Remedies for Constipation

The commercials call it “irregularity,” or “feeling sluggish,” or “out of sorts.” Euphemisms aside, if you feel constipated, you have plenty of company. From time to time, everyone has trouble going, and for more than 4 million Americans, constipation is a chronic problem. No wonder laxative sales approach $500 million a year.

On TV, “regularity” means one bowel movement a day. According to a recent survey of 42,000 adults, 83 percent do, indeed, go at least that often. The other 17 percent—some 45 million Americans—are targets for the laxative commercials. “But there’s nothing sacred about the daily bowel movement,” say pharmacists Joe and Teresa Graedon, co-authors of The People’s Pharmacy books. “Everyone is different. Anything in the range of three a day to three a week is perfectly normal.”

If you feel constipated, chances are you’re getting too little exercise, eating too little fiber, and not drinking enough fluids, says family practitioner Anne Simons, M.D. an assistant clinical professor of family and community medicine at the University of California’s San Francisco Medical Center. Exercise stimulates the natural wavelike contractions (peristalsis) along the lower colon that we recognize as “the urge.” Fiber adds bulk to the stool, which also helps stimulate peristalsis. Fluids spur digestion and help keep stools soft enough to pass comfortably.

However, says Alan Brauer, M.D., director of TotalCare Medical Center in Palo Alto, California, one of the nation’s oldest medical facilities to combine mainstream and complementary medicine, your constipation may have other causes:

• Travel. It alters your regular toilet rhythms, and diet and exercise habits. Travel by air is also dehydrating.

• Irritable bowel syndrome. This very common condition may cause either constipation or diarrhea.

• Drugs. Hundreds of popular medications are constipating.

• Pregnancy. The expanding uterus places pressure on the colon and decreases peristalsis.

• Iron supplements. They’re notorious constipators.

• Possibly serious medical problems. See the Red Flags.

• Aging. The older you get, the more likely you are to complain of constipation—and take laxatives. One reason is that colonic peristalsis loses some of its oomph in the elderly, Dr. Simons explains. In addition, many older people don’t get adequate exercise, and their sense of thirst loses some of its edge, so they drink less than they should. The survey mentioned earlier showed that while fewer than 4 percent of adults under 60 complain of chronic constipation, around 10 percent of those over 60 have the problem (and about 20 percent use a laxative at least once a month).

Another reason constipation increases with age is that as you grow older, your ability to produce stomach acid and pancreatic enzymes declines. The result, says naturopath Joseph Pizzorno, N.D., president of Bastyr University, the naturopathic medical school near Seattle, is less efficient digestion, and a tendency for things to get stuck in there.

But when the going gets tough, the tough can usually get going without resorting to laxatives.

Diet and Constipation

• Eat more fiber. “You don’t see much constipation in countries with high fiber diets,” says Marion Nestle, Ph.D., chair of nutrition and food studies at New York University. “You see it in countries like the U.S., where many people eat a low-fiber diet.” Dr. Nestle recommends eating fruits, vegetables, beans, and/or whole grain products at every meal and for snacks. Wheat bran, the leading constipation preventive, is available in dozens of cereals (All-Bran, Bran Buds, Bran Flakes, etc.). Popcorn makes a satisfying snack that helps get things moving. Enjoy bean soups or burritos, or snack on low-fat chips with bean dip. Prunes, raisins, broccoli, beans, peanuts, carrots, broccoli, figs, and dried apricots also contain generous helpings of fiber. “I’m a firm believer in a high-fiber diet to both prevent and treat constipation,” says Maryland botanist/herbalist James Duke, Ph.D., author of The Green Pharmacy. “Peanuts, prunes, and raisins are tasty and very portable. Munch them throughout the day.”

• Banish the binders. Some foods are constipating (“binding”), Dr. Simons says. Limit your consumption of bananas, cheeses, white rice, applesauce, and white flour products.

• Drink up! Drink plenty of nonalcoholic liquids, the Graedons advise. Liquids are natural stool softeners. Soft stools pass more easily than hard ones. A good drink to get things moving, Dr. Simons says, is coffee. Its caffeine stimulates not only wakefulness, but the colon as well. Tea, cocoa, and colas also contain enough caffeine to help, but chocolate probably does not.

Lifestyle Changes

• Make it a habit. In addition to diet problems, Dr. Pizzorno, says constipation often results from bad toilet habits. He recommends retraining yourself:

• Eat at regular hours without rushing so that coordinated bowel activity after eating becomes part of your body’s daily routine.

• Never ignore the urge.

• Establish a regular toilet time, preferably shortly after breakfast or exercise.

• Sit, but don’t strain. Straining contributes to hemorrhoids.

• The squatting solution. While sitting on the toilet, try placing your feet on a small footstool, Dr. Simons suggests. “It puts you in more of a squatting position, which helps some people go.”

Home Remedies for Constipation

• Freedom with fructose. More than 800 years ago, the Egyptian physician/rabbi Maimonides prescribed “honey mixed with warm water” every morning for three or four days to treat constipation. Honey in water became a popular folk remedy in Greece. Recently, Greek researchers demonstrated its value. They gave volunteers mixtures of different sugars in water. The more fructose, the sugar in honey, the more likely they were to report a bowel movement within 10 hours.

• Oil the machinery. Around the Mediterranean, another age-old home remedy for constipation is a tablespoon of olive oil every few hours. Vegetable oils are lubricants, Dr. Simons explains. They coat your stool, promoting easier passage.

Exercise

• Exercise daily. No need to run a marathon, Dr. Pizzorno says. A brisk walk for a half-hour a day usually does the trick.

Supplements for Constipation

• Take “C” for constipation. “High doses of vitamin C cause loose stools,” Dr. Brauer says. “That’s a problem for people prone to diarrhea. But it can help those who are constipated.” Dr. Brauer recommends 1,000 mg of vitamin C every two waking hours.

• Iron out the problem. If your multivitamin contains iron, the most constipating mineral, try one without it.

• Supplement your stomach. Naturopaths often recommend treating constipation, especially in the elderly, with supplemental stomach acid and digestive enzymes. Dr. Pizzorno suggests trying bromelain, the digestive enzyme found in pineapple (250 to 500 mg with meals); or papain, the enzyme in papaya (500 to 1,000 mg with meals); or pancreatin, an enzyme secreted by the pancreas (2 to 4 tablets of 4X, or 1 to 2 of 8X). Bromelain, papain, and pancreatin are available at most health food stores.

So is hydrochloric acid, though it’s sold in a modified form, hydrocholoride or betaine hydrochloride. Dr. Pizzorno suggests taking 10-grains at your next large meal, and adding another 10 grains per large meal after that until you’re taking 70 grains with large meals, or until you feel an unusual warmth in your abdomen. Warmth means you’re taking too much, and should cut back to five or six capsules. Maintain the dose you can tolerate at large meals, and take less at smaller meals. Take them throughout your meals. If the warm feeling returns, it means that your stomach is producing more acid on its own, and you can cut back further on your supplement. “I’ve had good success treating indigestion with supplemental stomach acid and digestive enzymes,” Dr. Gaby says.

• Fix it with folate. In one study, blood tests showed that women with constipation, fatigue, depression, and restless legs at night were deficient in folic acid, also called folate. A supplement relieved all their symptoms. Nutritional medicine expert Melvyn Werbach, M.D., an assistant clinical professor at the UCLA School of Medicine, suggests taking up to 60 mg a day.

• Give yourself a pantothenic push. A few studies suggest that pantothenic acid supplements may help treat constipation. Dr. Werbach suggests 250 mg a day.

Biofeedback

• Mind over waste matter. Researchers at the University of Amsterdam in the Netherlands recruited 29 children suffering from chronic constipation because they could not relax their anal sphincters. After an average of five biofeedback training sessions using a balloon-like anal probe to measure sphincter pressure, 90 percent learned sphincter relaxation and considered their problem cured. At the Cleveland Clinic Foundation, Steven Wexner, M.D., chief of colorectal surgery, says this type of biofeedback often eliminates the need for anal sphincter surgery.

Herbal Medicine

• Psyllium salvation. The best herbal treatment for constipation is psyllium seed, Dr. Duke says. It’s a bulk-former, the most natural approach to getting things moving. Psyllium seed contains a soluble fiber, mucilage, that expands a great deal in water. In the digestive tract, psyllium increases stool bulk. Bulkier stools press on the colon wall and stimulate peristalsis. Psyllium usually works in 12 to 72 hours. A convenient way to take it is by using one of the many commercial laxatives that contain it (Metamucil, Correctol, Fiberall, Naturacil, etc.). However, Dr. Duke cautions, psyllium does not work by itself. It must be taken with lots of water. (Psyllium has also been shown to help reduce cholesterol levels..

Homeopathy

• An extra little push. “Homeopathic medicines can give an extra little push to diet and lifestyle changes,” says Berkeley, California, homeopath Dana Ullman, M.P.H., author of The Consumer’s Guide to Homeopathy. He recommends Bryonia (wild hops), as a stool softener, Calcarea carb (carbonate of lime), for those who feel no urge, and Nux vomica (poison nut tree seed), for those who feel constant urges but can’t pass anything.

Chinese Medicine

• Stick to spicy stimulators. In Chinese medicine, constipation represents an imbalance in the Large Intestine and Lung organ systems, typically too much Dryness, brought on by overeating or an over-accumulation of food in the body, according to San Francisco Chinese physician Efrem Korngold, L.Ac. O.M.D., co-author (with Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine. Chinese physicians often prescribe warming or spicy herbs and foods, which help stimulate colonic peristalsis, for example: ginger, cinnamon, radishes, orange peel, citrus fruits, hot peppers, and the laxative, rhubarb.

In addition, for mild constipation, Chinese doctors often prescribe Curing Pills, a combination of 15 herbs, including: atractylodes, poria fungus, and medicated leven, a combination of fermented barley, wheat, and rice sprouts that’s rich in the kind of digestion-enhancing bacteria found in yogurt.

• Action with acupuncture. Chinese doctors also treat constipation with acupuncture. Make an appointment if you like, or try do-it-yourself acupuressure. Michael Reed Gach, director of the Acupressure Institute of America in Berkeley, California, suggests steady, penetrating finger pressure for about three minutes on the following points:

• Large Intestine (LI) 11. On the outside of your arm, in the hollow formed between the end of your elbow crease and your elbow when you hold your arm at a right angle.

• LI 4. At the highest spot of the muscle on the back of your hand, when you bring your thumb and index finger together.

• Conception Vessel 6. Three finger widths below your belly button.

• Stomach 36. Four finger widths below your kneecap and one finger width outside your shinbone.

Ayurvedic Medicine

• Seconding the motion. Ayurvedic physicians recommend different treatments for people with each of the three different constitutional types—Vata, Pitta, and Kapha—explains John Douillard, D.C., of the Invincible Life Spa, in Boulder, Colorado. But several of them echo the approaches of other healing arts: fiber, fluids, prunes, raisins, psyllium, and honey water.

• Plants that push. Ayurvedic medicine also endorses several herbal laxatives: senna, rhubarb, aloe, and cascara sagrada. These herbs all work. They’re ingredients in many OTC laxatives (see “And Finally…” section below). But they are also potent chemical stimulants that must be used carefully; otherwise, Dr. Pizzorno explains, they may cause cramping, diarrhea, other abdominal distress, and bloody stools.

OTC’s

• Pass, go. If you don’t get relief from any of the above within a few days, three over-the-counter approaches are gentle and safe, when used as directed—lubricants, saline laxatives, and stool softeners.

Lubricants contain mineral oil, a petroleum product. Like olive oil, they coat your stool to promote easier passage. You should experience relief in six to eight hours. But don’t use mineral oil routinely, the American Pharmaceutical Association (APA) cautions. Over time, it depletes the body of fat-soluble vitamins (A, D, E, and K). In addition, if you take other medications, mineral oil may interfere with their absorption. Wait at least two hours after taking mineral oil to take other medications, and vice versa.

Saline laxatives change the salt balance in the digestive tact, the Graedons explain. They draw water into your stool, which adds bulk and stimulates peristalsis. Milk of magnesia is the best-known saline laxative. It usually works in one to six hours. The recommended dose depends on your age. Read the package directions. Milk of magnesia should not be used for extended periods, according to the APA, because large doses of magnesium may cause muscle weakness, and a potentially serious drop in blood pressure.

Stool softeners work by pulling more water into stool, which softens it, making it easier to pass. Three stool-softening agents are available: docusate sodium (Colace, Regutol, etc.) docusate calcium (Surfak Liquigels, DC Softgels, etc.) and docusate potassium (Dialose, Diocto-K, etc.). They usually produce results within 12 to 72 hours. Follow package directions. For best results, Dr. Simons says, drink plenty of nonalcoholic liquids with these products. Stool softeners should not be used for more than one week without consulting your physician, the APA warns. Do not use a stool softener if you are also taking mineral oil or any prescription drug.

And Finally…

Chemical stimulants, which work in six to 12 hours, are the most potent laxatives—and the most potentially toxic. “They’re last resorts,” Dr. Duke says. “They can be unpleasantly powerful, and may cause cramping and bloody diarrhea. And if you use them for long periods, you can become dependent on them.”

The gentlest stimulant laxatives contain the medicinal herb, cascara sagrada (Stimulax, Comfolax). More potentially cathartic ones contain bisacodyl (Dulcolax), or extracts of other medicinal herbs: aloe vera (Nature’s Remedy), buckthorn (Herbal Laxative Tablets), or senna (Ex-Lax, Gentlax, Senolax, Fletcher’s Castoria).

In addition to their possible side effects, overuse of chemical-stimulant laxatives can actually cause a form of constipation known as “lazy bowel syndrome,” Dr. Simons says. Peristalsis ceases without chemical stimulation. Lazy bowel syndrome is one reason why physicians discourage using stimulant laxatives more than once or twice a month.

Finally, some people use enemas to treat constipation. Enemas irrigate the bowel and act as lubricants and stimulants. But frequent enemas can damage your colon and cause electrolyte imbalances. As a result, the APA discourages them as a treatment for constipation.

Red Flags

Most constipation is simply annoying. But it may also be a symptom of many potentially serious illnesses: diabetes, thyroid problems, uterine fibroids, or uterine, intestinal, or colorectal cancer. If your constipation does not clear up after a week of combining the diet, exercise and other approaches discussed in this Chapter, consult your physician.