Constipation information

Constipation is defined as difficult or infrequent passage of feces, hardness of stool, or a feeling of incomplete evacuation. Chronic constipation is harmful to the body.
   A person's diet should contain enough fiber to ensure adequate stool bulk in order to prevent constipation. Some fibers are soluble in water and others are insoluble. Soluble fiber slows digestion and helps you absorb nutrients from food. Insoluble fiber adds bulk to your stool, helping the stool pass more quickly through the intestines. Most plant foods contain some of each kind of fiber. Foods containing high levels of soluble fiber include dried beans, oats, oat bran, rice bran, barley, citrus fruits, apples, strawberries, peas, and potatoes. Foods high in insoluble fiber include wheat bran, whole grains, cereals, seeds, and the skins of many fruits and vegetables.
   Vegetable fiber, which is largely indigestible and unabsorbable, increases stool bulk and reduces the risk for constipation; certain components of fiber also absorb fluid into the solid phase, making stools softer and facilitating their passage. Fruits and vegetables are recommended, as are cereals containing bran taken to tolerance.
   One of the most important steps we recommend in order to reduce the risk for constipation is to drink plenty of fluids. The most important time to drink water is upon awakening. Drink one or two glasses of room temperature or cold water to stimulate peristalsis, and hence reduce your risk for constipation the rest of the day.

Bulking agents
Bulking agents include bran, Psyllium, calcium polycarbophil, and methylcellulose. They provide fiber and are the only laxatives acceptable for long-term use. They act slowly and gently and are the safest agents for promoting elimination and preventing constipation. Proper use involves gradually increasing the dose--best taken tid or qid with sufficient liquid (by adding 20 oz/day of extra fluid) to prevent impaction --until a softer, bulkier stool results. This approach produces natural effects and is not habit forming. Bulking agents normalize both constipation and diarrhea. You may also consider glucomannan.

Secretory or stimulant cathartics (eg, cascara sagrada, senna and its derivatives, bisacodyl, phenolphthalein, castor oil) are often used to cleanse the bowel for diagnostic tests. They act by irritating the intestinal mucosa or by directly stimulating the submucosal and myenteric plexus. Some are absorbed, metabolized by the liver, and returned to the bowel in bile. Peristalsis and intraluminal fluid both increase, with cramping and passage of semisolid stool in 6 to 8 h. With continued use, melanosis coli, neuronal degeneration in the colon, "lazy bowel" syndrome, and serious fluid and electrolyte disturbances may occur.

Laxatives should be used carefully. Some may interfere with absorption of various drugs by binding them chemically (eg, tetracycline, Ca, phosphate) or physically (eg, digoxin on cellulose matrices). Rapid fecal transit may rush some drugs and nutrients beyond their optimal absorptive locus.

Osmotic agents are used to prepare patients for some diagnostic bowel procedures and occasionally to treat parasitic infestations. They contain poorly absorbed polyvalent ions (eg, Mg, phosphate, sulfate) or carbohydrates (eg, lactulose, sorbitol) that remain in the bowel, increasing intraluminal osmotic pressure and drawing water into the intestine. The increased volume stimulates peristalsis, which moves the water-softened stool easily through the bowel. These agents usually work within 3 h.

Constipation help
Yoghurt containing galacto-oligosaccharides, prunes and linseed reduces the severity of mild constipation in elderly subjects.
Eur J Clin Nutr. 2007 Feb 14; Sairanen U, Piirainen L, Nevala R, Korpela R. 1Valio Ltd R&D, Helsinki, Finland.
Constipation is a common problem in the elderly. Dietary fibre is recommended for its treatment. The aim was to examine whether yoghurt containing galacto-oligosaccharides (GOS), prunes and linseed relieve constipation in elderly subjects. A group of 43 elderly subjects with self-reported constipation (mean age 76 years, range 61-92 years, 32 females, 11 males). The study consisted of a 2-week baseline period and 2, 3-week dietary interventions, with a 2-week wash-out period between the interventions. During the interventions, the subjects ingested, in random order, 260 g/day of either control yoghurt or test yoghurt containing GOS (12 g/day), prunes (12 g/day) and linseed (6 g/day). The use of laxatives was controlled and only allowed after 2 days without defecation. Daily intake of yoghurt containing GOS, prunes and linseed reduced the severity of constipation in elderly subjects with mild constipation.

Constipation questions
Q. Does Kava help with constipation?
   A. We doubt it.

Q. Which supplements do you find helpful for constipation?
   A. Consider cascara sagrada, psyllium and glucomannan fiber.

Q. Does prune juice really work for constipation. How many ounces are needed?
   A. Yes, prune juice is an excellent choice to help with constipation. Depending on the severity of the constipation, one to four ounces is beneficial. You may consider drinking about two ounces late in the evening and when you wake up in the morning drink a glass or two of cool water. This will help you eliminate. Some people notice a slight mood elevation by having an empty colon.

Q. Female, 65 years, melanosis coli and celiac disease - my colon looks black! What do you suggest for this situation caused by nearly forty years of constipation not being treated properly? Would any type of fiber be helpful along with a laxative? Maybe acacia, salvia or glucomannan? Lactalose and Miralax have been suggested as a laxative?
   A. Specific suggestions have to be done by your doctor, but prune juice and drinking 2 glasses of water first thing in the morning are safe options for constipation.

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