What is Constipation?

Constipation is defined as a reduced frequency of defaecation relative to what is normal for the individual, accompanied with the production of hardened stools. A normal bowl may vary from 2-3 times daily to once every 2-3 days, therefore, you must first establish what is normal for you.

What Causes Constipation?

Constipation is usually caused by the insufficient intake of fibre and fluids. It is though occasionally caused by certain drugs or supplements such as iron tablets, antidepressants, and some painkillers. Constipation is also common during pregnancy.

Constipation can be divided in to simple (or primary) constipation and secondary constipation.

Simple constipation is usually caused by:

• Poor nutrition lacking in nutrients, such as fibre.
• Reduced fluid intake (leading to dehydration).
• Changes in lifestyle.
• Ignoring the urge to defaecate (especially in children and the elderly).
• Reduced bowel muscle tone (leading to faecal stasis).

Secondary constipation can be caused by:

• Iatrogenic (caused by medicines such as, iron, aluminium containing antacids, antihistamines, cough suppressants, antidepressants, opioid painkillers, etc.).
• Pregnancy/lactation.
• Anxiety/depression.
• Disruption of normal daily routine.
• Disease.

In the case of secondary constipation you would usually need to visit your doctor in order to treat the underlying cause.

Natural Treatment for Simple Constipation

The treatment for simple constipation includes the following:

1. Increase intake of fruits and vegetables

All fruits and vegetables contain fibre which helps to prevent constipation. Fruits and vegetables with edible peels, such as apples, pears, dates, sweet potatoes, and legumes, contain much more fibre when the peel is consumed.

Prunes, which are dried plums, are used as a home remedy for treating constipation due to their high fibre content (100g of prunes contain 7g of fibre). Prunes also contain a phenolic compound which stimulates the intestines to contract (peristalsis) that makes you want to go. In addition, prunes contain sorbitol which softens the stools. Another great dried fruit choice is figs, which does not usually cause as much bloating as prunes.

Raisins are also effective for relieving constipation as they have a high fibre content and also contain tartaric acid, which has a laxative effect. Cherries and apricots are also rich in fibre and can help overcome constipation.

2. Increase the intake of dietary fibre

Fibre is very effective in removing food and waste particles from the digestive tract. It expands as it soaks up water thus increasing the stool bulk which in turn stimulates peristalsis. In general, with a high-fibre diet the body excretes waste in 18 hours, whereas with a low-fibre diet the body excretes waste in 48 hours. You should aim to eat 20-35g of fibre daily in order to stay regular.

Foods which are particularly high in fibre include wholemeal bread, bran cereals, beans, lentils, oatmeal, almonds, barley, many vegetables, and fresh and dried fruits. All of these can be used as home remedies for constipation. If you are constipated and are consuming additional fibre, you must ensure that you drink more water than usual in order to keep your stools soft and easy to pass.

3. Avoid processed foods

Processed foods such as cakes, biscuits, pastries, white bread and chocolates are high in sugar and low in fibre. Therefore, processed foods should be avoided in order to prevent constipation.

4. Increase fluid intake

Constipation is usually related to dehydration. This is because if you are dehydrated more water will be absorbed from the contents of the large intestine leading to slower transit and the formation of hardened stools. You must therefore ensure that you drink adequate water as this will mean that less water is absorbed from the large intestine resulting in the formation of soft stools which will be easy to pass.

5. Regular exercise

One of the most effective home remedies for constipation is exercise. This does not need to be vigorous. A brisk 15 minute walk daily has the effect of regulating the bowel movement and helping food pass through the bowels more quickly.

6. Psyllium

Psyllium is a bulk-forming laxative which is sometimes referred to as ΄Mother Nature’s laxative.’ It is one of the most effective fibres for maintaining regular digestive health. Psyllium powder is a soluble fibre that draws water into the intestines which increases the stool bulk and softens the stools, making them easier to pass. Psyllium seeds are actually the active ingredient in many over-the-counter laxative preparations. When taking psyllium it is important to ensure you drink adequate water in order to prevent the constipation getting worse.

7. Aloe vera

Aloe vera is a potent stimulant laxative as it contains compounds called anthraquinones which cause the laxative effect. It helps heal and cleanse the digestive tract while aiding with the formation of soft stools. Aloe vera can be taken in the form of a juice, tablets, capsules or tea.

8. Magnesium

Magnesium is an osmotic laxative which works by drawing fluid into the intestines. This results in an increase in stool bulk which in turn stimulates the intestines to contract (peristalsis). Magnesium can be taken in the form of magnesium sulphate, magnesium hydroxide (milk of magnesia), and magnesium citrate. Magnesium is only intended for short term use and should not be used by people who have hypertension, or by the elderly as it can lead to hypertension, confusion, etc.

9. Molasses

Blackstrap molasses are effective in relieving constipation. In fact, studies have shown that one tablespoon before bed can relieve constipation by the morning. Blackstrap molasses contain large amounts of vitamins and minerals, such as magnesium, which is an osmotic laxative. As magnesium may cause hypertension, molasses should not be taken by the elderly or those with hypertension.

10. Senna

Senna is a stimulant laxative which usually takes 8-12 hours to work and so should be taken at bedtime. It works by stimulating the intestines to contract which moves the stools along the intestines. It can cause abdominal cramps and must never be taken by pregnant women as it may stimulate uterine smooth muscle contraction. It is only for short term use as it may lead to tolerance, loss of smooth muscle tone and potassium loss. Long-term use may cause liver damage. It is available as tablets, syrup and tea. Senna tea tends to have a bitter taste, so honey can be added to it to make it more palatable.

11. Sesame seeds

Sesame seeds are one of the greatest constipation remedies out there as they have a high oil content. By moisturising and lubricating the gastrointestinal tract, they make passing a dry stool much easier. They are a great addition to various salads or cereals, while they can also be pulverised and used on food as a seasoning.

12. Healthy Fats

Avocados, nuts and olive oil contain healthy fats which can help lubricate the intestines and relieve constipation. A salad with fibre-rich leafy greens and a simple olive oil dressing, a handful of nuts, or guacamole are good options. Healthy fats are necessary for basic body functions; and are very satiating.

13. Lemon water

The citric acid in lemon juice draws water into the intestines. This increases the water content inside the intestines which increases the stool bulk, helps soften the stools and stimulates peristalsis.

Squeeze half a lemon in to a glass of warm water every morning and evening. This refreshing lemon water will act as a natural constipation remedy and it will also help you drink more water each day, which in turn will improve your long-term digestion.

14. Castor oil

This home remedy for constipation has been handed down for generations. Castor oil is a stimulant laxative which usually takes 8-12 hours to work and so should be taken at bedtime. It works by stimulating the intestines to contract which moves the stools along the intestines. It can cause abdominal cramps and must never be taken by pregnant women as it may stimulate uterine smooth muscle contraction. It is only intended for short term use as it may lead to tolerance, loss of smooth muscle tone and potassium loss. It is available as a tea.

15. Cascara (buckthorn)

This is a popular herbal laxative that comes from the bark extract of a species of buckthorn tree. This extract works by irritating the colon to stimulate peristalsis. It produces a strong laxative effect which may result in abdominal cramps. For this reason it should not be taken by pregnant women. It is only intended for short term use as it may lead to tolerance, loss of smooth muscle tone and electrolyte imbalance. Long-term use may cause liver damage. It is available as capsules and as a tea.

16. Folic acid

Folic acid deficiency has been found to be present in people who have chronic constipation; the condition usually resolves when supplements are used. 400 micrograms of folic acid daily is usually sufficient.

Treatment Timescale

A doctor should be consulted if 1 week of treatment does not produce relief from the constipation. If only dietary measures are used then the doctor should be consulted if the symptoms are still present after 2 weeks.

When to consult a doctor

A doctor should be consulted in the following cases:

• Change in bowel habit of 2 weeks or longer.
• Presence of abdominal pain, vomiting, bloating.
• Blood in stools.
• Prescribed medication suspected of causing symptoms.
• Failure of self-treatment.

In most cases constipation can be prevented through changes in diet and regular exercise, including drinking plenty of fluids (at least eight glasses of water daily) and eating plenty of high-fibre foods (such as oat bran, fruits, and vegetables with the peel). In addition to these, several supplements are available to relieve constipation.

Constipation should be treated promptly as not only are the symptoms unpleasant, but chronic constipation can lead to haemorrhoids, indigestion, and diverticulitis. Chronic or recurring constipation may be an indication of a more serious condition and so a doctor should be consulted in this case.