Constipation is defined as the passage of small dry bowel movements usually less than three times a week. Many people at some point in their life will suffer from these symptoms. There is no set number of bowel movements that one should have weekly; however less than three a week is considered an irregularity.
In fact, constipation is one of the most common gastrointestinal conditions that Americans suffer from. The reasons that one is constipated are multifactorial. It can be secondary to a number of conditions; some related to lifestyle choices, while others result from an underlying medical condition.
- Low fiber intake
- Highly refined foods
- Physical inactivity
- Inadequate exercise
- Long term bed rest
- Laxatives (chronic use)
- Endocrine abnormalities
- Structural abnormalities
- Bowel diseases
- Irritable bowel syndrome
- Low potassium stores
- Neurogenic abnormalities
Because there are so many causes of irregular bowels, it is very important that the onset of constipation be thoroughly investigated. Often, there is a simple solution. In some cases, however, a more serious condition such as a bowel obstruction or hypothyroidism (low functioning thyroid) needs to be ruled out first.
Most commonly, diet and lifestyle are big factors in those that suffer from constipation. Sedentary and overactive lifestyles are a major contributor to the irregularity of bowel movement. These inactive lifestyles may involve stationary jobs, where sitting for long periods of time is coupled with little or no physical activity; and where persons are consuming refined processed food. Interestingly, fast paced lifestyles, with little time for relaxation, also contribute to constipation. The normal rhythm of the digestive system is suppressed and many become dependent on a “digestive crutch,” such as a morning latte or laxatives to stay regular.
Although the accepted medical definition of this condition is fewer than three bowel movements a week, if one is striving towards optimal health, one to three bowel movements per day may be considered optimal. Dr. Denis Burkitt, the doctor that discovered Burkitt’s lymphoma, made an interesting and important observation about his African patients during his time in Uganda and Kenya. He noted that westerners have 3 to 21 bowel movements a week and the amount of stool passed is 85 to 150 grams/day (3 to 5 ounces), while Africans have 30 to 60 movements a week with a stool weight of 200 to 500 grams a day (7 to 17 ounces). Most importantly, he noticed that the diseases he had been trained to treat in Scotland were largely absent among Africans. He saw no cases of type II diabetes, obesity, appendicitis, diverticular disease, hemorrhoids, dental caries, varicose veins, pulmonary embolism, inflammatory bowel diseases (Crohn's disease and ulcerative colitis), or hiatal hernias. Upon the examination of more active cultures, he realized that it was common to have a bowel movement following each meal. 
The large intestine is home to vast amount of bacteria. This normal bacteria, or microflora, is extremely important for the healthy functioning of the colon, detoxification processes in the body, and prevention of acute and chronic diseases. An imbalance in this flora and constipation often occur together, and it is often difficult to discover which one preceded the other. Maintaining this environmental milieu can be achieved by supplementing with probiotics that ‘seed’ the gut with the appropriate bacteria. This is very important for those using antibiotics. These medicines cause the degradation of both bad and good bacteria. Probiotics may be equally beneficial after any gastrointestinal illness such as food poisoning, and in any condition that has digestive involvement.
Stress can also be a major contributing factor to constipation. Digestion and defecation are controlled by our parasympathetic nervous system, or what is referred to as our ‘rest and digest’ response. When the body is under stress, be it emotional or physical, there is a predominance of the sympathetic nervous system and our ‘fight or flight’ response. Therefore, if we are under chronic stress, it interrupts intestinal motility and decreases interstitial motor activity resulting in a tendency towards constipation.
Signs and Symptoms of constipation may include:
- Abdominal pain
- Abdominal fullness
- Small stool
- Dry stool
- Stool that is hard to pass
- Anal fissures
- Irritable bowel syndrome/ spastic constipation
- Sensation of a need for a bowel movement without evacuation
- According to the 1991 National Health Interview Survey, about 4 1/2 million people in the United States say they are constipated most or all of the time. Women (non pregnant and pregnant), children and adults over the age of 65 where those that reported constipation most often.
- Statistics show that between 1983 and 1987, constipation was the most common gastrointestinal complaint in the United States and likely still is. This resulted in about 2 million annual visits to the doctor. That being said, most people treat themselves instead of seeking medical attention, supported by the $725 million Americans spend on laxatives each year.
- Prevalence of Constipation: 4.4 million people in the USA 1983-87
- Hospitalizations for Constipation: 100,000 people in the USA 1983-87
- Physician office visits for Constipation: 2 million people in the US 1985
- Prescriptions for Constipation: 1 million people in the USA 1985
- Disability from Constipation: 13,000 people in the USA 1983-87
- Deaths from Constipation: 29 deaths in the USA 1982-85
Most conventional constipation treatments revolve around treating the symptoms of constipation, meaning increasing the frequency of stool and/or making it easier to pass. There are many over the counter products that can help with this situation.
Laxatives for Constipation:
Bulk forming laxatives are fiber supplements and are targeted at bulking the stool. They draw water in from the colon, and when this water is combined with the supplement, its create more bulk in the colon, thereby making it easier to pass. It is extremely important that these products be taken with plenty of water; if not, they can have the opposite effect.
Stimulant laxatives cause peristalsis (rhythmic contractions) of the intestines to help the stool move by increasing the sensation of the need for a bowel movement.
Stool softeners add moisture to the stool and make them easier to pass. They should be taken at bedtime and with a lot of water. Softeners usually take 1-3 days to take effect. The active ingredient is commonly Docusate Sodium, which helps by drawing water into the fecal mass.
Saline laxatives work in a way similar to bulk-forming laxatives, in that they attract water to the intestine to swell the stool and allow for the fecal mass to pass more easily. They usually produce results within a half-hour to three hours following a dose. Taking these products on an empty stomach speeds results. Like bulk forming laxatives, It is important to consume additional fluids to prevent dehydration.
Lubricants such as mineral oil can be consumed to reduce friction and to “grease up” the stool, allowing it to travel through the intestine more easily.
If constipation is due to a structural cause, surgery may be the only option to correct the problem.
When dealing with constipation, it is very important that the environment of the digestive system is seeded with the right bacteria, in the correct proportions. It is estimated that there are several trillion (1,000,000, 000, 000) bacteria living in the average gastrointestinal tract, encompassing over 400 different species. This normal flora, as it is called, serves many functions. Flora assists with carbohydrate, protein and lipid digestion, produces vitamins such as vitamin A, B and K, metabolizes hormones, participates in the detoxification process, digests lactose, helps acidify the digestive tract, regulates peristalsis and bowel movements, and prevents constipation. [4, 5, 6]
Of all the bacterial species that live in our digestive system, Lactobacillus acidophilus is dominant in the small intestine. Bifidobacteria are the prominent flora within the large intestine. Therefore, for optimal gut function, it is important to restore the dominance of these bacteria respectively.
Fiber supplementation helps with constipation and adds bulk to the stool, thereby making it easier to pass. While the first goal is to get adequate amounts of fiber from our diet, supplementation is sometimes necessary.
Psyllium is rich in dietary fiber, which is the both, the best preventative measure and treatment for functional constipation.  Dietary fibers bulks stools, improves their water content, and decreases colon transit. It must be remembered that all fiber supplements need to be taken with adequate water; if not, it can lead to a worsening of symptoms. As an added benefit, psyllium seed also has a positive effect on lowering cholesterol and heart disease. 
Flaxseeds are great source of omega-3 fatty acids, and are helpful lubricant for digestive function. In addition to lubrication, they may be used a dietary source of fiber that helps to bulk the stool. Grinding whole flax seeds will provide persons with fiber content and the lubrication, whereas the oil form would just add lubrication to the stool.
Cassia senna, or Senna, is an herb whose use for constipation dates back to ancient Arabian physicians. Today, many over the counter laxatives contain it as their active ingredient. Considered to be a stimulating laxative, senna decreases bowel transit time by increasing peristalsis. This shortened transit time allows for less water reabsorbtion by the colon, keeping the stool moister. Senna can be taken in various delivery forms, including teas, liquids, tablets, or powders. It is also commonly combined with other herbs to provide for a syngergistic effect. A study involving elderly patients in a nursing facility showed that a senna fiber combination was a cheaper, more effective treatment for constipation than lactulose, a common over the counter laxative. 
Cascara sagrada (Rhamnus purshiana)
Cascara sagrada is a natural laxative derived from the bark of the Rhamnus purshiana tree, which is native to the Pacific Northwest region of the United States. The use of cascara as a digestive aid dates back many centuries, Native American tribes being the first to discover its medicinal uses. It wasn’t until 1877 that it was incorporated into more popular laxative products. Cascara sagrada is considered a stimulating laxative due to its anthraquinone derivatives. These compounds stimulate the motility of the intestine keeping the food moving through the digestive system, and producing a softer stool. Several studies have shown that cascara sagrada is effective in easing chronic constipation in elderly people.
Aloe Vera has long been known for its mucilage soothing properties, and ability to enhance digestion and decrease bowel transit times. It is helpful in many conditions, such as minor cuts and burns, intestinal infections and reducing inflammation. Like other herbal laxatives, it contains anthraquinone glycosides that are metabolized by the internal flora to form other molecules that have a laxative action.  Aloe is considered a strong stimulating laxative. However, gentler herbs, such as cascara sagrada, are often used first.
 Online Document: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml
 Digestive diseases in the United States: Epidemiology and Impact – NIH Publication No. 94-1447, NIDDK, 1994
 Valeur N et al. “Colonization and immunomodulation by Lactobacillus reuteri ATCC 55730 in the human gastrointestinal tract.” Appl Environ Microbiol. 70, 2:1176-81, 2004.
 Turchet P et al. “Effect of fermented milk containing the probiotic Lactobacillus casei DN-114001 on winter infections in free-living elderly subjects: a randomised, controlled pilot study.” J Nutr Health Aging. 7, 2:75-7, 2003
Koebnick C et al. “Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation.” Can J Gastroenterol. 17, 11:655-9, 2003
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 Mac Mahon M, et al. Ispaghula husk in the treatment of hypercholesterolaemia: a double-blind controlled study. J Cardiovasc Risk. Jun1998;5(3):167-72.
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