Constipation is defined as having infrequent bowel movements, often fewer than three per week, and difficulty passing stools. Most people experience occasional constipation, but about 14% of adults suffer from chronic constipation. Many people turn to laxative medications, but these can lead to dependence and troubling side effects.
Natural interventions can be used to help relieve constipation including effervescent magnesium and vitamin C, fiber, and probiotics.
Causes and Risk Factors
- Impaired peristalsis (wave-like contractions of the gut)
- Blockages, neurological and hormonal conditions, and medications such as opioids
- Female gender (two to three times the risk of males) and advanced age (with greatest prevalence in those older than 70)
Diagnosis is based on bowel habits, symptoms, and medical history. Rome III, a set of criteria used to diagnose functional GI disorders, describes the diagnosis of chronic constipation as constipation for at least six months as well as specific symptoms for at least three months (eg, straining with at least 25% of bowel movements, details here).
- Adequate fluid and fiber are first-line treatments, and regular exercise is also an important intervention
- Laxatives (osmotic and stimulant), suppositories, and enemas
Note: Chronic use of stimulant laxatives may damage the neuromuscular system of the colon, worsening constipation and leading to dependence. They may also cause potentially dangerous electrolyte and fluid imbalances, especially when combined with diuretics.
Novel and Emerging Strategies
Fecal microbiota transplantation, which involves the transfer of colonic microorganisms from a healthy donor to a symptomatic person. Five case reports of patients with chronic constipation-predominant IBS treated with fecal microbiota transplant describe immediate remission in all five cases and stable improvement in follow-up.
- Biofeedback therapy, where patients learn to coordinate muscular activity, is a behavioral treatment that has demonstrated superiority to laxatives in several controlled clinical trials.
- Neurotrophin-3, a growth factor produced by the body, may be able to combat age-related neurodegeneration in the gut, which could help relieve constipation.
Dietary and Lifestyle Considerations
- A diet containing 25 g of fiber per day resulted in increased stool frequency and decreased laxative use
- Increasing fluid intake is an effective treatment for constipation, and appears to work best together with fiber
- Prunes, kiwifruit, olive and flaxseed oil have been found to improve bowel regularity
- Increasing physical activity has been shown to successfully improve chronic constipation
- Effervescent Magnesium and Vitamin C: Magnesium and vitamin C have both been shown to promote bowel evacuation. Taking magnesium and vitamin C simultaneously may stimulate a bowel movement.
- Fiber and Prebiotics: Soluble fiber supplements keep the stool soft and easy to move and function as a prebiotic, which helps establish and maintain beneficial bacteria in the gut. Psyllium, rich in soluble fiber, has been shown to relieve constipation. Other fiber supplements include inulin, partially hydrolyzed guar gum, and glucomannan.
- Probiotics: Probiotics containing Bifidobacterium lactis (B. lactis) may shorten intestinal transit time, and B. lactis and Lactobacillus casei may have positive effects in adults with chronic constipation.
- Cascara Sagrada: The bark of the buckthorn tree, known as cascara sagrada, has traditionally been used to treat constipation. Stimulant laxatives like cascara may cause diarrhea and electrolyte loss, and so are generally recommended for short-term use only.