In the nineteenth century, a naturopathic concept came into being whose influence persists today: namely, that regular, frequent, and complete bowel movements are necessary for optimum health. William Harvey Kellogg, of Kellogg's cereal fame, wrote extensively of the dangers of "auto-intoxication" purportedly caused by inadequate elimination. He and others claimed that a concrete-like sludge builds up on the wall of the colon, increasing in thickness over time and destroying the health of the body.
However, in modern times physicians have performed millions of direct examinations of the colon, using the procedure known as colonoscopy, without finding any evidence of such a coating. Caked colons are a myth.
Furthermore, conventional medicine has never observed any connection between elimination and overall health. Many people eliminate only once a week or so, and their health appears to be no worse than that of the population at large.
In addition, one study found that there is no connection between constipation and colon cancer.1
Nonetheless, most people find occasional constipation unpleasant. For some, it becomes a severe chronic problem. It can be associated with irritable bowel syndrome (IBS), in which case it is called constipation-predominant IBS.
Conventional treatment for constipation involves mainly increasing exercise and intake of dietary fiber and water, while reserving laxatives, suppositories, and enemas for emergencies.
Occasional constipation can be safely self-treated. However, if constipation becomes a chronic problem, it should be evaluated by a physician.
Increasing dietary fiber and water intake is the first treatment to try for chronic constipation. Whole grains and fruits and vegetables add fiber in the diet. In addition, fiber supplements may be taken in the form of debittered fenugreek seeds, glucomannan,8,17 and flaxseed. Psyllium, another source of fiber, is also helpful in relieving constipation. In a review of 3 trials involving 283 adults, psyllium effectively improved bowel movements compared to placebo.22
A typical dosage of fiber is 5 to 10 g, 1 to 3 times daily, with at least 16 ounces of liquid. Start with the lower doses and work up gradually, as too much fiber all at once can actually worsen constipation.
The herbs cascara sagrada and senna are stimulant laxatives approved as over-the-counter treatments for constipation. Another herb, common buckthorn, also contains these substances, but it is not an approved OTC drug in the US. All of these work by virtue of chemical constituents called anthraquinones that irritate the colon wall. When taken to excess, stimulant laxatives can cause dependence. In addition, if overused, they can cause depletion of potassium. This is especially dangerous for people taking drugs in the digoxin family.
Traditional Chinese herbal medicine offers numerous herbal combinations for the treatment of constipation. One such combination has undergone study: a combination of the herbs rhubarb and licorice called Daio-kanzo-to. In this 2-week, double-blind, placebo-controlled trial, 132 people complaining of constipation were randomly assigned to one of three groups: placebo, low-dose Daio-kanzo-to, or high-dose Daio-kanzo-to.2 The results indicate that the higher-dose group, but not the lower-dose group, experienced statistically significant improvements in constipation compared to placebo.
Some evidence indicates that probiotics ("friendly bacteria") alone, or taken in combination with prebiotics (nutrients that encourage the growth of probiotics) may improve constipation.5,6,13-16,18 For example, 266 women with constipation who consumed yogurt containing the probiotic Bifidobacterium animalis and the prebiotic fructoligosaccharide twice daily for two weeks experienced significant improvement compared to women consuming regular yogurt as a placebo.18 In addition, a 6-week double-blind, placebo-controlled trial of 274 people with constipation-predominant irritable bowel syndrome, use of a probiotic formula containing Bifidobacterium animalis significantly reduced discomfort and increased stool frequency.14 In another double-blind, placebo-controlled study of 45 children with chronic constipation, researchers found that use of Lactobacillus rhamnosus was more effective than placebo and equally effective as magnesium oxide.13 Furthermore, a small trial found benefits in children, this time with a mixture of bifidobacteria and lactobacilli,16 and a study not limited to children found benefit with Lactobacillus casei Shirota.6 Finally, one study found that a combination of B. lactis and B. longus improved bowel regularity in seniors.15
The psychological aspect of constipation should be considered as well. Like sleep, elimination is inhibited by thinking too much about it. Part of the key to solving chronic constipation problems is to decrease the sense of worry and anxiety that surrounds the issue. Although constipation is certainly unpleasant, its evils have been greatly exaggerated. Thinking less about it will often go a long way toward solving the problem.
Numerous herbs are used alone or in combination formulas for the treatment of constipation, including: aloe, Ayurvedic herbal combinations, barberry, bladderwrack, basil, buckthorn, cayenne, dandelion, goldenseal, He shou wu, red raspberry, and slippery elm. Honey has also shown a bit of potential.7 However, the effectiveness of these therapies has not been scientifically evaluated to any meaningful extent.
Besides herbs, other alternative medicine therapies have been proposed for use in the treatment of constipation. Biofeedback may be effective for some forms of constipation (particularly those associated with uncoordinated functioning of pelvic muscles), but the evidence is mixed for short-term and lacking for long-term benefits.3,9-12,19,20 ,21 One small study failed to find acupuncture helpful.4 However, some success was reported with self-acupuncture applied to the perineal area, the area between the anus and base of the genitals. In a randomized trial of 100 adults with functional constipation, applied pressure and massage to this area was associated with improved bowel function and quality of life when compared to standard treatment alone. The trial was unblinded and the patients self-reported their results, which can affect outcomes.23
Electroacupuncture, the use of electricity to acupuncture pressure points, was associated with improved bowel function when compared to sham electroacupuncture in a randomized trial with 1,075 patients. Bowel function included frequency, completeness, and spontaneity of bowel movements. The participants had 28 electroacupuncture sessions over the course of 8 weeks.24
Dukas L, Platz EA, Colditz GA, et al. Bowel movement, use of laxatives and risk of colorectal adenomatous polyps among women (United States). Cancer Causes Control. 2000;11:907-914.
A Double-Blind Study Is Used to Reevaluate Constipation Formula. Kampo Today [serial online]. 2000:4. Available at: http://www.tsumura.co.jp/english/kthp/4-1-02.htm. Accessed: November 4, 2002.
Heymen S, Wexner SD, Vickers D, et al. Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Dis Colon Rectum. 1999;42:1388-1393.
Klauser AG, Rubach A, Bertsche O, Muller-Lissner SA. Body acupuncture: effect on colonic function in chronic constipation. Z Gastroenterol. 1993;31:605-608.
Zunft HJ, Hanisch C, Mueller S, et al. Symbiotic containing Bifidobacterium animalis and inulin increases stool frequency in elderly healthy people. Asia Pac J Clin Nutr. 2004;13(suppl):S112.
Koebnick C, Wagner I, Leitzmann P, et al. Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Can J Gastroenterol. 2003;17:655-659.
Ladas SD, Haritos DN, Raptis SA. Honey may have a laxative effect on normal subjects because of incomplete fructose absorption. Am J Clin Nutr. 1996;62:1212-1215
Chen HL, Cheng HC, Liu YJ, et al. Konjac acts as a natural laxative by increasing stool bulk and improving colonic ecology in healthy adults. Nutrition. 2006 Oct 3. [Epub ahead of print]
Rao SS, Seaton K, Miller M, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clin Gastroenterol Hepatol. 2007;5:331-338.
Chiarioni G, Ferri B, Morelli A, et al. Bio-feedback treatment of fecal incontinence: where are we and where are we going? World J Gastroenterol. 2005;11:4771-4775.
Coulter ID, Favreau JT, Hardy ML, et al. Biofeedback interventions for gastrointestinal conditions: a systematic review. Altern Ther Health Med. 2002;8:76-83.
Loening-Baucke V. Biofeedback training in children with functional constipation. A critical review. Dig Dis Sci. 1996;41:65-71.
Bu LN, Chang MH, Ni YH, et al. Lactobacillus casei rhamnosus Lcr35 in children with chronic constipation. Pediatr Int. 2007;49:485-490.
Guyonnet D, Chassany O, Ducrotte P, et al. Effect of a fermented milk containing Bifidobacterium animalis DN-173 010 on the health-related quality of life and symptoms in irritable bowel syndrome in adults in primary care: a multicentre, randomized, double-blind, controlled trial. Aliment Pharmacol Ther. 2007;26:475-486.
Pitkala KH, Strandberg TE, Finne Soveri UH, et al. Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial. J Nutr Health Aging. 2007;11:305-311.
Bekkali N, Bongers ME, Van den Berg MM, et al. The role of a probiotics mixture in the treatment of childhood constipation: a pilot study. Nutr J. 2007 Aug 4. [Epub ahead of print]
Chen HL, Cheng HC, Wu WT, et al. Supplementation of konjac glucomannan into a low-fiber Chinese diet promoted bowel movement and improved colonic ecology in constipated adults: a placebo-controlled, diet-controlled trial. J Am Coll Nutr. 2008;27:102-108.
De Paula JA, Carmuega E, Weill R. Effect of the ingestion of a symbiotic yogurt on the bowel habits of women with functional constipation. Acta Gastroenterol Latinoam. 2008;38:16-25.
Koh CE, Young CJ, Young JM, et al. Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. Br J Surg. 2008 Jul 25.
Coulter ID, Favreau JT, Hardy ML, Morton SC, Roth EA, Shekelle P. Biofeedback interventions for gastrointestinal conditions: a systematic review. Altern Ther Health Med. 2002;8:76-83.
Rao SS, Valestin J, Brown CK, et al. Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol. 2010 Apr;105(4):890
Suares NC, Ford AC. Systematic review: the effects of fibre in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 2011;33(8):895-901.
Abbott R, Ayres I, et al. Effect of perineal self-acupuncture on constipation. A randomized controlled trial. J Gen Intern Med. 2014 Nov 18 [Epub ahead of print].
Liu Z, Yan S, Wu J, et al. Acupuncture for chronic severe functional constipation: a randomized trial. Ann Intern Med. 2016;165(110):761-769.
Last reviewed December 2015 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.