Constipation (from the Latin co-’with’ stipare ‘make stiff, compact’) is a difficulty to defecate. The stools are usually hard and then a small volume. Several medical definitions coexist, the most common is: ‘Less than 3 stools per week and / or difficulty exempt’.
It is estimated that constipation reached between 10% and 30% of the adult population in Western countries and 3-5% chronically. It is especially common in women (a hormonal cause is discussed due to the action of prostaglandins on motility of smooth muscles and therefore potentially on the digestive tract as a whole) and elderly (due to their sedentary from their diets, several diseases associated with aging and a number of drugs).
Conventionally, constipation and serious digestive complications induced by certain drugs would be explained by their anticholinergic effects (also called impact or effect parasympatholytics atropine).
But it is likely that more complex physiological mechanisms remain to be discovered concerning the action of the neuroleptic hundred million neurons in the nervous system tract.
The drug classes that may cause constipation iatrogenic
Complementary include bulk laxatives, stool softeners and laxatives and herbal stimulants. Some of them are also used in traditional medicine. The same side effects and warnings apply. The mainstay of treatment for constipation remains a high fiber diet along with water and exercise.
Psyllium (seed or seed coat). For centuries, psyllium is used as a laxative for many people. It is a natural soluble fiber (mucilage) derived from the seed of the plantain. Medical authorities acknowledge its effectiveness in relieving constipation. Psyllium is available in flakes and powder form in health food stores and herbalists.It is the main ingredient in commercial preparations such as Metamucil ®, Regulan Prodiem ® and ®. Psyllium has a taste fade.Dosage-Soak for a few minutes 10 g of psyllium in 100 ml of warm water. Drink without delay to prevent the mixture thickens and gels. Then drink the equivalent of at least 200 ml of water to prevent obstruction of the gastrointestinal tract. Repeat from 1 to 3 times daily as needed. Increase the dose gradually until the desired effect .- It may be necessary to continue treatment for at least 2 to 3 days before receiving a laxative effect optimal.
Flaxseed. Its mucilage (pectin) explains its laxative effect. Commission E and ESCOP recognize its effectiveness in treating constipation-chronique.Dosage Add 1 tablespoon (10 grams) of whole seeds, crushed or coarsely ground in a glass of water (150 ml minimum) and drink all .- Take 2 to 3 times per day.Some sources recommend soaking the time they release their mucilage, others think they should rather swell in the intestines to be effective .- Flaxseed is most effective when it is first coarsely crushed ( but not powdered). Rich in polyunsaturated fatty acids, it must be freshly ground to avoid these fats becoming rancid unstable (the ground seeds can be stored in refrigerator 1 week only) .- We can take the seeds alone or add them to applesauce, the Milk, muesli, oatmeal, etc..
Agar-agar and guar gum. These substances have been used traditionally to treat constipation. Agar-agar is a substance rich in mucilage extracted from various species of red algae (Gelidium or Gracilia). Guar gum is a polysaccharide derived from an Indian plant, guar (Cyamopsis tetragonolobus). They swell in water contact. Strength-Guar Gum: Take 4 g, 3 times a day (12 g in total) just before or during meals, with at least 250 ml of liquid. Start with a dose of 4g per day and increase gradually to avoid gastrointestinal discomfort intestinaux6 .- Agar: Take 5 grams to 10 grams per day7. It is sold in slabs, or white powder that is dissolved in water to produce a jelly that can be flavored with fruit juice and can replace gelatin desserts.
Konjac glucomannan. Traditionally consumed in Asia, konjac glucomannan showed its effectiveness in relieving constipation in several uncontrolled studies. In 2008, a small study was conducted on 7 patients with constipation to evaluate the effectiveness of konjac glucomannan supplements (1.5 g, 3 times daily for 3 weeks) compared to placebo in relieving constipation. Glucomannan has increased from 30% stool frequency and improve the quality of the flora intestinale20. In children, a study published in 2004 (31 children) showed that the glucomannan reduces abdominal pain and symptoms of constipation (45% of children felt better against 13% Of those treated with placebo). The dose used was at most 5 g / day (100 mg / kg per day) 21.
Slippery elm (Ulmus rubra). The inner bark, the phloem, the tree native to North America is used by Native Americans to treat irritations of the digestive system. The phloem is still used today to treat constipation or provide an emollient and easily digestible food to convalescents.DosageVoir recipe oatmeal red elm Orme in the plug section Herbarium medicinal.
This type of laxative is usually composed of plants that contain anthranoids (or anthracene). The dosage is based on the content anthranoids, not the weight of the plant séchée7. We may adjust the dosage so as to use the smallest amount needed to get loose stools. Do not exceed 20 mg to 30 mg per day anthranoids.
Warning. Stimulant laxatives-cons are given to pregnant and lactating women.All products listed below should be used with caution, preferably under medical advice and only for short term treatment (10 days).
Castor oil (Ricinus communis). Castor oil forms a separate category in the world of stimulant laxatives, because it contains no anthranoids. It owes its purgative activity to a fatty acid, ricinoleic acid, which forms sodium salts. Medical authorities acknowledge its effectiveness in treating constipation so ponctuelle.DosageOn takes an amount of about 1 to 2 teaspoons (5 g to 10 g) in adultes7. It takes about eight hours before acting. For a more rapid take up to 6 teaspoons (30 g). Fasted state, it is more efficace.Contre-indicationsLes people with gallstones or other gallbladder problems.
Latex aloe (Aloe vera).Widely used in Europe, the aloe latex (yellow juice present in the tiny channels in the bark) is much less so in North America. Powerful laxative, it contains 20% to 40% anthranoids. Commission E, the ESCOP and World Health Organization recognize its effectiveness in treating occasional constipation. Its laxative effect is well demonstrated by studies pharmacologiques8. DosagePrendre 50 mg to 200 mg of aloe latex evening at bedtime. Start with small doses and increase if necessary, for the laxative effect can occur at very variable among individuals.
Senna (Cassia angustifolia or Cassia senna). The efficacy of senna to treat constipation in the short term, is recognized by medical authorities. Several products obtained over the counter laxatives contain senna extract (Ex-Lax ®, Senokot ®, Riva-Senna ®, etc.).. The pod contains grains of senna 2% to 5.5% anthranoids, while the leaves contain about 3% 7.Dosage-Follow the manufacturer’s recommendations.- You can also infuse 0.5 g to 2 g of senna leaves in warm water for 10 minutes. Take one cup in the morning and, if necessary, a cup at bedtime .- Pod: infuse for 10 minutes, ½ level teaspoon of powdered cloves in 150 ml of warm water. Take one cup in the morning and, if necessary, a cup at night.
Cascara sagrada (Rhamnus purshiana). The bark of this tree from the Pacific coast of North America contains about 8% of anthranoids. Commission E approves its use to treat constipation. Several products containing laxatives, particularly the United States. DosagePrendre 2 ml to 5 ml of liquid standardized extract 3 times jour.On can also make an infusion: infuse for 5-10 minutes 2 gd’écorce dried in 150 ml of boiling water and filtered. Take one cup per day. Its odor is unpleasant, however.
Buckthorn (Rhamnus frangula or alder).The dried bark of the trunk and branches of buckthorn, a shrub with presence in Europe and Asia, contains 6% to 9% anthranoids. The berries also contain, but somewhat less (from 3% to 4%). Its effect is somewhat lighter than other plants. Commission E acknowledges its effectiveness in treating constipation.Dosage-Brew for 5 to 10 minutes 2 gd’écorce dried in 150 ml of boiling water and filtered. Take one cup per day .- Brew 2 g to 4 g of buckthorn berries in 150 ml of boiling water for 10-15 minutes, then strain. Take a cup in the evening and, if necessary, in the morning and afternoon.
Rhubarb root (Rheum sp.). The roots of rhubarb contain about 2.5% anthranoïdes7. Its laxative effect is slight, but some people are more susceptible than others. DosageConsommer 1 g to 4 g of dried rhizome per day. Grind finely and take it with a little water. There are also tablets and alcohol-based extracts.
Boldo.Commission E and ESCOP approved the use of Boldo leaves to treat various gastrointestinal disorders, including Commission E recommends constipation.DosageLa 3 g of dried leaves per day for digestifs12 disorders. Attention, Boldo should not be used in the elderly because it may be toxic to the foie22.
ProbiotiquesIl are some clinical trials showing the beneficial effect of probiotics on the likely constipation23-25. Stool frequency increased from 20% to 25% at a daily consumption of probiotics. In adults, probiotics that increase stool frequency and improve their consistency are Bifidobacterium animalis (DN-173 010), Lactobacillus casei Shirota, and Escherichia coli Nissle 1917. In children, L. casei rhamnosus showed Lcr35 bénéfiques25 effects.
Dandelion. Few preliminary clinical trials indicate that preparations of dandelion can relieve constipation.The fresh or dried leaves of dandelion, like the root, traditionally used for their laxative infusion douces12.
Biofeedback. Perineal rehabilitation by biofeedback (also called biofeedback) is effective in treating the difficulty to defecate in adults (constipation). Biofeedback rehabilitation must be performed in a specialized center, and consists of exercises to release voluntary pelvic floor muscle (using a balloon catheter). Biofeedback can ‘relearn’ to synchronize the release of the anal sphincter and straining. Generally, 3 to 10 sessions are needed to obtain résultats26.
Colonic irrigation. Some people with constipation chronique10 have obtained good results with colonic irrigation. Consult an industrial hygienist or naturopath. See also our fact sheet Colon Hydrotherapy.
Massage therapy.A massage therapist specializing in the abdomen can help to stimulate contractions of the intestines and mobilize fluides11. It is also possible to self massage the abdomen by movements in the direction of rotation clockwise around the navel. This helps to boost bowel movements, especially in children or babies constipated. See our Massage Therapy page.
Traditional Chinese Medicine. Acupuncture may be useful in cases where the intestinal transit movements are so irregular that laxatives are inefficaces11. Traditional Chinese herbal medicine may also help. Consult a practitioner.
Psychotherapy. In cases of chronic constipation, psychological aspects are not négliger12. Like sleep, elimination functions can be inhibited when you think too much. See our fact sheets that Psychotherapy and associated tab Complementary to know the different types of psychotherapy.
Reflexology. Reflexology treatments can help relax the body and mind.They would activate the bowel by stimulating the reflex zones, breaking blocks énergétiques10.
Prevention of Constipation
Adopt a diet rich in fiber. The plant foods – fruits, vegetables, legumes, whole grains, nuts and seeds, seaweed – all contain fiber, while those of animal origin do not. There are 2 types of fiber: insoluble and soluble fiber. Generally, plants contain these two types of fiber, insoluble fiber is the most abundant. Some plants only contain soluble fiber in large quantity.
Cellulose, hemicellulose and lignin are insoluble. They prevent constipation by absorbing much water, which increases stool bulk and stimulates contractions of the intestine.
Pectin, gums and mucilages are soluble fibers. Psyllium is one of the few plants to contain mostly soluble fiber. Oats and barley also contain.This type of fiber helps prevent constipation by absorbing water and creating a gel. They also help control blood sugar and lowering cholesterol.
Recall that according to the Food Guide, we should drink 6 to 8 servings of grain products per day, preferably whole grain or enriched.
To learn more about the best sources of dietary fiber, see our Best of nutrients Dietary Fiber.
Drink enough. It is generally recommended to absorb 2 to 3 liters of fluid per day, much of which is provided by food. In general, it is suggested to drink 6 to 8 glasses of water daily, between meals. Mineral waters rich in magnesium have a mild laxative effect and may be preferred in case of constipation.
Regular exercise. Walking, cycling, being physically active has an influence on the abdominal muscles and helps digestion. See our file Fitness.
Responding to the need to go to the bathroom when it presents itself. After eating, intestines come in a wave of contractions to evacuate stool. This is a natural reflex that helps to smooth out the stool. Not listening to the desire to go to stool, evacuation becomes difficile.Les doctors recommend that people with constipation to go to the bathroom 2 times per day, about 30 minutes after meals and not to effort thrust for longer than 5 minutes (as this increases the risk of crisis of hemorrhoids). This ‘ritual’ helps the regular evacuation of stool, particularly in children.18.
We must first determine if constipation is a real or just a slowdown of intestinal transit. We can possibly help a visual scale, the Bristol Stool Scale.
The main problem facing constipation constipation is to differentiate benign (functional) and constipation associated with a serious organic disease (especially colorectal cancer). If a serious cause is suspected, certain tests must be prescribed: colonoscopy, abdomen without preparation, barium enema, occult blood in stool, blood count … These examinations have no value if it is unnecessary to call sign and must not be made systematically.
In case of suspicion of abnormal anal sphincter tone, we can perform anorectal manometry (examination of the anal sphincter pressure at rest and during defecation).
Constipation, which is the difficulty of the exemption gut, is a disease of our century which reaches more women than men.
The diagnostic criteria of constipation are:
The presence of at least two of the following signs for at least twelve weeks (not necessarily consecutive)
Difficulty-exemption in more than a quarter of bowel movements.
Selles-hard or fragmented into more than one fourth of defecation.
Print-incomplete defecation in more than one fourth of defecation
– Sensation of anorectal blockage in more than a quarter of bowel movements.
– Duty of maneuvers to facilitate defecation in more than a quarter of exemptions.
– Frequency of less than three bowel movements per week with no loose stools, and no signs of irritable bowel syndrome.
The major causes are physical inactivity and a diet totally inadequate in fiber (such failure being also involved in the increase in colon cancer)
and lack of water intake between meals adequately.
Some diseases can cause constipation and it goes without saying that the treatment of this case that will resolve problems. Examples include inflammatory bowel diseases, benign or malignant tumors, hemorrhoids, anal fissure.
Habitual constipation in women is due largely to lack of rigor in the schedule of defecation. Often, too absorbed by the work they do, they postpone, the care of the toilet and envy their password.Gradually settles and this can become obstinate constipation.
In cases of occasional constipation implementation of a suppository Eductyl be scared enough.
One good habit is to go to the bathroom at the same time (eg morning at sunrise) and make the necessary efforts without being distracted by a possible reading which is necessary to stop these efforts. Therefore rehabilitate motor function of the anal sphincter. A glycerin suppository may possibly be a useful aid.
The second is to drink a liter and a half to two liters of water per day (God it is difficult to make women drink between meals).
The third is to remove the laxatives that irritate the intestinal mucosa and end up having the opposite effect to that intended, although some mild laxative may be recommended, such as paraffin oil or products such as Dulcolax or macrogol (forlax)
The fourth is to make walking every day. This simple practice is extremely beneficial.Take the time to do it, for example by going to work or doing errands.
Finally, and crucially, it is necessary to increase fiber intake by a diet rich in cooked green vegetables (endive, green beans, carrots, cooked salads, spinach).
Some constipation may have a psychic origin and a small sedative treatment may be beneficial.
Finally say that we should not make an obsession of the saddle daily, especially at the beginning of a bowel retraining.
CAUTION: To conclude, say that a recent obstipation and must quickly consult your doctor.
– DIETARY FIBER