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Constipation is usually a symptom of some other health issue, finding the root of the problem may be the most effective cure

Constipation – that problem we don’t like to talk about

It’s the health problem that most of us don’t like to mention.

And yet at some time in our lives, all of us have suffered from constipation – where we either are unable to have a bowel movement or to empty our bowels fully.

Constipation is usually a symptom of some other health issue. A low-fibre diet, for instance, combined with lack of exercise and often coupled with a sluggish lifestyle or personality, can lead to con­stipation.

Constipation may also be made worse by not drinking enough fluids and by low fibre slimming diets. It can also be a side-effect of certain medicines, such as painkillers (particularly those with codeine, such as co-codamol, or very strong painkillers, such as morphine), some antacids, some antidepressants (including amitriptyline) and iron tablets, but there are many others.

Cyclical hormonal changes can mean that women are more prone to constipation during certain points in their menstrual cycle (often around the midpoint) and also during pregnancy and menopause. It may also be related to an underlying medical condition, such as an under-active thyroid, irritable bowel syndrome, some gut disorders and food allergies, though in many cases, the cause is not clear.

Having said all this, a normal bowel movement is whatever is normal for you, and you should take some time to observe your normal pattern before diagnosing constipation.

Fibre

While fibre is important in the diet not all fibres are the same and randomly adding fibre to your diet is not necessarily the answer. For example, since wheat bran can’t be digested and acts as an irritant. There is evidence that it may actually increase the pain and urgency to defecate especially in those with IBS.

When considering an increase in fibre choose soluble fibre such as psyllium rather than wheat bran. Insoluble fibre acts by encouraging water retention in the stool, while soluble fibre like wheat bran acts as a bulking agent. Psyllium, in addition has a lubricating effect on the gut.

A recent analysis reports that there is more supportive evidence for soluble than for insoluble fibre in treating chronic constipation and psyllium has been shown to be as effective as conventional treatments.

And don’t rule out that old stalwart prunes (or dried plums as they are now being called). One randomised trial recently showed that prunes were more effective than psyllium in patients with mild to moderate constipation. This effect was put down to their fibre as well as their sorbitol content.

Fibre supplements are, like laxatives, a short term solution that can help as a quick fix. An improved diet, however, is the more permanent solution.

Having said this, it’s extraordinary that there are actually no studies into the effectiveness of consuming a high-fibre diet rich in fruits and vegetables. Even so logic dictates that over the long-term improving your diet in this way is a better way to ‘get more fibre’ and relieve constipation.

Try adding more mucilaginous seeds (which help lubricate the gut) such as linseeds or chia to your diet or adding ‘green food’ powders rich in nutrients and soluble fibre (seaweeds are a great example) to you soups and salads. Greater variety in your diet will likely improve your fibre as well as your nutrient intake.

Any increase in any type of fibre will have other uncomfortable effects including flatulence and bloating.

Laxatives

All laxatives will work initially – though many can cause diarrhoea, which is just as uncomfortable as constipation. Prolonged use of laxatives can produce the very problem they claim to cure. While it’s true they open the bowels, they also cause a kind of sling-shot reaction that tightens them again.

Herbal laxatives – for instance those containing senna, aloe, yellow dock, alder, buckthorn, rhubarb root or Cascara sagrada – are not much better than conventional ones. They work by irritating the bowel, and can only be used for short-term relief.

A combination of psyllium and senna may be the most effective short term fix as has a combination of psyllium, aloe and celandine.

Herbs

Aloe vera is considered a powerful stimulant laxative because it stimulates bowel muscle contractions, as such it can be used to bring short term relief. The laytex of the plant, which is contained in the fresh juice, has a powerful effect but there is evidence that when used regularly the body develops a tolerance to it that means you must take more and more to get the same effect. For constipation, try a single 50–200 mg capsule of aloe latex, or 75-100ml (2-3 oz) of the juice taken each day for a maximum of ten days. Like all powerful laxatives aloe should be used with caution.

There are other herbs that may be supportive. Chamomile, valerian and wild yam will help reduce tension. Fennel seed stimulates proper digestion; barberry aids the liver and gallbladder; and rhubarb root exerts a generally normalising effect on the bowels.

Homoeopathy

Constipation is usually part of a large picture of health problems. A consultation with a homeopath can help find a remedy that fits. If you wish to try self-treatment general guidelines are: if constipation is caused by chronic use of laxatives, use Nux vomica. For large dry stools, Bryonia. If in difficulty passing even soft stools, Alumina; or if only passing stools at two-day intervals or longer, and when they are hard and crumbly, Nat mur. For incomplete evacuation of stools, Sulphur; difficulty expelling stools, Silicea; excessive wind and incomplete evacuation, Lycopodium; jabbing sensation in the rectum, Aesculus; and grip­ping, colicky pain, Graphites. Try a 6C potency or for acute symptoms 30C. Remember to stop taking the remedies when you sense improvement.

Try also

Hypnosis has been shown to be useful for all symptoms of IBS, including constipation.