Overview 

The term constipation refers to an inability to have a bowel movement, or producing stool that is hard, dry and difficult to pass. Constipation affects nearly everyone at one time or another and is usually temporary. It is also the most common gastrointestinal condition that affects people of all ages and backgrounds. 

It is a misconception that constipation can be identified according to the number (or the lack of) bowel movements a person produces. For instance, only three bowel movements per week is the norm for some people. For others, it is normal to pass stool as much as three times each day. However, hard, dry stool that is painful to pass is a symptom that should be addressed. Likewise, chronic constipation may be accompanied by other symptoms and should not be ignored. Abdominal pain and a constant feeling of fullness may be a signal of fecal impaction or blockage. In addition, constipation or a sudden change in bowel habits can occur with serious medical conditions, such as cancer.

Risk Factors 

A variety of factors can initiate a bout of constipation, such as a change in diet, stress, and certain medications. The following represent some of the most common risk factors. 

Medications.  Iron supplements, calcium channel blockers, antidepressants and some pain medications may promote constipation. 

Sedentary lifestyle.  Inactivity and lack of regular exercise may contribute to constipation. 

Disease.  In particular, the formation of tumors can lead to intestinal blockage. 

Diet.  A diet lacking in adequate fiber may promote constipation. However, contrary to popular belief, fluid intake is not connected with constipation.

Symptoms and Diagnosis 

Clinical constipation is indicated when at least two of the following symptoms are present for at least 12 weeks in the previous 12 months. In addition, the first five symptoms must be present at least 25% of the time while producing a bowel movement. 

Hard, lumpy or pebble-like stools.

A feeling of fullness or incomplete elimination.

A feeling of blockage.

Manual attempts to assist in elimination of stool.

Less than three bowl movements per week. 

Diagnosis 

In addition to an evaluation of symptoms, chronic constipation may be determined by measuring colonic transit time, or the amount of time necessary to eliminate. If further complications are suspected, the physician may use other diagnostic tools, including: 

Lower GI Series.  A series of x-rays of the large intestine, colon and rectum to look for abnormal growths made visible by a barium enema. 

Colonoscopy.  A lighted scope is inserted into the rectum to allow the physician to make a visual inspection of the colon lining. 

Electrolyte screening.  Levels of glucose, creatinine, calcium and potassium are checked. 

Thyroid screening. Hormone levels are measured to rule out a thyroid condition. 

Complications of Constipation 

As previously mentioned, chronic constipation may indicate another underlying medical condition. In addition, constipation may cause secondary problems, such as anal fissures or hemorrhoids. Other complications include: 

Loss of bladder control.  Repetitive straining to produce a bowel movement can weaken pelvic muscles and lead to a lack of bladder control. In addition, a full bowl compressing the bladder can contribute to unexpected urination or even urine blockage. 

Rectal prolapse.  This occurs when a portion of the intestinal lining gets pushed out of the rectum from repeated straining. Usually, a physician can correct this condition manually. However, if this portion of the intestinal lining resists manual manipulation then it is referred to as an incarcerated rectal prolapse, which can only be corrected by emergency surgery. 

Dietary Considerations 

An adequate amount of fiber in the diet is necessary for healthy intestinal tract functioning. The minimum recommended daily amount of fiber is 25 grams per day, yet most Americans only obtain an average of 10 grams per day from their diet. While most people tend to think of fiber as providing a ‘broom’ effect in the intestinal tract, this is only partially correct. For one thing, fiber cannot be digested in the human intestinal tract. However, certain beneficial bacteria that reside in the intestinal tract utilize fiber to manufacture short-chain fatty acids for energy production. In addition, fiber is either soluble or insoluble in water. Both forms contribute to forming and adding volume to stool. However, the latter promotes contraction of the colon to encourage elimination of stool. 

A diet rich in fruits, vegetables and grains can ensure adequate fiber intake. Soluble fiber is obtained from cereal, bread, oats, apples and some legumes. Insoluble fiber is obtained from whole grains and most fruits and vegetables. 

Recommended Supplements in the Treatment of Constipation 

In addition to increasing fiber in the diet, the following supplements can help to promote volume to stool mass and regular elimination. 

Probiotics 

Supplementation with probiotics, such as Lactobacillus acidophilus and Bifidobacterium bifidum, can help to balance the ratio of beneficial intestinal bacteria and promote healthy digestion. 

Prebiotics 

Supplementation with probiotics, or fructose oligosaccharides, can also promote healthy digestion. Fructose oligosaccharides provide sugars that are used by intestinal bacteria for fermentation to produce short chain fatty acids (SCFA’s), namely acetate, proprionate and butyric.  

Glucomannan 

Glucomannan is a plant-based starch derived from the konjac root (also known as devil's tongue), which is native to China and cultivated in Japan.  Glucomannan provides water-soluble fiber, in addition to mannose and glucose sugars. Glucomannan, or konjac starch, is available in pre-formed strips or squares with a texture similar to licorice and can be consumed by incorporating it into cooked foods. It is also available in supplement form. When added to the diet, this starch helps to add volume to stool and encourage natural elimination within 24 hours.

Chitosan 

Chitosan is obtained from chitin, a component found in the shell of crustaceans, such as shrimp and lobster. It acts as a fat inhibitor by binding to fats from food in the stomach, which helps to contribute to the formation of softer stools. 

Herbs Used in the Treatment of Constipation 

Peppermint

The presence of thymol and eugenol in peppermint oil help to balance intestinal flora and reduce spasms of the colon and intestinal tract. Peppermint oil is taken in supplement form as enteric-coated capsules since the coating prevents the release of the oil's therapeutic agents before reaching the colon.  

Cascara sagrada

Cascara’s action as a natural laxative is due to the presence of anthraquinone aglycons, which stimulate contractions of the large intestine. 

Senna 

Senna is a rich source of dietary fiber and the presence of dianthrone glycosides contribute to its laxative effects. In addition, these compounds help to reduce colon pH and increase butyrate production. 

Psyllium 

Psyllium, commonly known as ‘Colon Broom,’ also contains glycosides. Psyllium seeds expand up to 14 times their original size when introduced to water, translating to larger stool formation. 

Safety Precautions 

Fiber 

Be sure to take fiber supplements, including Cascara, Senna and Psyllium with plenty of water, or as otherwise instructed. 

Chitosan 

Avoid if you have an allergy to shellfish.