consumption to 8 glasses per day
- Avoiding refined foods that have had fiber taken out of them (white flour, white rice, peeled vegetables, etc.)
- Increase fiber (both water-soluble and non-water-soluble types) in the diet with more fruits and vegetables. If too difficult for now, try supplementing natural fibers such as flax, psyllium, pectin or guar gum. These possess a mild laxative action due to their ability to attract water and form a gelatinous mass.
- Consider the possibility of food allergies, especially milk, when you see diarrhea, alternating constipation and diarrhea, anal fissures, or other general allergy signs. A recent study found that 10 of the 86 patients allergic to milk showed "very delayed reactions" to a cow's milk challenge averaging over 13 days (range 4-26 days). These "very delayed" reactions included constipation, wheezing, and dermatitis.
Stimulant laxatives act on the large intestine by increasing peristalsis. The most common stimulant laxatives are derived from either Cascara sagrada or senna. Both plants have long been used as laxatives and although extremely effective in promoting bowel movements, the use of stimulant laxatives should be avoided.
Dietary fibre is the treatment of choice for constipation. However the side-effects of a high-fibre diet (including bloating, flatulence and irregular bowel movements) may reduce patient compliance. Fibre intake is generally lower in the northern countries than in the countries of southern Europe.
Since low fluid intake also plays an important role in constipation, the patient should drink at least 1.5 litres of fluid a day, with increased intake in the summer.
Regular bowel movement and physical exercise are important. In case of limited mobility, simply maintaining an upright position may be helpful.
Application of Vaseline to the anal region before defecation is a useful measure to reduce the pain and irritation caused by passage of the dry hard feces.
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Signs, symptoms & indicators of Constipation:
Conditions that suggest Constipation: | | | | | Autoimmune |  Ulcerative Colitis | Dr. Batmanghelidj, MD in his book Your Body's Many Cries For Water says that the left lower quadrant pain of colitis is sometimes a signal of localized thirst and associated with constipation. |
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Circulation |
 Varicose Veins |
Digestion |
Hemorrhoids| | The hemorrhoidal plexuses drain through veins without valves, so factors that increase the pressure inside these veins - such as straining while on the toilet - can lead to hemorrhoids. |
Diverticular Disease |
Infections |
Yeast / Candida Infection |
Organ Health |
Enlarged Prostate| | Chronic constipation has been implicated as a contributing factor to prostatic discomfort when there is an already enlarged gland. A correction of the constipation will bring some relief of symptoms since the rectum puts pressure on the prostate gland when it is enlarged. In addition, there is a buildup of waste products in the circulation with chronic constipation. This will indirectly have an effect on the function of the prostate. |
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Skin-Hair-Nails |
Adult Acne| | Bowel toxins from poor digestion or a prolonged transit time may contribute to acne. |
Adolescent Acne| | Bowel toxins from poor digestion or a prolonged transit time may contribute to acne. |
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Risk factors for Constipation: | | | | | Allergy | Allergy to Foods (Hidden)
Environmental Illness / MCS |
Diet |
 Effects of a Low Carbohydrate Diet| | Authorities recommend that Americans get "at least 30-35 grams" [Gastroenterology 118 (2000): p.1233] of fiber each day "from foods, not from supplements." [Circulation. 102 (2000): p.2284] The initial phase of Atkins’ diet, which dieters may have to repeatedly return to, has about 2gm of fiber per day. [Atkins, RC. Dr. Atkins New Diet Revolution. Avon Books, 1999]
The May 2004 Annals of Internal Medicine study showed once again that most of the Atkins Dieters are constipated and headachy. |
Inadequate Fiber Intake |
Digestion |
Increased Intestinal Permeability / Leaky Gut
Dyspepsia / Poor Digestion
IBS (Irritable Bowel Syndrome) |
Environment / Toxicity |
Mercury Toxicity (Amalgam Illness)
Fluoride Toxicity |
Hormones |
Hypothyroidism
Hyperparathyroidism |
Mental |
Stress| | In a study of 34 women with chronic constipation, investigators led by Dr. Anton Emmanuel and colleagues at St. Mark's Hospital in Middlesex linked emotional distress with changes in the nerve pathway that helps control gut function. They say the findings suggest a specific path through which psychological factors directly influence the digestive system.
The researchers compared the patients, who had suffered bouts of constipation for an average of 21 years, with a group of women with no history of gastrointestinal illness. All took standard tests that measure psychological symptoms such as anxiety and depression, self-image, social functioning and ability to form intimate relationships.
Women with chronic constipation were more likely than healthy women to report anxiety, depression and feeling less "feminine". They also found it harder to form close relationships. [Gut Aug 2001;49: pp.209-213] |
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Metabolic |
Anorexia / Starvation Tendency |
Nervous System |
Guillain-Barre Syndrome| | Constipation is often a problem, due to the reduced activity of the intestines, change of diet, weakened stomach muscles that resist efforts by the patient to express the intestinal content. |
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Tumors, Benign |
Fibroids| | Mural fibroids (located in the uterine wall) and subserous fibroids (protrude outside the uterine wall) may reach a large size before causing symptoms. These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back and abdominal pain, as well as heavy bleeding. |
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Constipation suggests the following may be present: | | | | | Diet | Effects of a Low Carbohydrate Diet| | Authorities recommend that Americans get "at least 30-35 grams" [Gastroenterology 118 (2000): p.1233] of fiber each day "from foods, not from supplements." [Circulation. 102 (2000): p.2284] The initial phase of Atkins’ diet, which dieters may have to repeatedly return to, has about 2gm of fiber per day. [Atkins, RC. Dr. Atkins New Diet Revolution. Avon Books, 1999]
The May 2004 Annals of Internal Medicine study showed once again that most of the Atkins Dieters are constipated and headachy. |
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Constipation can lead to: | | | | | Circulation | Varicose Veins |
Digestion |
Hemorrhoids| | The hemorrhoidal plexuses drain through veins without valves, so factors that increase the pressure inside these veins - such as straining while on the toilet - can lead to hemorrhoids. |
Diverticular Disease |
Environment / Toxicity |
General Detoxification Requirement |
Organ Health |
Enlarged Prostate| | Chronic constipation has been implicated as a contributing factor to prostatic discomfort when there is an already enlarged gland. A correction of the constipation will bring some relief of symptoms since the rectum puts pressure on the prostate gland when it is enlarged. In addition, there is a buildup of waste products in the circulation with chronic constipation. This will indirectly have an effect on the function of the prostate. |
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Recommendations and treatments for Constipation: | | | | | Botanical |  Chlorella
 Picrorhiza| | Picrorhiza is used in India for people with constipation due to insufficient digestive secretions. [Nadkarni KM, Nadkarni AK. Indian Materia Medica. Bombay, Popular Prakashan, 1976, pp.953–5] |
Bladderwrack| | Bladderwrack has historically been used as a bulk-forming laxative. |
Cascara Sagrada| | Parke-Davis recognized its use as an herbal laxative, and marketed it as such as early as 1877. It is still one of the best herbal laxatives available today (along with Cape Aloes and Senna), because it is both quick and mild.
The US FDA in February of 2002 issued a final ruling that aloe and Cascara sagrada will not be included in the final monograph for over-the-counter (OTC) laxative drug products because they have not been shown to be generally safe and effective as stimulant laxatives. According to the ruling, aloe extract, aloe flower extract, cascara fluid extract aromatic, Cascara sagrada extract, casanthranol, Cascara sagrada bark and Cascara sagrada fluid extract will no longer be allowed in OTC laxative drug products and are not GRAS (Generally Recognized As Safe).
Cascara Sagrada bark is "Approved" by the German Commission E for constipation. |
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Detoxification |
Supplemental Fiber| | Psyllium is a popular fiber supplement which cleanses the intestines and promotes softer stools. It is a good source of both soluble and insoluble fiber. |
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Diet |
 High/Increased Fiber Diet| | A diet with enough fiber (20 to 35gm each day either from food or supplements) helps form a soft, bulky stool. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, Brussels sprouts, cabbage and carrots. For people prone to constipation, limiting foods that have little or no fiber such as ice cream, cheese, meat, and processed foods is also important. |
Plant-Based Nutrition| | A vegetarian diet is generally higher in fiber than non-vegetarian diets. Constipation amongst those on vegan and raw-food diets is extremely rare. |
Increased Water Consumption| | Drinking water adds fluid to the colon and bulk to stools, making bowel movements softer and easier to pass. People who have problems with constipation should drink enough water every day, at least eight 8-ounce glasses depending on weight. Other liquids such as coffee and soft drinks contain caffeine and seem to have a dehydrating effect. |
Soy Isoflavones (genistein, daidzein)| | Amongst 65 children aged 11 to 72 months with chronic constipation, 68% had a positive response with regard to bowel movements while receiving soy milk. |
Dairy Products Avoidance| | A double-blind trial found that chronic constipation among infants and problems associated with it were triggered by intolerance to cows’ milk in two-thirds of the infants studied. Symptoms disappeared in most infants when cows’ milk was removed from their diet. [N Engl J Med 1998;339: pp,1100-4]
Dairy products are also devoid of fiber which is important in maintaining normal bowel movements. |
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Habits |
Aerobic Exercise| | Lack of exercise can lead to constipation, although doctors do not know precisely why. |
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Lab Tests/Rule-Outs |
Test for Food Allergies| | Constipation triggered by food allergies might be responsible for chronic constipation in some adults. Individual foods, such as milk and milk-containing products, may be at fault in some individuals. |
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Mineral |
Magnesium| | When given orally in sufficient quantities, magnesium citrate or sulfate (Epsom salts) is not fully absorbed but attracts water into the colon and thus acts as an effective laxative. |
MSM (Methyl Sulfonyl Methane)| | Some patients with chronic constipation have experienced continuing relief with a daily supplement of 100-500mg of MSM. The effect appears particularly strong in those who are older. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link |  | | Strongly counter-indicative |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acne
A chronic skin disorder due to inflammation of hair follicles and sebaceous glands (secretion glands in the skin).
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Aerobic (Aerobically)
Using oxygen. For example, aerobic exercises such as running, swimming, bicycling or playing tennis use up lots of oxygen and burn up lots of calories and fat.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Candidiasis (Candida)
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge. Candidiasis is also known as: Candida; Candida albicans; Candida Related Complex; Chronic Candida Syndrome; (Chronic) Systemic Candidiasis; Monilia; Candidiasis Hypersensitivity Syndrome; Candidosis; (Chronic) Mucocutaneous Candidosis; Thrush (oral or vaginal); Moniliasis; Polysystematic Candidiasis.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Colitis
Colon inflammation, usually involving the mucus membranes. Mucus colitis is a type with cramps, periods of constipation, and copious discharge of mucus with feces. Ulcerative colitis has pain, inflammation, ulceration, fever, and bleeding, all interspersed at various times - a long and serious illness.
Colon (Colonic)
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Commission E
The body of scientists and panel of experts that provides advice on herbal treatments and evaluates the safety, effectiveness and dosage of medicinal herbs; Germany's equivalent of the FDA.
Constipation (Constipated)
Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.
Dermatitis
A general term used to refer to eruptions or rashes on the skin.
Diarrhea
Excessive discharge of contents of bowel.
Dietary Fiber (Insoluble Fiber, Insoluble Fibers, Soluble Fiber, Soluble Fibers)
There are two types of dietary fiber - soluble and insoluble. Insoluble fiber acts like a sponge; it absorbs water and moves solid waste out of the intestines. It is found mainly in whole grains and on the outside of seeds, fruits, and legumes. Soluble fiber is found in fruits, vegetables, seeds, brown rice, barley, oats and oat bran. It forms a gel when mixed with liquid producing a softer stool. It also prevents and reduces the absorption of certain substances from the intestines into the bloodstream.
FDA
The (American) Food and Drug Administration. It is the official government agency that is responsible for ensuring that what we put into our bodies - particularly food and drugs - is safe and effective.
Flatulence
Abnormal amount of gas in the stomach and intestines.
Flax (Flax Oil, Flax Seed)
Flax Seed or Flax Oil. Flax oil is nutty-flavored oil that is pressed out of flax seeds and is one of the richest sources of Essential Fatty Acids (EFAs), a vital element for good health. The oil making process removes many of the seed's phytoestrogens which offer several health-related benefits including reducing the risk of cancer and alleviating menopausal symptoms. Many choose to use the whole seed because of its fiber and lignan content. Flaxseed oil is light- and temperature-sensitive and must be stored in the refrigerator.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Hemorrhoids
Varicose disorder causing painful swellings at the anus; piles.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Laxative (Laxatives)
A substance (food, herb, chemical) that stimulates evacuation of the bowels. Examples include cascara sagrada, senna, castor oil, aloe vera, bisacodyl, phenolphthalein and many others.
Leiomyomas (Fibroids, Fibromyoma, Leiomyoma, Myofibroma)
Benign tumors of the involuntary muscle. An encapsulated tumor made up of disorganized and irregular connective tissue. The most common of these is the "fibroid" tumor that develops in many women. It is really a leiomyoma of the uterus.
Liter (Liters, Litre, Litres)
A metric measure of volume equivalent to 1.057 liquid quarts or 0.2642 gallons.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Obsessive-Compulsive Disorder (Obsessive Compulsive, Obsessive-Compulsive, OCD)
Those suffering from OCD have obsessions and/or compulsions. Obsessions refer to recurrent and persistent thoughts, impulses, or images that are intrusive and cause severe anxiety or distress. Compulsions refer to repetitive behaviors and rituals (such as hand washing, hoarding, ordering, checking) or mental acts (like counting, repeating words silently, avoiding). These obsessions and compulsions significantly interfere with normal routine, functioning, social activities and relationships.
Ounce (Ounces, oz)
Approximately 28 grams.
Over-The-Counter (OTC, Over The Counter)
A drug or medication that can legally be bought without a doctor's prescription being required.
Peristalsis
Movement characterized by alternate circular contraction and relaxation of the intestine or other tubular structure which propels the contents onward.
Prostate
The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.
Psychogenic
Of a psychological origin.
Stimulant Laxative (Stimulant Laxatives)
Stimulant laxatives are believed to stimulate nerve endings in the nerve plexuses of the bowel wall, increasing the movement of its content via several mechanisms. The most common active ingredients include the Anthraquinones (Senna, Aloin, Frangula, Cascara and Powdered rhubarb) and the Diphenylmethane derivatives (Bisacodyl, Sodium picosulfate, Phenolphthalein). Traditionally-used castor oil has fallen into disuse because of its 'drastic' action and unpleasant taste.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Varicose Veins
Twisted, widened veins with incompetent valves.
Vegan (Veganism, Vegans)
A person who consumes no animal products of any kind. In other words, vegans do not consume meat, fish, fowl, dairy products, eggs, honey, or products containing gelatin or any other animal-derived ingredients such as whey powder or food colorings.
Vegetarian (Lacto-Ovo-Vegetarian, Vegetarianism, Vegetarians)
A person who consumes no meat, fish or fowl (chicken, turkey, etc.), but who may consume animal products such as dairy products (milk, cheese, butter, etc.), eggs or honey.
Last updated: Apr 13, 2008
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