The frequency of defaecation and the consistency and volume of stools vary so greatly from individual to individual that it is difficult to determine what is normal. Familial, social and dietary customs have a major effect on bowel habits.
There are many causes of constipation, as shown in the following list:
- Dietary- highly refined and low-fibre foods and/or inadequate fluid intake
- Physical inactivity-inadequate exercise and/or prolonged bed rest
- Advanced age
- Drugs- antacids, iron salts, muscle relaxants, blood pressure medicines, beta-blockers, anti-depressants to name a few
- Metabolic abnormalities eg elevated blood sugar levels
- Endocrine abnormalities eg thyroid malfunction
- Structural abnormalities
- Bowel diseases eg irritable bowel syndrome
- Neurogenic abnormalities eg nerve disorders of the bowel.
In general, inappropriate diet, inadequate exercise and laxative/enema abuse are the most common causes, although more serious disease must always be borne in mind.
Proper elimination is very important as the bowel is a potential source of many toxins. For example, antigens and toxins from bowel bacteria have been found to be possibly related to the development of diabetes, meningitis, thyroid disease, ulcerative colitis and other diseases. Naturopathic physicians have long stressed the importance of proper bowel health.
Although a healthy bowel is important, the exact treatment goal is somewhat unclear since there is no generally agreed upon frequency of bowel movements. In general, most nutritionally-orientated physicians recommend two or three bowel movements per day, as is typically found in healthy people eating a high-fibre diet and getting adequate exercise. Some suggest that more frequent movements are appropriate since each time food is consumed, a peristaltic action is initiated which, in infants, will result in a bowel movement.
After the causes of constipation have been eliminated, the bowels need to be retrained to establish healthy habits. Here is a list of recommended rules for bowel regularity. The recommended procedure will take four to six weeks.
- Never repress an urge to defaecate.
- Eat a high fibre diet, particularly fruit and vegetables.
- Drink six to eight glasses of fluid each day
- Sit on the toilet at the same time each morning (even when the urge to defaecate is not present), preferably immediately after breakfast or exercise.
- Exercise at least twenty minutes, three times a week.
- Stop using laxatives and enemas except in the following way-
Week one: every night before bed take three herbal laxative tablets (determine the actual needed by the amount needed reliably to ensure a bowel movement every morning)
Weekly: each week decrease the dosage by half a tablet. If constipation recurs, go back to the previous week’s dosage. Decrease by one tablet if diarrhoea occurs.
When high fibre foods are being used to increase bulk, the typical recommendation is half a cup of bran cereal increasing to one and a half cups over several weeks. Corn bran is better than wheat bran, while oat bran is less irritating and a better absorber of fats. For best results, adequate amounts of fluids must be consumed. If bran alone is being used, a quarter to half a cup per day is the recommended dosage.
One study found that women with a folic acid deficiency presented with chronic constipation as well as the typical signs and symptoms of restless legs, depression, tiredness, depressed ankle jerks and impaired vibratory sensation. The symptoms all resolved with folic acid supplementation.
Basically most laxatives act through one of a number of defined mechanisms. Lubricants such as mineral oil are not recommended since not only do they not treat the cause of the disorder, but they also interfere with the absorption of fat soluble vitamins and deposits of mineral oil have been found in the lymph system of chronic users. Although most herbs are popularly considered always to be safe, excess dosages can cause toxic reactions. It is important to recognize that any agent which causes a physiological response can also cause a toxic response. Most of the herbal laxatives (eg. castor oil, cascara, aloe, senna and rhubarb) are active due to their anthraquinone content. Excessive dosages of any of these can cause purging, griping, collapse and blood in the stools.
Constipation is a common symptom, not a true disease. Treatment starts by first eliminating all known causes of constipation. A healthy high fibre diet should be instituted, and then bowel retraining begun. Laxative herbs are only to be used as part of the bowel retraining program. Bulking agents such as oat bran and psyllium seed husks can be very useful.
Constipation tends to be more pronounced during pregnancy, when its causes may include the pressure of the baby on the bowel, changed eating and drinking habits, or the side effects of some types of iron supplements. Some forms of iron supplements are gentler on the stomach than others. Pregnancy and breast feeding formulas seem to have a better balance of iron included.
Slippery elm and linseed are both sources of fibre which produce a jelly-like substance in the bowel, making stools easier to pass. They should always be taken with large amounts of water.
Probiotic supplements such as acidophilus and bifidobacter improve the balance of good bacteria in the bowel and help maintain regularity.
Bitter herbal tonics help to stimulate liver and gall bladder function, important for initiating bowel movements. Look for liquid formulas containing dandelion root, globe artichoke or gentian, combined with anti-spasmodic remedies such as peppermint, aniseed and cinnamon.
As we come in to winter, lots of cough and cold preparations can slow gut motility, resulting in harder motions and resultant discomfort. Increase fluid intake accordingly along with lots more vegetables at each meal.