Constipation natural treatment and home remedy, herbs, fiber supplements
August 17 2018 by Ray Sahelian, M.D.

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 potentially leading to serious health conditions.

Constipation diet
A person's diet should contain enough fiber to ensure adequate stool bulk in order to prevent constipation. 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.

An excellent choice are dried plums or fruits. Dried plums are safe, palatable and more effective than psyllium for the treatment of mild to moderate constipation, and should be considered as a first line therapy. Aliment Pharmacol Ther. 2011. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation.

Fluids, water
One of the most important steps I 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. I also recommend prune juice. You can drink a couple of ounces before bed, and when you wake up in the morning you will have an urge to empty your bowels, especially if you drink a glass or two of cool water when you wake up.

Q. When is the best time to drink prune juice to relieve constipation?
   A. Anytime of the day is fine. A good option is to drink one to three ounces of prune juice an hour or two before bed, and when you wake up in the morning you will have a natural urge to eliminate, particularly if you drink a glass of cool or cold water as soon as you wake up.

Q. Would the fructose sugar contained in prune juice increase blood sugar levels and possibly be harmful for someone with diabetes?
   A. It depends on the quantity of prune juice consumed. If it is an ounce or two at one serving, it would not. But if more than 3 or 4  ounces at a time, it could increase blood sugar levels.

Laxative benefit and harm
Laxatives should be used carefully for constipation. Some laxatives may interfere with absorption of various drugs by binding them chemically (tetracycline, Ca, phosphate) or physically (digoxin on cellulose matrices). Rapid fecal transit may rush some drugs and nutrients beyond their optimal absorptive locus. Laxative supplements are sometimes used as weight loss pills, but there are healthier options. Prune juice is an excellent natural laxative.

Possible problems associated with laxative use include:
Abdominal cramps or nausea.
Gas, diarrhea or bloating.
Electrolyte imbalance, which can affect the muscles, nerves and organs.
Those most at risk include children and people with kidney disease or diabetes.
Muscle weakness or muscle spasms.
Fatigue, confusion, headache or vomiting.

Danger of laxatives
Higher-than-recommended doses of the antidiarrheal medicine loperamide, sold under the brand name Imodium, can lead to serious heart problems and even death, the U.S. Food and Drug Administration warned in June 2016. The warning applies to both over-the-counter and prescription strength medications, which are also sold under other generic names.

Fiber and bulking agents
Bran, psyllium, calcium polycarbophil, methylcellulose 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 with sufficient liquid (by adding 2 or 3 extra glasses a day of 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.
Psyllium is a bulk-forming fiber. Other fibers that belong to the class of bulk-forming fibers are cellulose, methylcellulose, carboxymethylcellulose sodium, karaya, malt soup extract, polycarbophil, and wheat bran. Bulk-forming fibers are laxatives because of their water-holding properties. They exert their action primarily through mechanical effects by bulking the colonic contents and decreasing transit time. Also consider flax seeds and chia seeds to soften stools. Add flax seeds to soups.

Zhonghua Yi Xue Za Zhi. 2014. Clinical benefits after soluble dietary fiber supplementation: a randomized clinical trial in adults with slow-transit constipation/ Four-week pectin soluble dietary fiber use accelerates colon transit time and alleviates clinical symptoms in patients with slow-transit constipation. Additionally, supplementary fiber offers protective effects on gut microbiota by increasing the population of healthy microflora.

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. See also buckthorn.

Wetting agents (detergent laxatives [eg, docusate]) soften stools, making them easier to pass. They break down surface barriers, allowing water to enter the fecal mass to soften and increase its bulk. Increased bulk may stimulate peristalsis, which moves the softened stool more easily. Mineral oil softens fecal matter, resulting in more easily passed stool mass, but it may decrease absorption of fat-soluble vitamins. Wetting agents and mineral oil act slowly; either may be useful after MI or anorectal surgery and when prolonged bed rest is required.

Osmotic agents are used to prepare patients for some diagnostic bowel procedures and occasionally to treat parasitic infestations. They contain poorly absorbed polyvalent ions (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.

2014 -- If you are constipated and need to use a laxative, the U.S. Food and Drug Administration says some products can be dangerous if you don't follow the dosing instructions or you have certain medical conditions. The agency said there have been dozens of reports of serious side effects, including 13 deaths, among people taking sodium phosphate laxatives, which are sold over-the-counter.

Q. Please tell us about Miralax. Our dad have enlarge polyp removed from his colon and Miralax was recommend to take daily.
MirlaLax is an oxmotic type laxative that works by holding water in the stool to soften it and increase the number of bowel movements.

Probiotics, gut bacteria supplementation
Probiotics may improve whole gut transit time, stool frequency, and stool consistency.

Constipation in pregnancy
Half of all pregnant women will suffer from constipation at some time during their pregnancy, new research shows. Women who take iron supplements are more likely to have constipation. Women who have been treated for constipation in the past had a higher risk of constipation during pregnancy.

Other pages of interest
Diverticulitis information

Other over the counter products for constipation
MiraLax appears to be safe when use for up to 6 months in patients with chronic constipation. MiraLax is, also known as polyethylene glycol (PEG) 3350 and is currently approved for the short-term treatment of occasional constipation. Side effects of MiraLax include diarrhea, flatulence and nausea. However, it is best to take breaks from the use of MiraLax, and substitute other products useful in constipation. American Journal of Gastroenterology, 2007.

Sodium picosulfate is both safe and effective for chronic constipation. Sodium picosulfate, found in laxative pills and also in oral drinks that purge intestines and bowels in preparation for a colonoscopy exam, was identified as a laxative long before drugs had to be studied to become licensed. American Journal of Gastroenterology, 2010.

Constipation in children
Parents and doctors may overlook constipation as the cause of stomach pain in children, but constipation may account for most of the abdominal pain among kids.

BPH, prostate enlargement
I am sixty years old and have had on going constipation for many years. Is it possible that bph can affect bowel motility? Mayo clinic documented chemical exposure probably due to toluene exposure when I was in the navy. I have a dysautonomia called postural tachacardia. I have documented extremity neuropathy.
    A. BPH or prostate enlargement should not have much of an effect on constipation.

I have been using 5htp supplement 50 to 100 mg  a day for few weeks and after that I have developed really strong constipation. Its been more than 2 months when I stopped taking it and the problem still occurs. Its like my bowels are sleeping, there is no movement even after a meal, the only thing that helps are irritant laxatives.

Epicor dietary supplement
Q. Have you heard of the product EpiCor? If so, what is your opinion of it in general and specifically is it safe for someone who is immune suppressed to be able to take a supplement like this?
   A. I have seen few human trials with EpiCor, therefore I do not have a good understanding on how it works in the body.

BMC Complement Altern Med. 2017. A yeast fermentate improves gastrointestinal discomfort and constipation by modulation of the gut microbiome: results from a randomized double-blind placebo-controlled pilot trial. A previous study performed in vitro suggests that EpiCorŪ fermentate has prebiotic-like properties, being able to favorably modulate the composition of the gut microbiome. Therefore, the aim of this study was to investigate the effects of EpiCor fermentate in a population with symptoms of gastrointestinal discomfort and reduced bowel movements and to evaluate its effect at the level of the gut microbiome. Despite the relatively low dose administered (500 mg/day), particularly when comparing to the high recommended doses for prebiotic fibers, EpiCor fermentate was able to modulate the composition of the gut microbiome, resulting in improvement of constipation-associated symptoms. Conversely, the reported increase in bowel movements may have altered the gut microbial community by increasing those groups of bacteria that are better adapted to a faster gastrointestinal transit time.