Constipation is a condition that causes you to have difficulty passing stools. Normally, people have anywhere from two or three bowel movements a week to two or three a day. Constipation can occur at any age, but it is more frequent in infancy and old age.

• Infrequent, difficult passage of stools (fewer than three bowel movements a week)
• Sudden decrease in frequency of bowel movements
• Stools harder than normal
• Bowel still feels full after bowel movement
• Bloated sensation

Most cases of constipation are caused by changes in diet or physical activity, including not drinking enough fluids. Psychological factors, particularly depression, may cause constipation. Chronic abuse of laxatives can also lead to chronic constipation. Certain drugs can cause it, as can physical abnormalities in the bowel or intestinal tract.

Your health care provider will perform a physical exam and may feel your abdomen or give you a rectal examination. Tests may include blood and stool evaluations, or more specialized tests such as a barium enema (where a contrast dye is given in an enema—the dye outlines the intestines on x-ray).

Chronic constipation can usually be prevented with a combination of dietary changes, extra fluid intake, exercise, and, when necessary, short-term use of a laxative. Your health care provider may talk with you about proper bowel habits (consistent, unhurried elimination practices). He or she may have you use a laxative or stool softener over the short term or suggest a bulk-forming agent, such as psyllium, bran, or methylcellulose. You can purchase these bulk-forming agents over the counter.

With more than 700 commercial laxative products available, the choice is often individual preference. People with any bowel obstruction, abdominal inflammation, or kidney or heart failure should not take the following laxatives:

• Bulk-forming agents (such as psyllium, bran, calcium polycarbophil, and methylcellulose) are generally effective and work by stimulating contractions of the large intestine. They also tend to carry a low risk of adverse effects.

• Stool softeners (such as docusate sodium) increase the amount of water in the stool, increasing bulk and stimulating natural contractions of the large intestine.

• Saline laxatives (such as milk of magnesia, magnesium citrate, sodium phosphate, lactulose, sorbitol, and alumina-magnesia) stimulate the release of cholecystokinin, which stimulates movement of the colon

• Stimulant laxatives, or irritant laxatives (such as senna, aloe, cascara, phenolphthalein, bisacodyl) increase intestinal activity

Lifestyle and dietary changes along with nutritional support can contribute to the long-term resolution of constipation. Certain herbs may help promote bowel activity. Use laxative herbs with caution because they may become less effective with habitual use.

• Take time to eat, breathe slowly, and chew food thoroughly.
• Eat smaller, more frequent meals and avoid overeating at one sitting.
• Eliminate refined foods, sugars, caffeine, alcohol, and dairy products from your diet.
• Decrease intake of saturated fats (animal products) and increase essential fatty acids (cold-water fish, nuts, and seeds).
• Eat more fresh vegetables and whole grains.
• Drink more water.
• Stewed or soaked prunes, 1 to 3 a day, have a slightly laxative effect.
• Flax meal, 1 heaping tsp. in 8 oz. of apple juice, provides fiber and soothes the digestive tract. Follow with an additional 8 oz. of water.
• Warm lemon water taken before meals stimulates digestion.
• Consider digestive enzymes for chronic constipation.
• Vitamin C, 250 to 500 mg, two times per day
• Magnesium, 250 mg, two to three times per day

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups a day. Tinctures may be used singly or in combination as noted.

A combination of herbs to aid digestion and relieve constipation includes the following in equal parts as a tea or tincture: licorice root (Glycyrrhiza glabra), cascara sagrada (Rhamnus purshiana), dandelion root (Taraxacum officinale), yellowdock (Rumex crispus), fennel seed (Foeniculum vulgare), and ginger (Zingiber officinale). Steep tea for 20 minutes. Drink 1 cup, three times a day, before meals. You may take 15 to 20 drops of a tincture, three times a day, before meals. For long-term use (more than two weeks), eliminate cascara and substitute burdock (Arctium lappa). Do not take licorice if you have high blood pressure.

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of constipation based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Calcarea carbonica -- for constipation without the urge to have a bowel movement; for children who often feel better when constipated rather than when bowel habits are normal; this remedy is most appropriate for individuals who tend to be overweight, lack stamina, experience heartburn, and produce sour-smelling belches; the individual may also suffer from pica (a craving for something not normally considered nutritional, such as dirt, clay, or chalk) and milk sensitivity
• Nux vomica -- for constipation accompanied by a constant urge to move the bowels, but with little success; or for constipation associated with overeating, alcohol, or drug use; this remedy is most appropriate for individuals who tend to be sensitive to noise, odors, and light
• Silica -- for constipation with the sensation that stool remains in the rectum after bowel movements; children for whom this remedy is appropriate may be wary of going to the bathroom; this remedy is most appropriate for individuals who tend to dislike cold temperatures but prefer cold foods and drinks
• Bryonia -- for constipation with large, hard, dry stools; food feels like a lump in the individual's stomach and he or she may suffer from headaches with pain in both temples that may worsen with motion; this remedy is most appropriate for individuals who tend to be disagreeable, prefer cool rooms with open air, and whose thirst is quenched with cold drinks
• Lycopodium -- for small, hard stools with flatulance and bloating following a meal; this remedy is appropriate for individuals, particularly children, who fear being alone and have worsened symptoms in the late afternoon and early evening

Castor oil packs to the abdomen may be useful in resolving constipation. Apply oil directly to skin, cover with a clean, soft cloth (for example, flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results, use for three consecutive days in one week.

Contrast hydrotherapy may help to stimulate digestion. Apply hot and cold towels to the abdomen. Alternate three minutes hot with one minute cold. Repeat three times to complete one set. Do two to three sets a day.

The studies investigating acupuncture treatment for constipation have been small and have produced both positive and negative results. In one study of 17 children, acupuncture successfully treated constipation.

Although acupuncturists do treat constipation, they generally believe that constipation is a symptom of a different underlying gastrointestinal condition. Acupuncturists treat people with constipation based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of gastrointestinal conditions, a qi deficiency is usually detected in the colon and lung meridians.

Although no well-designed trials have evaluated chiropractic treatment for constipation, some chiropractors suggest that manipulation (particularly in the lower spine) helps relieve constipation in certain individuals.

Therapeutic massage can help reduce stress and relieve constipation due to spasm and nervous tension.

If you have chronic constipation, you may need to work regularly with your provider. Left untreated, it can cause serious health problems.

Constipation is common in pregnancy and is usually relieved by changing your diet and drinking more water. If you are pregnant, do not take herbs that are stimulating to the digestive tract since they can induce contractions. Do not use laxative herbs in pregnancy without a provider's supervision.

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